辅助生育中子宫内膜异位症与前置胎盘相关性的研究

发布时间：2018-07-24 13:12

【摘要】：背景子宫内膜异位症(endometriosis)是指具有活性的子宫内膜出现在宫腔以外的部位生长繁殖,并在局部生长、浸润、反复出血。子宫内膜异位症发生确切的发病机制迄今不清,传统的病因学理论是Sampon的经血逆流种植学说,其他学说还有体腔上皮化生学说、播散学说、干细胞学说以及新近形成的“在位内膜决定论”等。子宫内膜异位症最严重及影响最深远的并发症是不孕。研究发现不孕妇女中子宫内膜异位症的发生率高达25-40%。子宫内膜异位症可引起不孕的机制尚未完全清楚,辅助生育技术是治疗子宫内膜异位症合并不孕的重要手段。但子官内膜异位症对辅助生育的妊娠结局也会产生一定的影响,子宫内膜异位症不孕患者其卵子受精率低,胚胎的发育潜能差,妊娠后的并发症却高。因此,子宫内膜异位症患者的生育能力及对妊娠结局的影响受到广泛的关注。前置胎盘是指孕28周后,胎盘附着于子宫下段,其下缘甚至达到或覆盖宫颈内口,低于胎先露部。前置胎盘的发病率国外报道为0.63%,国内报道为0.24%-1.57%。传统的理论认为子宫内膜病变和各种宫腔操作损伤包括流产、刮宫、引产、放取环、宫腔镜操作、剖宫产等等,都有可能引起不同程度的子宫内膜炎或内膜的萎缩性病变,再次受孕时子宫蜕膜血管缺陷,胎盘血供差,存在慢性缺血缺氧,为摄取足够的营养而增大胎盘面积就容易发生前置胎盘。有研究报道合并子宫内膜异位症的孕妇有发生前置胎盘的明显倾向性。故本文将探讨在辅助生育中子宫内膜异位症患者和前置胎盘发生的相关性并分析其可能的原因。方法回顾性复习2008年1月至2012年12月在浙江大学附属妇产科医院分娩的产科病历及辅助生育病历,对通过辅助生殖技术(包括体外受精-胚胎移植和卵细胞质内单精子注射)妊娠并在28周后单胎在本院分娩的并能顺利完成电话随访得到完整资料者共2060例进行统计分析,其中有110例发生了前置胎盘。统计这些孕妇年龄、体重指数、孕次、产次、流产次数、剖宫产史、子宫内膜异位症、排卵障碍、男性不孕等9个指标,分析它们与前置胎盘的相关性。同时对子宫内膜异位症分型与前置胎盘的相关性做了进一步分析。结果 1.各组人群中前置胎盘发病率：2008年1月至2012年12月在浙江大学附属妇产科医院住院分娩非辅助生育的总人数为60725人次,前置胎盘的发生率为3.23%。在2060例观察资料中,前置胎盘的发生率为5.34%,子宫内膜异位症患者中前置胎盘的发生率为21.56%。其中内异患者与普通人群比较χ2=260.16(P0.005),差异有统计学意义。 2.子宫内膜异位症组320例患者中前置胎盘发生率为21.56%,而非子宫内膜异位症组1740例患者中前置胎盘发生率为2.41%。经方差分析,χ2=192.75(P0.005),差异有统计学意义。 3.110例发生前置胎盘患者中合并子宫内膜异位症的有69例,前置胎盘组合并子宫内膜异位症达62.7%,而非前置胎盘组合并子宫内膜异位症为12.9%,OR值为19.7,95%CI(0.5-300.6),其P值为0.001,具有统计学意义。 4.子宫内膜异位症类型及严重程度与前置胎盘的发生存在正相关,Kendall相关系数为0.274,Spearman相关系数为0.281,均为P0.001。结论 1.子宫内膜异位症不仅造成不孕而且还影响着妊娠结局,在辅助生殖中子宫内膜异位症与前置胎盘的发生有一定的相关性,观察资料中显示辅助生育前置胎盘的发生率为5.34%,高于普通人群3.23%的发生率,而子宫内膜异位症患者的前置胎盘的发生率21.56%,远远高于前两者,有显著性差异。子宫内膜异位症增加了前置胎盘发生的风险。 2.本资料显示辅助生育组患者中前置胎盘合并内膜异位症达62.7%,而非前置胎盘合并内异为12.9%,经Logistic回归分析其OR值为19.7,辅助生育中子官内膜异位症与前置胎盘的发生存在明显相关性。 3.子宫内膜异位症不仅与前置胎盘的发生存在相关性,而且子官内膜异位症病变程度与前置胎盘的发生呈正相关。接受辅助生育的内膜异位症患者发生前置胎盘的有110例,其中重型子宫内膜异位症发生前置胎盘的有48例,轻型发生前置胎盘的为21例,经Spearman非参数检验相关性分析提示子宫内膜异位症与前置胎盘的发生有相关性并与病变程度呈正相关,子宫内膜异位症程度越重发生前置胎盘的风险率越高。
[Abstract]:background
Endometriosis (endometriosis) refers to the growth and reproduction of the active endometrium outside the uterine cavity, and local growth, infiltration, and repeated bleeding. The exact pathogenesis of endometriosis is not clear so far. The traditional etiology theory is Sampon's theory of reflux planting, and other theories and body cavity. Epithelial metaplasia theory, dissemination theory, stem cell theory and the newly formed "eutopic endometriodeterminism" and so on.
The most serious and most far-reaching complication of endometriosis is infertility. Studies have found that the mechanism of endometriosis in infertile women is not completely clear in the incidence of endometriosis as high as 25-40%. endometriosis. Assisted reproductive technology is an important means for the treatment of endometriosis with infertility. Heterotopic has a certain influence on the outcome of pregnancy assisted fertility. Endometriosis infertile patients have low fertilization rate, poor development potential and high complications after pregnancy. Therefore, the fertility of endometriosis patients and the effect on pregnancy outcome are widely concerned.
Placenta previa refers to the attachment of the placenta to the lower uterine segment after 28 weeks of pregnancy. The lower edge of the placenta can even reach or cover the inner mouth of the cervix. The incidence of placenta previa is lower than that of the fetus. The incidence of placenta previa is 0.63%. The domestic report is that endometrial lesions and various intrauterine operation injuries include abortion, curettage, induction, curettage, ring, and uterus. Endoscopic operation, cesarean section and so on, may cause different degrees of endometritis or endometrium atrophy, uterine decidua vascular defects, placental blood supply is poor, chronic ischemic anoxia exists, and the placenta is prone to increase placenta area. There are obvious tendentiousness of placenta previa in pregnant women. Therefore, this article will discuss the correlation of endometriosis and placenta previa in assisted childbirth and analyze the possible reasons.
