發(fā)布時間：2018-05-21 09:22

  本文選題：女性不孕癥 + 病因�。� 參考：《山東大學》2014年碩士論文

【摘要】：[研究目的] 通過對女性不孕癥的病因及相關影響因素的調(diào)查結果進行統(tǒng)計分析,探討不孕癥可能的主要病因及高危影響因素,為預防及診治不孕癥提供參考依據(jù)。 [研究對象] 1.本研究采用醫(yī)院為基礎1：1匹配病例對照研究,選擇2013.5—2014.1間就診于濟南某三級甲等醫(yī)院生殖醫(yī)學中心并明確診斷為不孕癥的女性患者216例為病例組。 2.選擇同期就診于同一醫(yī)院婦產(chǎn)科生育功能正常的女性216例作為對照組,其中包括自然而無任何人為干預的情況下受孕的孕產(chǎn)婦、意愿外或避孕失敗而懷孕行人工流產(chǎn)術者。 [研究方法] 1.研究方法采用病例對照研究,以醫(yī)院就診者為研究人群,其中不孕女性為病例組,能自然正常懷孕者為對照組。 2.數(shù)據(jù)資料是通過對每位研究對象進行不孕癥的臨床系統(tǒng)檢診、填寫女性健康調(diào)查問卷的方法獲取。 2.1臨床檢診對病例組、對照組均采集病史、系統(tǒng)檢診等8項檢查項目。 2.2調(diào)查問卷病例組、對照組均認真填寫“女性健康狀況調(diào)查問卷”,問卷包括7方面內(nèi)容共126個問題。 3.統(tǒng)計分析 (1)應用EPidata3.1建立數(shù)據(jù)庫,應用SPssl6.0軟件進行分析描述。 (2)應用構成比來描述致病因素的構成。 (3)利用條件Logistic回歸模型,對各因素進行單因素分析。 (4)將篩選出的因素導入Logistic回歸模型,進行多因素分析。 [結果] 本調(diào)查共獲取有效問卷432份,其中女性不孕患者、女性正常生育能力者各216份。分析結果如下： 1.病因構成比分析：女性不孕的主要病因排序依次為輸卵管類疾病(41.3%)、卵巢類疾病(32.4%)、免疫性不孕類疾病(8.3%)、不明原因類疾病(5.1%)、子宮類疾病(4.6%)、陰道炎癥(4.6%)、內(nèi)分泌疾病(2.3%)、遺傳病(1.4%)。 輸卵管類不孕主要為輸卵管梗阻性不孕,其主要致病因素為：性傳播性疾病、婦科炎癥(非特異性)、子宮內(nèi)膜異位癥。 卵巢類不孕主要為卵巢排卵障礙性不孕,其主要病因為：多囊卵巢綜合征、卵巢巧克力樣囊腫、婦科炎癥(非特異性)。 2.單因素分析結果：女性不孕病因影響因素中具有顯著性差異的因素如下： 2.1生物學因素中包括：婦科炎癥、月經(jīng)不規(guī)律、人工流產(chǎn)次數(shù)多、異位妊娠史、性交痛、痛經(jīng)、內(nèi)分泌疾病史、肝病、腫瘤、風濕等免疫性疾病史、婦科手術史、甲狀腺疾病史、應用藥物史(安定、激素類藥)、胃腸道疾病史等。 2.2社會因素 2.2.1基本情況因素包括：職業(yè)(農(nóng)民)、文化水平低、年齡大等。 2.2.2婚姻性生活因素包括：性伴侶人數(shù)多、第一次性交年齡過小、外陰陰道清洗頻繁、經(jīng)常經(jīng)期性生活、性生活滿意度低等。 2.2.3生活飲食習慣因素包括：經(jīng)常熬夜、睡前經(jīng)常使用手機、燙發(fā)頻繁、經(jīng)常飲酒、常使用電熱毯、吸煙、飼養(yǎng)寵物、常使用微波爐；經(jīng)常食用甜點煎炸食品、腌制食品、棉籽油等。 2.2.4心理因素包括：與父母關系緊張、夫妻關系不和諧、同事關系不融洽、心理壓力大、無助失望等。 2.3環(huán)境因素包括：同事吸煙多、近期住房裝修,經(jīng)常夜班作業(yè)、經(jīng)常接觸毒物、重金屬、農(nóng)藥等。 3.多因素分析結果：年齡(OR=34.979)、婦科炎癥(OR=2.688)、月經(jīng)不規(guī)律(OR=3.273)、第一次性交年齡小(OR=4.255)、性伴侶個數(shù)多(OR=2.396)、經(jīng)常食用甜點煎炸食品(OR=3.755)、熬夜(OR=2.801)、睡前使用手機(OR=2.814)、接觸毒物/重金屬/農(nóng)藥(OR=1.990)、心理壓力大(OR=3.067)等可能是女性不孕癥的高危因素。 [結論] 1.輸卵管梗阻性疾病及卵巢排卵障礙性疾病可能是導致女性不孕癥的主要疾病。 2.婦科炎癥、子宮內(nèi)膜異位癥、多囊卵巢綜合征等疾病是導致輸卵管梗阻性疾病及卵巢排卵障礙性疾病的主要病因,其間接地成為女性不孕的危險因素。 3.年齡、第一次性交年齡小、性伴侶個數(shù)多、熬夜、心理壓力大、經(jīng)常食用甜點及煎炸食品、睡前使用手機等社會因素可能是導致女性不孕的危險因素。 4.經(jīng)常接觸毒物、重金屬、農(nóng)藥等因素等可能是女性不孕癥的環(huán)境危險因素。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.6

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