剖宫产术后子宫瘢痕妊娠相关因素分析

发布时间：2019-01-15 09:07

【摘要】：目的:探讨可能发生剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的相关危险因素,为CSP的防治提供理论依据。方法:选取2011年10月至2016年10月在遵义医学院附属医院妇产科确诊为CSP的90例患者为研究组,选取同期该院诊断瘢痕子宫并早孕90例为对照组。收集研究组及对照组可能导致CSP的观察因素(共14个)的临床资料。经单因素Logistic回归分析,筛选出具有统计学意义的变量(P0.05)。将上述变量进行多因素非条件Logistic回归分析,将有统计学意义的变量(P0.05)纳入回归模型,计算出相关自变量的回归系数、比值比、95%可信区间,并建立Logistic回归预测模型,推导出预测CSP发生的概率P值公式。结果:1.单因素分析提示:年龄、本次妊娠距前次剖宫产时间、人流史、胎盘粘连史、剖宫产次数、上环史、子宫内膜炎及文化程度在两组间的差异具有统计学意义(P0.05)。2.多因素分析显示人流史、胎盘粘连史、年龄及子宫内膜炎(P0.05)可能为CSP的高危因素,上述因素的OR1,其回归系数依次为:1.532、1.292、1.179及0.953。3.推导出预测CSP发生概率公式:P=1/[1+exp(2.005-1.179X_1-1.532X_4-1.292X_5-0.953X_(10))],其灵敏度及特异度分别为73.33%及74.44%。结论:1.与CSP发生可能相关的危险因素有四个,对其影响因素由大到小分别为:人流史、胎盘粘连史、年龄、子宫内膜炎。2.推导预测CSP发生概率公式:P=1/[1+exp(2.005-1.179X_1-1.532X_4-1.292X_5-0.953X_(10))]。3.通过绘制ROC曲线,得出本预测模型AUC=0.826,表示预测效果中等。
[Abstract]:Objective: to explore the risk factors of (cesarean scar pregnancy,CSP in uterine scar pregnancy after cesarean section, and to provide theoretical basis for the prevention and treatment of CSP. Methods: from October 2011 to October 2016, 90 patients with CSP diagnosed in gynecology and obstetrics department of affiliated Hospital of Zunyi Medical College were selected as study group and 90 patients with scarred uterus and early pregnancy as control group. The clinical data of 14 factors that may lead to CSP in the study group and control group were collected. Single factor Logistic regression analysis showed that the variables were statistically significant (P0.05). The above variables were analyzed by multivariate conditional Logistic regression analysis. The statistically significant variables (P0.05) were incorporated into the regression model. The regression coefficient, ratio, 95% confidence interval of the related independent variables were calculated, and the Logistic regression prediction model was established. The probability P value formula for predicting the occurrence of CSP is derived. Results: 1. Univariate analysis showed that: age, pregnancy from the previous cesarean section time, history of abortion, history of placenta adhesion, cesarean section times, history of upper ring, endometritis and education between the two groups had statistical significance (P0.05). Multivariate analysis showed that the history of abortion, history of placental adhesion, age and endometritis (P0.05) may be the high risk factors of CSP. The regression coefficients of OR1, of the above factors were: 1.532n 1.292n 1.179 and 0.953.3% respectively. The probability formula for predicting the occurrence of CSP was derived as follows: Pian 1 / [1 exp (2.005-1.179XT 1-1.532X4-1.292X5-0.953X10)], its sensitivity and specificity were 73.33% and 74.44%, respectively. Conclusion: 1. There are four risk factors associated with CSP, and the influencing factors are: history of abortion, history of placental adhesion, age, endometritis, etc. The probability formula for predicting the occurrence of CSP is derived as follows: Pian 1 / [1 exp (2.005-1.179XT _ 1-1.532XS _ 4-1.292X _ (10)]. By drawing the ROC curve, the prediction model AUC=0.826, indicates that the prediction effect is moderate.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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