女性不孕症病因及相关影响因素的病例对照研究

发布时间：2018-05-21 09:22

本文选题：女性不孕症 + 病因　；参考：《山东大学》2014年硕士论文

【摘要】：[研究目的] 通过对女性不孕症的病因及相关影响因素的调查结果进行统计分析,探讨不孕症可能的主要病因及高危影响因素,为预防及诊治不孕症提供参考依据。 [研究对象] 1.本研究采用医院为基础1：1匹配病例对照研究,选择2013.5—2014.1间就诊于济南某三级甲等医院生殖医学中心并明确诊断为不孕症的女性患者216例为病例组。 2.选择同期就诊于同一医院妇产科生育功能正常的女性216例作为对照组,其中包括自然而无任何人为干预的情况下受孕的孕产妇、意愿外或避孕失败而怀孕行人工流产术者。 [研究方法] 1.研究方法采用病例对照研究,以医院就诊者为研究人群,其中不孕女性为病例组,能自然正常怀孕者为对照组。 2.数据资料是通过对每位研究对象进行不孕症的临床系统检诊、填写女性健康调查问卷的方法获取。 2.1临床检诊对病例组、对照组均采集病史、系统检诊等8项检查项目。 2.2调查问卷病例组、对照组均认真填写“女性健康状况调查问卷”,问卷包括7方面内容共126个问题。 3.统计分析 (1)应用EPidata3.1建立数据库,应用SPssl6.0软件进行分析描述。 (2)应用构成比来描述致病因素的构成。 (3)利用条件Logistic回归模型,对各因素进行单因素分析。 (4)将筛选出的因素导入Logistic回归模型,进行多因素分析。 [结果] 本调查共获取有效问卷432份,其中女性不孕患者、女性正常生育能力者各216份。分析结果如下： 1.病因构成比分析：女性不孕的主要病因排序依次为输卵管类疾病(41.3%)、卵巢类疾病(32.4%)、免疫性不孕类疾病(8.3%)、不明原因类疾病(5.1%)、子宫类疾病(4.6%)、阴道炎症(4.6%)、内分泌疾病(2.3%)、遗传病(1.4%)。输卵管类不孕主要为输卵管梗阻性不孕,其主要致病因素为：性传播性疾病、妇科炎症(非特异性)、子宫内膜异位症。卵巢类不孕主要为卵巢排卵障碍性不孕,其主要病因为：多囊卵巢综合征、卵巢巧克力样囊肿、妇科炎症(非特异性)。 2.单因素分析结果：女性不孕病因影响因素中具有显著性差异的因素如下： 2.1生物学因素中包括：妇科炎症、月经不规律、人工流产次数多、异位妊娠史、性交痛、痛经、内分泌疾病史、肝病、肿瘤、风湿等免疫性疾病史、妇科手术史、甲状腺疾病史、应用药物史(安定、激素类药)、胃肠道疾病史等。 2.2社会因素 2.2.1基本情况因素包括：职业(农民)、文化水平低、年龄大等。 2.2.2婚姻性生活因素包括：性伴侣人数多、第一次性交年龄过小、外阴阴道清洗频繁、经常经期性生活、性生活满意度低等。 2.2.3生活饮食习惯因素包括：经常熬夜、睡前经常使用手机、烫发频繁、经常饮酒、常使用电热毯、吸烟、饲养宠物、常使用微波炉；经常食用甜点煎炸食品、腌制食品、棉籽油等。 2.2.4心理因素包括：与父母关系紧张、夫妻关系不和谐、同事关系不融洽、心理压力大、无助失望等。 2.3环境因素包括：同事吸烟多、近期住房装修,经常夜班作业、经常接触毒物、重金属、农药等。 3.多因素分析结果：年龄(OR=34.979)、妇科炎症(OR=2.688)、月经不规律(OR=3.273)、第一次性交年龄小(OR=4.255)、性伴侣个数多(OR=2.396)、经常食用甜点煎炸食品(OR=3.755)、熬夜(OR=2.801)、睡前使用手机(OR=2.814)、接触毒物/重金属/农药(OR=1.990)、心理压力大(OR=3.067)等可能是女性不孕症的高危因素。 [结论] 1.输卵管梗阻性疾病及卵巢排卵障碍性疾病可能是导致女性不孕症的主要疾病。 2.妇科炎症、子宫内膜异位症、多囊卵巢综合征等疾病是导致输卵管梗阻性疾病及卵巢排卵障碍性疾病的主要病因,其间接地成为女性不孕的危险因素。 3.年龄、第一次性交年龄小、性伴侣个数多、熬夜、心理压力大、经常食用甜点及煎炸食品、睡前使用手机等社会因素可能是导致女性不孕的危险因素。 4.经常接触毒物、重金属、农药等因素等可能是女性不孕症的环境危险因素。
[Abstract]:[research purposes]
Through the statistical analysis of the causes of female infertility and related factors, the main causes of infertility and the risk factors are discussed to provide reference for the prevention and treatment of infertility.
[object of study]
1. in this study, a case-control study based on a hospital based 1:1 matched case was used, and 2013.5 to 2014.1 were selected from the reproductive medical center of a class three class a hospital in Ji'nan and 216 cases of female patients diagnosed as infertility.
2. selected 216 women with normal reproductive function in the same hospital and obstetrics and gynecology in the same hospital as the control group, including pregnant and parturient women who were naturally pregnant without any intervention, and were pregnant with abortions without the intention or failure of contraception.
[research methods]
1. the case-control study was conducted in the study group. The patients in the hospital were the study group, and the infertile women were case group.
2. data is obtained through the systematic clinical diagnosis of infertility and the completion of the female health questionnaire.
2.1 clinical cases were collected from the case group and the control group by 8 items, including medical history, systematic examination and so on.
2.2 the questionnaire group and the control group were filled in the "women's health questionnaire". There were 126 questions in the questionnaire including 7 aspects.
3. statistical analysis
(1) using EPidata3.1 to build database, using SPssl6.0 software to analyze and describe.
(2) the composition of the application composition ratio to describe the pathogenic factors.
(3) using conditional Logistic regression model, single factor analysis was carried out on all factors.
(4) to import the screened factors into Logistic regression model and conduct multivariate analysis.
