Analysis of influencing factors of intrauterine adhesions after early missed abortion surgery and construction of predictive model

ZHOU Linlin; WANG Zhongjie; XU Dian; WANG Jianing

doi:10.7619/jcmp.20232300

Journal of Clinical Medicine in Practice > 2023 > 27(18): 107-112. > DOI: 10.7619/jcmp.20232300

ZHOU Linlin, WANG Zhongjie, XU Dian, WANG Jianing. Analysis of influencing factors of intrauterine adhesions after early missed abortion surgery and construction of predictive model[J]. Journal of Clinical Medicine in Practice, 2023, 27(18): 107-112. DOI: 10.7619/jcmp.20232300

Citation:

PDF (2020 KB)

Analysis of influencing factors of intrauterine adhesions after early missed abortion surgery and construction of predictive model

1.
Obstetrics and Gynecology Department, Suzhou Ninth People's Hospital of Jiangsu Province, Suzhou, Jiangsu, 215200
2.
Obstetrics and Gynecology Department, the Second Hospital Affiliated to Suzhou University, Suzhou, Jiangsu, 215200

More Information

Received Date: July 19, 2023
Revised Date: September 06, 2023
Available Online: October 08, 2023

Graphical Abstract

Abstract

Abstract

Objective
To analyze the influencing factors of intrauterine adhesions after early missed abortion surgery and construct a predictive model.
Methods
The data of 438 patients with missed abortion were retrospectively collected. A total of 307 patients were randomly selected as modeling set and 131 as test set. Univariate and multivariate Logistic regression analysis was performed on the modeling set data and the prediction model was constructed. The effectiveness of the model was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve, respectively, and a test set to verify the effectiveness of the model was introduced.
Results
A total of 58 patients with early missed miscarriage in the modeling set one month after curettage experienced intrauterine adhesions, with an incidence rate of 18.89% (58/307). Among them, there were 46 cases of partial adhesions in the uterine cavity and 12 cases of extensive adhesions in the uterine cavity. Multivariate Logistic regression analysis showed that times of previous induced abortions, previous uterine cavity procedures, methods of curettage, overexpressed transforming growth factor β1 (TGF-β1) and low expression of matrix metalloproteinase-9 (MMP-9) were influencing factors for postoperative uterine adhesions in early missed abortion (P < 0.05). The area under the ROC curve of the risk prediction model of intrauterine adhesion after early missed abortion based on the above indicators was 0.894, the optimal cutoff value (threshold probability) was 0.440, sensitivity was 0.890, and specificity was 0.848. The Brier index for calibration curve analysis was 0.068. The area under the ROC curve introduced into the test set for model verification was 0.877, the sensitivity was 0.875, and the specificity was 0.802. The Brier index for calibration curve analysis was 0.165. When the threshold probability value in the decision curve was set to 0.44, this predictive model can provide significant additional clinical net benefits.
Conclusion
Based on the number of previous induced abortions, the number of uterine cavity procedures, and methods of curettage, TGF- β1 and MMP-9, the construction of a predictive model for the risk of intrauterine adhesions after early missed abortion has certain practical value.
- missed abortion,
- curettage technique,
- intrauterine adhesions,
- influencing factors,
- prediction model,
- transforming growth factor β1,
- matrix metalloproteinase-9

FullText(HTML)

References (26)

