子宫性不孕的多参数MRI、MR-HSG及临床特征分析

Multiparametric MRI,MR-HSG and clinical characteristics of uterine factor infertility

目的 探讨子宫性不孕(uterine factor infertility,UFI)多参数磁共振成像(magnetic resonance imaging,MRI)、磁共振子宫输卵管造影(magnetic resonance hysterosalpingography,MR-HSG)及临床特征,并建立预测UFI模型。材料与方法 回顾性分析312例仅有UFI患者临床、MRI与MR-HSG影像资料,并随访中西医治疗后的妊娠结果。统计比较随访后不孕及已孕两组患者临床指标(年龄、饮食、月经周期等)、性激素及子宫异常(子宫肌瘤、宫腔粘连、瘢痕子宫、子宫腺肌症、子宫内膜息肉、宫颈纳氏囊肿等)差异。先后通过单、多因素logistic回归分析,筛选UFI的风险因素,采用logistic回归输入法构建临床参数模型、临床联合MRI及MR-HSG预测模型。受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估模型效能,并采用DeLong检验比较模型间AUC值差异。结果 经治疗后随访不孕组86例,已孕组226例,两组间年龄、月经周期不规律、子宫多发肌瘤、瘢痕子宫及宫腔粘连差异有统计学意义(P<0.05);多因素logistic回归分析证实年龄(OR=0.822,P<0.001)、子宫多发肌瘤(OR=0.540,P=0.002)及宫腔粘连(OR=0.367,P=0.036)是UFI的独立危险因素;联合模型(年龄+子宫多发肌瘤+宫腔粘连)预测UFI的AUC为0.809,显著高于单独年龄模型(P<0.05),与年龄+宫腔粘连、年龄+子宫多发肌瘤模型差异无统计学意义(P>0.05)。结论 年龄、子宫多发肌瘤、宫腔粘连是UFI的危险因素,联合模型预测妊娠结果具有临床价值。

Objective:To investigate multiparametric magnetic resonance imaging(MRI),magnetic resonance hysterosalpingography(MR-HSG)and clinical characteristics of uterine factor infertility(UFI)and to develop a model for predicting UFI.Materials and Methods:The clinical characteristics,MRI and MR-HSG imaging data of 312 patients with UFI only were analyzed retrospectively.The pregnancy results were followed up after treatment and divided into the infertile group and the pregnant group.The differences were compared including clinical indexes(age,diet,menstrual cycle,etc),sex hormones,and uterine abnormalities(such as uterine fibroids,intrauterine adhesions,scarred uterus,adenomyosis,endometrial polyps,Nabothian cyst,etc)between the two groups.Risk factors for UFI were then identified through univariate and multivariate logistic regression analysis.The enter method was performed to construct the clinical parameter model,the combination of clinical and MRI and MR-HSG parameter prediction models.The performance of the model was evaluated by the area under the curve(AUC)of receiver operating characteristic(ROC),and the AUCs were compared using the DeLong test.Results:The differences in age,menstrual cycle irregularity,uterine fibroids,cesarean scar diverticulum,and intrauterine adhesions between the infertility group of 86 cases and pregnant group of 226 cases were statistically significant(all P<0.05).Multivariate logistic regression analysis confirmed that age(OR=0.822,P<0.001)、multiple uterine fibroids(OR=0.540,P=0.002)and intrauterine adhesion(OR=0.367,P=0.036)were independent risk factors for UFI.The AUC for the combined model(age+multiple uterine fibroids+intrauterine adhesion)was 0.809,which was significantly higher than the age model(P<0.05).The combined model did not show a statistically significant difference compared to the age+intrauterine adhesion model and the age+multiple fibroids model(all P>0.05).Conclusions:Age,multiple uterine fibroids,and intrauterine adhesion are identified as risk factors for UFI,and the combined model has clinical value in predicting pregnancy.