输卵管妊娠破裂的相关危险因素分析

Analysis of risk factors associated with ruptured tubal pregnancy

目的探讨输卵管妊娠破裂的相关危险因素。方法回顾性分析武汉市中心医院2017—2021年妇科收治住院的输卵管妊娠病例的临床特征,将其分为输卵管妊娠破裂组与未破裂组。采用χ^(2)检验、t检验、非参数检验进行两组的差异比较,用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析相关变量找到最佳临界值,通过多元二项逻辑回归分析发现危险因素。结果共纳入885例输卵管妊娠,其中未破裂患者780例(88.1%),破裂患者105例(11.9%)。主要症状(腹痛、阴道出血)、输卵管妊娠类型、B超包块最大直径和术前人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)水平差异有统计学意义(P<0.001)。多元二项逻辑回归分析显示,年龄、停经天数与输卵管妊娠破裂无关(P>0.05)。B超包块最大直径>3.5cm(OR=3.966,95%CI:2.473~6.358,P<0.001)和术前血清HCG>2600mIU/ml(OR=4.756,95%CI:2.916~7.759,P<0.001)是输卵管妊娠破裂的重要危险因素。结论当输卵管妊娠患者的B超包块最大直径>3.5cm及术前血清HCG>2600mIU/ml时可能有破裂的风险。

Objective The aim of study was to explore the risk factors associated with ruptured tubal pregnancy.Methods We retrospectively studied the clinical characteristics of inpatients with tubal pregnancy in the Central Hospital of Wuhan during 2017-2021 and divided them into ruptured and unruptured groups.The clinical characteristics of two groups were compared by χ^(2) test,t test,and nonparametric test.Analysis of correlation variables with receiver operating characteristic(ROC)curve to find optimal prediction value.Multivariate binomial logistic regression to analyze the relevant variables to find risk factors.Results There were 855 patients with tubal pregnancy,of which 780(88.1%)were unruptured and 105(11.9%)were ruptured.The main symptom(abdominal pain,vaginal bleeding),the type of tubal pregnancy,the maximum diameter of cladding block by ultrasound and the preoperative human chorionic gonadotropin(HCG)in two groups were significantly different(P<0.001).In multivariate binomial logistic regression analysis,the variables of age,menstrual days,history of induced abortion were not linked to the ruptured ectopic pregnancy significantly(P>0.05).And the maximum diameter of cladding block by ultrasound(OR=3.966,95%CI:2.473-6.358,P<0.001)and the preoperative serum HCG value>2600mIU/ml(OR=4.756,95%CI:2.916-7.759,P<0.001)were the important risk factors to the ruptured tubal pregnancy.Conclusion When the maximum diameter of the B-ultrasound mass in patients with tubal pregnancy was greater than 3.5 cm and the preoperative serum HCG was greater than 2600mIU/ml,there may be a risk of rupture.