Logistics回归分析剖宫产瘢痕妊娠治疗后再入院治疗的影响因素及不同治疗方案的最佳获益人群

目的采用Logistics回归分析剖宫产瘢痕妊娠治疗后再入院治疗的影响因素及不同治疗方案的最佳获益人群。方法收集湖北省妇幼保健院2016年4月至2018年4月收治的430例剖宫产瘢痕妊娠患者临床资料,根据患者治疗后是否再次入院治疗分为未再次入院组(389例)和再次入院组(41例)。采用复方米非司酮联合米索前列醇进行药物流产后联合B超引导下刮宫术治疗的患者为A方法组,共240例;采用双侧子宫动脉栓塞术联合甲氨蝶呤动脉灌注化疗联合B超引导下刮宫术为B方法组,共190例。分别采用单因素方差分析、Logistic回归多因素分析对年龄、孕周、孕次、囊胚大小、瘢痕厚度、瘢痕妊娠至剖宫产时间、术前血人绒毛膜促性腺激素水平(human chorionic gonadotropin,h CG)、术后h CG下降速率、治疗方法、术中出血量、术后并发症发生率、住院时间、住院费用等因素进行分析并筛选相关危险因素;采用ROC曲线分析对危险因素进行评估,并分析不同治疗方法的最佳获益人群。结果单因素方差分析结果显示未再次入院组和再次入院组间孕周、孕次、胎囊大小、瘢痕厚度、术中出血量比较,差异均有统计学意义(P<0.05)。对上述5项因素进行多因素Logistics回归分析,结果显示孕周≥7周、囊胚大小≥2.5 cm、瘢痕厚度≤3 mm是影响剖宫产瘢痕妊娠治疗后再入院治疗的独立危险因素;采用ROC曲线确定孕周临界值为7.12周,囊胚大小临界值为2.52 cm,瘢痕厚度临界值为2.98 mm。B方法组患者中孕周≥7.12周,囊胚≥2.52 cm,瘢痕厚度≥2.98 mm患者比例均高于A方法组患者,差异有统计学意义(P<0.05),再入院率比较,差异无统计学意义(P>0.05)。结论孕周、胎囊大小、瘢痕厚度是影响剖宫产瘢痕妊娠治疗后再入院治疗的独立危险因素,当孕周≥7.12周,胎囊大小≥2.52 cm,瘢痕厚度≤2.98 mm时发生率最高。对这部分患者建议采用双侧子宫动脉栓塞术联合甲氨蝶呤动脉灌注化疗联合B超引导下刮宫术进行治疗。

Logistics regression analysis of the influencing factors of re-admission treatment after caesarean section scar pregnancy treatment and the best benefit group of different treatment options

Objective To use logistic regression to analyze the influencing factors of readmission treatment after caesarean section scar pregnancy treatment and the best benefit groups of different treatment options.Methods The clinical data of 430 patients with caesarean section scar pregnancy admitted to Hubei Maternal and Child Health Hospital from April 2016 to April 2018 were collected.According to whether the patients were re-admitted after treatment,they were divided into no re一admission group(n=389)and re-admission group(n=41).Patients treated with compound mifepristone combined with misoprostol for drug abortion combined with B-guided curettage were A method group,a total of 240 patients.Bilateral uterine artery embolization combined with methotrexate arterial infusion chemotherapy combined with B一guided curettage was performed in the B method group,a total of 190 cases.One-way analysis of variance,logistic regression multivariate analysis and ROC curve analysis were used to analyze the influencing factors of re-admission treatment after treatment of caesarean section scar pregnancy.Results One-way analysis of variance showed that there was a statistically significant difference in gestational age,pregnancy times,fetal sac size,scar thickness,and intraoperative blood loss between the re一admission group and the re-admission group(P<0.05).Multivariate logistic regression analysis was performed on the above five factors.The results showed that gestational age M 7 weeks,fetal sac size M 2.5 cm,and scar thickness W 3 mm were independent risk factors for re-admission treatment after cesarean section scar pregnancy treatment;the ROC curve was used to determine the gestational age threshold of 7.12 weeks,the blastocyst size threshold was 2.52 cm,and the scar thickness threshold was 2.98 mm.In the B group,the proportion of patients with gestational age M7.12 weeks,blastocyst m2.52 cm,scar thickness M2.98 mm was higher than that of the A method group,the difference was statistically significant(P<0.05),there was no significant difference in the rate of re-admission(P>0.05).Conclusion The gestational age,embryo sac size and scar thickness are independent risk factors of re-admission treatment after caesarean section scar pregnancy treatment.When the gestational age is M7.12 weeks,the fetal sac size is M2.52 cm,and the scar thickness is W2.98 mm,the re-admission rate is higher.For these patients,bilateral uterine artery embolization combined with methotrexate arterial infusion chemotherapy combined with B一guided curettage is recommended.