临床特征联合血清INF-γ和ICAM-1检测对双镜治疗输卵管性不孕患者妊娠的预测价值

The predictive value of serum INF-γand ICAM-1 combined with clinical features in patients with tubal infertility after double mirror treatment

目的探讨血清γ-干扰素(IFN-γ)和细胞间黏附分子(ICAM-1)检测联合临床特征对双镜治疗输卵管性不孕患者妊娠的预测价值。方法选取行宫、腹腔镜联合手术治疗的输卵管性不孕患者60例,接受双镜治疗后随访1年,根据术后是否成功妊娠分为妊娠组(n=36)和未妊娠组(n=24),记录2组患者年龄、不孕时间、不孕类型、输卵管柔软程度、盆腔积液、输卵管积水、盆腔黏连、盆腹腔手术史、输卵管妊娠史、是否合并腺肌症等临床资料;检测2组患者出院当日血清IFN-γ和ICAM-1水平,采用受试者工作(ROC)曲线下面积(AUC)评估血清IFN-γ、ICAM-1水平预测双镜治疗输卵管性不孕患者妊娠的价值;采用Logistic回归模型分析患者双镜手术后不孕的危险因素。结果未妊娠组患者年龄≥30岁、不孕时间≥3年、输卵管积水≥3 cm、盆腔重度黏连、盆腹腔手术史、输卵管妊娠史患者比例及血清IFN-γ及ICAM-1水平等指标都高于妊娠组(P<0.05);经ROC分析血清IFN-γ、ICAM-1水平预测双镜治疗输卵管性不孕患者妊娠的AUC分别为0.723、0.719;Logistic回归分析表明年龄≥30岁、不孕时间≥3年、输卵管积水≥3 cm、盆腔重度黏连、盆腹腔手术史、输卵管妊娠史、血清IFN-γ≥39.710 ng/L及ICAM-1≥277.110μg/L是双镜治疗输卵管性不孕患者不孕的危险因素。结论年龄、不孕时间、输卵管积水程度、盆腔黏连程度、盆腹腔手术史、输卵管妊娠史等临床特征及血清IFN-γ、ICAM-1水平均可能对双镜治疗输卵管性不孕患者妊娠率产生影响。

Objective To study the predictive value of the joint detection of serum interferon-γ(IFN-γ)and intercellular adhesion molecule-1(ICAM-1),and observe clinical features in the treatment of tubal infertility with double endoscopy.Methods Sixty patients with tubal infertility who underwent hysteroscopic and laparoscopic surgery were selected.They were followed up for 1 year after the treatment.According to whether the pregnancy was successful or not,they were divided into the pregnancy group(n=36)and the non-pregnancy group(n=24).The clinical data of age,infertility time,infertility type,tubal softness,pelvic effusion,hydrosalpinx,pelvic adhesions,pelvic,and abdominal surgery history,tubal pregnancy history,whether combined with adenomyosis were collected;5 mL of fasting elbow venous blood was extracted from the two groups on the morning of the discharge day,and the serum IFN-γand ICAM-1 of the two groups were detected by automatic biochemical analyzer-1.The clinical data mentioned above were collected.5 mL of fasting elbow venous blood was collected from the two groups on the morning of the discharge day,and the serum IFN-γand ICAM-1 concentrations of the two groups were detected by automatic biochemical analyzer;the value of IFN-γand ICAM-1 levels was analyzed by receiver operating curve(ROC)to predict the pregnancy value of patients with tubal infertility after double endoscopy surgery.The risk factors of infertility after surgery were analyzed by Logistic regression.Results The proportion of the non-pregnant group with age≥30 years,infertility time≥3 years,hydrosalpinx≥3 cm,severe pelvic adhesion,history of pelvic and abdominal surgery,history of fallopian tube pregnancy,and levels of IFN-γand ICAM-1 were significantly higher than those in the pregnancy group(P<0.05).ROC analysis showed that the area under the curve of IFN-γand ICAM-1 levels in predicting pregnancy after double endoscopy surgery in patients with tubal infertility were 0.723 and 0.719 respectively;Logistic regression analysis showed that age≥30 years,infertility time≥3 years,hydrosalpinx≥3 cm,severe pelvic adhesion,history of pelvic and abdominal surgery,history of tubal pregnancy,IFN-γ≥39.710 ng/L,and ICAM-1≥277.110μg/L were risk factors for tubal infertility after double endoscopy surgery.Conclusion Clinical features such as age,infertility time,degree of hydronephrosis,degree of pelvic adhesions,history of pelvic and abdominal surgery,history of fallopian tube pregnancy,and IFN-γand ICAM-1 levels may have an effect on the pregnancy rate of patients with tubal infertility after double endoscopy surgery.The impact requires close attention.