输卵管再通术后妊娠率影响因素分析及列线图模型验证

Analysis of the fiactors influencing the pregnancy rate after fallopian tube recanalization and its nomogram model validation

目的探讨输卵管再通术(FTR)后妊娠率的影响因素,构建并验证列线图预测模型。方法回顾性分析2018年1月至2022年12月在武汉市第三医院接受FTR治疗的322患者临床资料。根据FTR后12个月患者是否自然受孕,分为妊娠组、不孕组。采用logistic回归分析确定FTR后妊娠的独立影响因素。将患者以1:1比例随机分为训练组和验证组,在训练组构建列线图模型,验证组验证模型的预测效能。结果FTR后患者1年内自然妊娠率为45.34%(146/322)。年龄>35岁、原发性不孕、不孕年限>3年、输卵管远端堵塞以及输卵管中重度病变是影响FTR后妊娠率的独立危险因素(均P<0.05)。构建的列线图模型区分度和校准度良好,临床效用高。结论本研究构建的列线图模型可有效预测FTR后1年不孕风险,有助于制定个体化治疗方案。

Objective To explore the factors influencing the pregnancy rate after fallopian tube recanalization(FTR),and to construct and validate a nomogram prediction model.Methods The clinical data of a total of 322 female patients with tubal obstructive infertility,who received FTR at the Wuhan Municipal Third Hospital of China between January 2018 and December 2022,were retrospectively analyzed.According to whether the female patient had natural pregnancy or not within 12 months after FTR treatment,the female patients were divided into the pregnant group and the non-pregnant group.Logistic regression analysis was used to determine the independent factors influencing pregnancy.The female patients were randomly divided into training group and validation group at 1:1 ratio.A nomogram model was constructed in the training group,and the predictive efficacy of the model was verified in the validation group by using receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA).Results The natural pregnancy rate at one year after FTR was 45.34%(146/322).Age>35 years,primary infertility,duration of infertility>3 years,distal fallopian tube obstruction,and moderate to severe tubal lesion were the independent risk factors affecting the pregnancy rate after FTR(all P<0.05).The constructed nomogram model had a good differentiation and calibration ability and it carried a high degree of clinical utility.Conclusionn The nomogram model constructed in this study can effectively predict the risk of infertility within one year after FTR treatment,which is helpful for formulating the individualized therapeutic scheme for infertility female patients.