Method
A retrospective review of the obstetric and assisted reproductive medical records from January 2008 to December 2012 at the Department of Obstetrics and Gynecology, affiliated to Zhejiang University, was reviewed, and a complete telephone follow-up was completed through assisted reproductive technology (including in vitro fertilization - embryo transfer and intracytoplasmic sperm injection) and the single fetus was delivered in our hospital after 28 weeks. A total of 2060 cases were statistically analyzed, including 110 cases of placenta previa. Statistics of these pregnant women's age, body mass index, pregnancy times, birth times, abortion times, cesarean section history, endometriosis, ovulation disorder, male infertility and other 9 indicators, analysis of their correlation with the placenta previa, and endometriosis classification and prepositional The correlation of placenta has been further analyzed.
Result
1. the incidence of placenta previa in all groups: the total number of non assisted childbirth in the affiliated obstetrics and Gynecology Hospital of Zhejiang University from January 2008 to December 2012 was 60725. The incidence of placenta previa was 3.23%. in 2060 cases, the incidence of placenta previa was 5.34%, placenta previa in endometriosis patients. The birth rate was 21.56%. Among them, 2=260.16 (P 0.005) was significantly different between endometriosis patients and the general population.
2. the incidence of placenta previa in 320 patients with endometriosis group was 21.56%, but the incidence of placenta previa in 1740 patients of non endometriosis group was 2.41%. via variance analysis and X 2=192.75 (P0.005), the difference was statistically significant.
There were 69 cases of endometriosis in 3.110 patients with placenta previa. Placenta previa combined with endometriosis was 62.7%, but not placenta previa combined with endometriosis 12.9%, OR value was 19.7,95%CI (0.5-300.6), and the value of P was 0.001, which had statistical significance.
4. the type and severity of endometriosis were positively correlated with the occurrence of placenta previa. The correlation coefficient of Kendall was 0.274, and the correlation coefficient of Spearman was 0.281, all P0.001..
conclusion
1. endometriosis not only causes infertility but also affects pregnancy outcomes. There is a certain correlation between endometriosis and placenta previa in assisted reproduction. The incidence of placenta previa is 5.34% in the observation data, which is higher than the incidence of 3.23% in the general population, and the prepositional previa of endometriosis patients. The incidence of placenta is 21.56%, which is much higher than that of the former two. There is a significant difference. Endometriosis increases the risk of placenta previa.
2. the data showed that the placenta previa combined with endometriosis in the assisted reproductive group was 62.7%, while the non placenta previa combined with internal differentiation was 12.9%, and the OR value was 19.7 by Logistic regression analysis. There was a significant correlation between the assisted reproductive neutrons endometriosis and the placenta previa.
3. endometriosis is not only associated with the occurrence of placenta previa, but also a positive correlation between the degree of endometriosis and the occurrence of placenta previa. There are 110 cases of placenta previa in patients with endometriosis receiving assisted fertility. There are 48 cases of placenta previa in severe endometriosis and light prepositional previa. In 21 cases of placenta, the correlation analysis between endometriosis and placenta previa was found to be correlated with the incidence of placenta previa by Spearman nonparametric test. The higher the risk rate of placenta previa was the more severe endometriosis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

【参考文献】