稽留流产清宫术后患者卵巢功能激素水平与宫腔黏连所致不孕的关系

Correlation between the hormonal levels of ovarian function of women after curettage of missed abortion and their infertility caused by intrauterine adhesions

目的:观察稽留流产清宫术后患者卵巢功能与宫腔黏连导致的不孕关系。方法:回顾性分析本院门诊2018年1月-2019年10月行稽留流产清宫术患者180例临床资料,根据随访结果分组,其中因术后宫腔粘连导致不孕20例纳入不孕组,余160例纳入非不孕组,于清宫术后2~3个月门诊复查时检测患者卵巢功能指标促卵泡激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E;),回归分析清宫术后患者卵巢功能与宫腔黏连导致不孕相关性,绘制受试者工作曲线(ROC)分析卵巢功能激素预测宫腔黏连导致不孕价值。结果:与非不孕组相比,不孕组E;水平较低,FSH、LH、T水平均较高(均P<0.05);经logistic回归分析,清宫术后发生宫腔黏连导致不孕受患者FSH、LH、T、E;水平影响(OR>1,P<0.05);将清宫术后FSH、LH、T、E;作为检验变量绘制ROC曲线,得到FSH、LH、T、E;及FSH+LH+T联合检测的AUC分别为0.965、0.878、0.943、0.994、0.971。结论:稽留流产清宫术后患者机体卵巢功能激素指标水平与术后宫腔黏连导致不孕有一定关系,针对稽留流产清宫术后有生育需要女性,临床应定期监测其卵巢功能,并对E;低表达、FSH、LH、T高表达者及时行合理干预,降低因宫腔黏连导致的不孕发生。

Objective: To observe the correlation between the ovarian function of women after curettage of missed abortion and their infertility caused by intrauterine adhesions infertility. Methods: The clinical data of 180 women with missed abortion after curettage from January 2018 to October 2019 were analyzed retrospectively. According to the results of followed up of the women after curettage, these women were divided group A(20 women with infertility due to intrauterine adhesions) and group B(160 women without infertility due to intrauterine adhesions). The levels of the ovarian function indicators, such as follicle-stimulating hormone(FSH), luteinizing hormone(LH), testosterone(T), and estradiol(E;), of the women in the two groups were detected in 2-3 months after curettage. The correlation between the ovarian function of the women after curettage of missed abortion and their infertility caused by intrauterine adhesions was analyzed by regression analysis. Receiver operating characteristic(ROC) curve was drawn to analyze the value of the hormone’s levels of the ovarian function for predicting infertility caused by intrauterine adhesion. Results: The level of E;of the women in group A was significantly lower than that of the women in group B, but the levels of FSH, LH, and T of the women in group A were significantly higher(all P<0.05). Logistic regression analysis showed that the FSH, LH, T and E;levels of the women in group A affected their infertility caused by intrauterine adhesion after curettage(OR>1, P<0.05). ROC curve was drawn based on the test variables of the levels of FSH, LH, T, and E;, and the results showed that the AUC of FSH level, LH level, T level, E;level, or the combined detection of the FSH, LH, and T levels for predicting infertility were 0.965, 0.878, 0.943, 0.994, and 0.971, respectively.Conclusion:The hormonal levels of ovarian function of the women with missed abortion after curettage have certainly relevent to their infertility caused by intrauterine adhesions.In order to reduce the infertility caused by intrauterine adhesion,regular monitoring of ovarian function should be conducted in the women who want pregnancy after curettage of missed abortion,and should be reasonablely intervene their low expression level of E2 and high expression levels of FSH,LH,and T.