References

[1]	赵璐, 杨华. 早期妊娠稽留流产与碘营养超适宜关系的研究[J]. 中国计划生育和妇产科, 2023, 15(5): 67-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JHFC202305014.htm
[2]	陶丽丹, 贾旺, 杨娜, 等. 稽留流产清宫术后去氧孕烯炔雌醇辅助治疗对子宫内膜组织MMP9、TGF-β3 mRNA水平及内膜修复效果[J]. 中国计划生育学杂志, 2021, 29(9): 1956-1959. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202109038.htm
[3]	JIANG P, TANG X, WANG H, et al. Collagen-binding basic fibroblast growth factor improves functional remodeling of scarred endometrium in uterine infertile women: a pilot study[J]. Sci China Life Sci, 2019, 62(12): 1617-1629. doi: 10.1007/s11427-018-9520-2
[4]	潘宁宁, 李蓉. 从生育力保护角度探讨宫腔粘连的围手术期治疗[J]. 中国实用妇科与产科杂志, 2022, 38(11): 1092-1096. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF202211008.htm
[5]	CHEN L, XIAO S, HE S, et al. Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study[J]. J Minim Invasive Gynecol, 2020, 27(1): 54-59. doi: 10.1016/j.jmig.2018.12.023
[6]	中华医学会妇产科学分会. 《宫腔粘连临床诊疗中国专家共识》发布[J]. 中华医学信息导报, 2016, 13(1): 8-10.
[7]	彭燕蓁, 段华. 子宫内膜损伤宫腔粘连评价指标的临床应用[J]. 中国实用妇科与产科杂志, 2022, 38(9): 873-877. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF202209003.htm
[8]	侍繁, 高原, 吴晓燕, 等. 血清MMP-9、TIMP-1水平对早期稽留流产术后宫腔粘连的预测价值[J]. 中国医药导报, 2022, 19(18): 82-85. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202218019.htm
[9]	沈文娟, 叶园园, 周恺玥, 等. 医用聚乙二醇小檗碱液改善清宫术后临床结局的效果分析[J]. 实用临床医药杂志, 2019, 23(8): 47-50. doi: 10.7619/jcmp.201908013
[10]	MO X, QIN G, ZHOU Z, et al. Assessment of Risk Factors of Intrauterine Adhesions in Patients With Induced Abortion and the Curative Effect of Hysteroscopic Surgery[J]. J Invest Surg. 2019, 32(1): 85-89.
[11]	谷楠楠, 杨荷, 陈继明, 等. 宫腔粘连电切术后不同干预方案的临床效果观察[J]. 实用临床医药杂志, 2021, 25(17): 128-132. doi: 10.7619/jcmp.20211672
[12]	刘姝岑, 朱雪红, 宾力, 等. 中国地区人工流产术及宫腔镜术后出现宫腔粘连危险因素的Meta分析[J]. 中国性科学, 2023, 32(1): 93-97. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ202301023.htm
[13]	张明玮, 刘倩, 谢青贞. 慢性子宫内膜炎对宫腔粘连治疗结局的影响[J]. 生殖医学杂志, 2023, 32(6): 823-828. https://www.cnki.com.cn/Article/CJFDTOTAL-SZYX202306004.htm
[14]	于洋, 邹凌霄, 李外星, 等. 宫腔粘连好发和相对严重部位的临床特征[J]. 中南大学学报: 医学版, 2022, 47(11): 1568-1574. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202211013.htm
[15]	左欣曌, 孔伟, 彭蓉, 等. 宫腔镜刨削刀系统治疗稽留流产34例[J]. 中国微创外科杂志, 2019, 19(1): 31-33, 49. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK201901009.htm
[16]	沈晔, 钱芳波, 朱燕华. 直视人流系统与超声引导下人流术对患者子宫内膜恢复的影响及宫腔黏连发生风险比较[J]. 实用医院临床杂志, 2023, 20(3): 44-47. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202303013.htm
[17]	李新琴, 石庆伟. 稽留流产的治疗研究进展[J]. 医学综述, 2019, 25(24): 4956-4959, 4964. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201924027.htm
[18]	赵芳芳, 覃晓楣, 迟博, 等. PINK1/Parkin通路介导的线粒体自噬对宫腔粘连纤维化的影响及机制[J]. 现代妇产科进展, 2021, 30(8): 575-579, 584. https://www.cnki.com.cn/Article/CJFDTOTAL-XDFC202108004.htm
[19]	CHEN J X, YI X J, GU P L, et al. The role of KDR in intrauterine adhesions may involve the TGF-β1/Smads signaling pathway[J]. Braz J Med Biol Res, 2019, 52(10): e8324.
[20]	张友, 王琮, 杨燕. 宫腔粘连组织中miR-22、TGFβR1表达与三维能量超声参数的相关性及临床意义[J]. 分子诊断与治疗杂志, 2022, 14(11): 1841-1844, 1849. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYQ202211004.htm
[21]	邱爽, 张璇, 王晓庆. 血清TGF-β1、VEGF、HIF-1α在子宫内膜息肉患者中的表达及与息肉切除术后宫腔粘连关系[J]. 中国妇产科临床杂志, 2022, 23(5): 486-488. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC202205013.htm
[22]	LIU L, CHEN G, CGEN T, et al. si-SNHG5-FOXF2 inhibits TGF-β1-induced fibrosis in human primary endometrial stromal cells by the Wnt/β-catenin signalling pathway[J]. Stem Cell Res Ther, 2020, 11(1): 479.
[23]	ABUDUKEYOUMU A, LI M Q, XIE F. Transforming growth factor-β1 in intrauterine adhesion[J]. Am J Reprod Immunol, 2020, 84(2): e13262.
[24]	方子昂, 程靖, 王文艳, 等. 新生化颗粒联合透明质酸钠对宫腔粘连患者的疗效及血清TIMP-1、PDGF、MMP-9的影响[J]. 中国妇产科临床杂志, 2019, 20(5): 401-403. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC201905007.htm
[25]	王红钰, 马恩萍, 涂国凤. 稽留流产孕早期预测模型的构建与验证[J]. 中国计划生育和妇产科, 2020, 12(5): 43-47. https://www.cnki.com.cn/Article/CJFDTOTAL-JHFC202005010.htm
[26]	刘凯, 朱琳, 刘政文, 等. 宫腔粘连患者妊娠预后的列线图预测模型建立[J]. 中国妇产科临床杂志, 2021, 22(5): 498-500. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC202105017.htm

