Page 7 - 南京医科大学自然版

第46卷第5期 南京医科大学学报（自然科学版）
2026年5月 Journal of Nanjing Medical University（Natural Sciences） ·629 ·

·专题研究：妇产科疾病·

HSG影像特征联合临床特征诊断宫腔粘连的效能研究

刘 婷 ，杜子伟 ，徐文健 ，鲁景元 ，李秀玲 2
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南京医科大学附属妇产医院（南京市妇幼保健院）放射介入科，生殖医学中心，江苏 南京 210004
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［摘 要］ 目的：探讨子宫输卵管造影（hysterosalpingography，HSG）影像特征联合临床因素对宫腔粘连（intrauterine adhesions，
IUA）的诊断价值，并评估其在不同分型中的鉴别效能。方法：回顾性分析2019年1月—2024年10月在南京医科大学附属妇产
医院放射介入科接受HSG检查疑似IUA且完成宫腔镜检查患者的资料。其中HSG疑似IUA患者282例（含164例术前三维超
声数据）。应用单因素分析HSG影像特征（如充盈缺损数量及位置、输卵管阻塞、宫腔形态等）及临床特征（宫腔操作史、流产
次数、月经量减少等），将具有统计学意义（P < 0.05）的变量纳入多因素有序Logistic回归分析，筛选独立预测因子，绘制受试者
工作特征（receiver operating characteristic，ROC）曲线，分析HSG影像特征联合临床因素对IUA诊断及分型的价值，并与三维超
声进行对比。结果：宫腔镜确诊 IUA 251 例（89.0%），并基于美国生育协会（American Fertility Society，AFS）分型标准分为无
IUA（n=31），轻度IUA（n=64），中度IUA（n=129），重度IUA（n=58）。分别筛选出临床特征包括人流等，以及影像学特征包括宫腔充
盈缺损等预测因子。诊断IUA的ROC曲线下面积（area under the curve，AUC）为0.920，灵敏度为87.3%，特异度为80.7%；诊断轻
度及重度IUA的AUC分别为0.704和0.786，灵敏度分别为46.9%和77.6%，特异度分别为87.6%和65.2%。三维超声诊断IUA的灵
敏度和特异度分别为81.4%和68.4%。结论：HSG影像特征联合临床因素等多参数指标在宫腔粘连的诊断中具有较高的敏感性和
特异性，尤其在鉴别轻度和重度IUA方面具有较好的效能，HSG可作为无创筛查工具，为临床分层管理提供了重要依据。
［关键词］ 子宫输卵管造影术；宫腔粘连综合征；宫腔镜检查；三维超声；多因素回归分析
［中图分类号］ R711.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2026）05⁃629⁃08
doi：10.7655/NYDXBNSN250754

Diagnostic efficiency of HSG imaging features and clinical characteristics in diagnosing
intrauterine adhesions

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LIU Ting ，DU Ziwei ，XU Wenjian ，LU Jingyuan ，LI Xiuling 2
1 Department of Interventional Radiology，Reproductive Medicine Center，Women’s Hospital of Nanjing Medical
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University，Nanjing Women and Children’s Healthcare Hospital，Nanjing 210004，China
［Abstract］ Objective：To explore the diagnostic value of the imaging features of hysterosalpingography（HSG）combined with
clinical factors for intrauterine adhesions（IUA），and to evaluate its diagnostic performance in different types of IUA. Methods：A
retrospective analysis was conducted on the clinical data of patients with suspected IUA who underwent diagnostic HSG at the
Department of Intervention Radiology，Women’s Hospital of Nanjing Medical University，between January 2019 and October 2024，
and subsequently completed hysteroscopy. This cohort included 282 patients suspected of IUA（including 164 with preoperative three⁃
dimensional ultrasound data）. Univariate analysis was conducted to evaluate HSG imaging features，including the number and location
of filling defects，tubal occlusion，and uterine cavity morphology，as well as clinical characteristics such as history of intrauterine
procedures，abortion count，and menstrual flow reduction，etc. Variables demonstrating statistical significance（P < 0.05）were
subsequently included in multivariate ordinal logistic regression analysis to identify independent predictors. Receiver operating
characteristic（ROC）curve analysis was performed to evaluate the diagnostic and classification value of combined HSG imaging
features and clinical factors for IUA. This value was further compared with that of three⁃dimensional ultrasound. Results：Hysteroscopy
confirmed IUA in 251 cases（89.0%），who were further categorized according to the American Fertility Society（AFS）classification

［基金项目］ 江苏省妇幼保健协会科研立项（FYX202010）；南京市卫生科技发展专项基金（YKK22152）
通信作者（Corresponding author），E⁃mail：mexuwenjian@163.com（ORCID：0009⁃0003⁃1814⁃3747）
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