[results]
A total of 432 valid questionnaires were obtained, including 216 female infertile women and normal fertile women. The results are as follows:
1. factor analysis: the main causes of female infertility were fallopian tube disease (41.3%), ovarian disease (32.4%), immune infertility (8.3%), unexplained disease (5.1%), uterine disease (4.6%), vaginitis (4.6%), endocrine disease (2.3%), and hereditary disease (1.4%).
Tubal infertility is mainly oviduct obstructive infertility, and its main pathogenic factors are sexually transmitted diseases, gynecological inflammation (non-specific), endometriosis.
Ovarian infertility is mainly ovarian ovulatory infertility. The main diseases are polycystic ovary syndrome, ovarian chocolate like cyst and gynecological inflammation (non-specific).
2. univariate analysis: there are significant differences in the factors influencing female infertility.
2.1 biological factors include: gynecologic inflammation, irregular menstruation, many times of induced abortion, history of ectopic pregnancy, sexual pain, dysmenorrhea, history of endocrine disease, liver disease, the history of immune diseases such as tumor, rheumatism, gynecologic operation history, history of thyroid disease, history of application of drugs (andin, hormone drugs), and the history of gastrointestinal diseases.
2.2 social factors
2.2.1 the basic situation factors include: occupation (farmers), low educational level, age and so on.
2.2.2 sexual life factors include: the number of sexual partners, the first sexual intercourse age is too small, vaginal vaginal cleaning frequent, frequent menstrual life, sexual life satisfaction is low.
2.2.3 lifestyle factors include: often staying up late, regular use of mobile phones before bedtime, frequent perm, frequent drinking, frequent use of electric blankets, smoking, raising pets, often using microwave ovens, often eating dessert fried food, pickled food, cottonseed oil and so on.
2.2.4 psychological factors include: tension with parents, disharmony between husband and wife, lack of harmony among colleagues, psychological pressure, helpless disappointment, etc.
2.3 environmental factors include: colleagues smoking too much, recent housing renovation, frequent night shift operations, frequent exposure to poisons, heavy metals, pesticides and so on.
3. multiple factors analysis: age (OR=34.979), gynecologic inflammation (OR=2.688), irregular menstrual (OR=3.273), the first sexual intercourse age (OR=4.255), sex partner more (OR=2.396), often eating dessert fried food (OR=3.755), staying up (OR=2.801), using cell phone (OR=2.814) before bedtime, exposure to poison / heavy metal / pesticide (OR=1.990), and psychological pressure (OR=3.067) etc. may be a high risk factor for female infertility.
[Conclusion]
1. Tubal Obstructive Diseases and ovarian ovulatory disorders may be the main cause of female infertility.
2. diseases such as gynecologic inflammation, endometriosis and polycystic ovary syndrome are the main causes of oviduct obstruction and ovarian ovulatory disorders, and earthing between them is a risk factor for female infertility.
The 3. age, the first sexual intercourse age, the number of sexual partners, staying up late, the psychological pressure, often eating dessert and fried food, the use of mobile phone before bedtime and other social factors may be a risk factor for female infertility.
4. exposure to poisons, heavy metals, pesticides and other factors may be environmental risk factors for female infertility.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6

【参考文献】