[1]	BAO Qingying, ZHANG Lingling, MA Songhua, CHEN Xiaobo, JIANG Zhi, JIANG Qiqun. Correlations between serum soluble growth stimulationgene 2 protein, brain natriuretic peptide and the degree of carotid atherosclerosis in patients with acute ischemic stroke[J]. Journal of Clinical Medicine in Practice, 2024, 28(8): 70-74, 78. DOI: 10.7619/jcmp.20240200
[2]	JIANG Nengmei, GUAN Xinjuan, YANG Shezhen. Correlations of growth arrest specific 6 and C1q/TNF-related protein 4 with carotid atherosclerosis in patients with type 2 diabetes[J]. Journal of Clinical Medicine in Practice, 2023, 27(5): 123-127. DOI: 10.7619/jcmp.20223211
[3]	WU Zhen, XU Yan, SU Wentao, WU Gangyong. Correlations of serum parathyroid hormone and 25 hydroxyvitamin D with glycolipid metabolism in patients with type 2 diabetes mellitus complicated with carotid atherosclerosis[J]. Journal of Clinical Medicine in Practice, 2022, 26(17): 120-124. DOI: 10.7619/jcmp.20221479
[4]	CHEN Yuchi, LIU Qiang. Correlation between monocyte to high-density lipoprotein cholesterol ratio and carotid artery stenosis in patients with acute cerebral infarction[J]. Journal of Clinical Medicine in Practice, 2021, 25(3): 36-39. DOI: 10.7619/jcmp.20201217
[5]	SHI Guiwen. Risk factors of type 2 diabetes mellitus complicated with carotid atherosclerosis and analysis of neutrophil to lymphocyte ratio and platelets to lymphocyte ratio levels[J]. Journal of Clinical Medicine in Practice, 2018, (1): 27-30. DOI: 10.7619/jcmp.201801009
[6]	CHEN Ying. Influence of different doses of atorvastatin on carotid atherosclerosis and inflammatory factors in patients with cerebral infarction[J]. Journal of Clinical Medicine in Practice, 2016, (5): 25-28. DOI: 10.7619/jcmp.201605008
[7]	GAO Lin. Correlation between blood pressure variability and carotid atherosclerosis in hypertensive patients[J]. Journal of Clinical Medicine in Practice, 2016, (3): 1-3. DOI: 10.7619/jcmp.201603001
[8]	GUO Yuyu, CHEN Yingchao, SUI Chunhua. Relationship between subclinical hypothyroidism and carotid artery atherosclerosis in type 2 diabetes mellitus patients[J]. Journal of Clinical Medicine in Practice, 2015, (19): 16-18. DOI: 10.7619/jcmp.201519005
[9]	WANG Yingxin, LI Ai. Difference of serum uric acid level in type 2 diabeticpatients with different gender and its correlation with carotid atherosclerosis[J]. Journal of Clinical Medicine in Practice, 2015, (13): 8-11. DOI: 10.7619/jcmp.201513003
[10]	WANG Junjun, YU Chunjuan, DING Qilong, XING Ting. Correlation between serum high sensitivity C-reactive protein and atherosclerosis in patients with type 2 diabetes mellitus[J]. Journal of Clinical Medicine in Practice, 2015, (5): 5-7. DOI: 10.7619/jcmp.201505002

Cited By

Cited by

Periodical cited type(9)

1.	宋俊迎，王琼，李凤德. 冠心病及冠状动脉病变严重程度的影响因素分析. 中西医结合心脑血管病杂志. 2024(18): 3402-3406 .
2.	罗德钦，刘婷婷，熊青，聂荣杰. CD147/MMP-9通路与2型糖尿病合并高血压患者发生颈动脉粥样硬化的关系. 南昌大学学报(医学版). 2023(02): 50-53+79 .
3.	李婷，崔荣荣. 2型糖尿病合并MIS患者心室重构与血清CysC水平的相关性分析. 临床医学研究与实践. 2022(34): 118-120 .
4.	杨青，仝海燕，高雪梅. 2型糖尿病患者血清胱抑素C、半乳糖凝集素3、人软骨糖蛋白39与颈动脉粥样硬化的相关性. 中国卫生工程学. 2022(06): 991-993+996 .
5.	陈鹏程. 高血压患者血脂水平与颈动脉内膜增厚的相关性分析. 慢性病学杂志. 2021(01): 69-70+73 .
6.	朱宗国，杨洪余，黄澜，谭旭斌，卞西杰，钟铠璟. 糖尿病患者血清microRNA-152表达水平与血脂代谢、胰岛素抵抗的相关性. 中国现代医学杂志. 2021(08): 1-6 .
7.	王庆，虞寒芬，陈萍. 2型糖尿病患者继发颈动脉粥样硬化的危险因素分析. 现代实用医学. 2021(07): 923-924 .
8.	岳军. 血清HDL-C、LDL-C对老年2型糖尿病患者动脉粥样硬化的评估分析. 心血管病防治知识. 2021(30): 3-5 .
9.	郎慧芳，李红梅. 血清小而密低密度脂蛋白胆固醇与2型糖尿病患者颈动脉病变严重程度的相关性. 中国医药指南. 2020(34): 22-24 .

Other cited types(0)

Get Citation

PDF

XML

Article views (150) PDF downloads (23) Cited by(9)

Turn off MathJax

Article Contents

Abstract

References

Analysis of influencing factors of intrauterine adhesions after early missed abortion surgery and construction of predictive model