中国全科医学 ›› 2026, Vol. 29 ›› Issue (35): 5212-5218.DOI: 10.12114/j.issn.1007-9572.2026.0026

• 论著 • 上一篇    下一篇

肌壁间子宫肌瘤对自然受孕的影响研究

吴春香1,2, 魏敏3, 张志将1,*()   

  1. 1.430071 湖北省武汉市,武汉大学公共卫生学院流行病与卫生统计学系
    2.430062 湖北省武汉市武昌区妇幼保健院
    3.430060 湖北省武汉市,武汉大学人民医院妇产科
  • 收稿日期:2026-02-13 修回日期:2026-04-28 出版日期:2026-12-15 发布日期:2026-10-26
  • 通讯作者: 张志将

  • 作者贡献:

    吴春香负责数据收集与分析、图表制作及论文撰写;魏敏负责研究指导、数据解读;张志将负责研究设计、论文撰写与修改。

  • 基金资助:
    湖北省公共卫生领军人才建设项目(2021ewt073)

Study on the Impact of Intramural Uterine Fibroids on Natural Conception

WU Chunxiang1,2, WEI Min3, ZHANG Zhijiang1,*()   

  1. 1. Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan 430071, China
    2. Wuchang Maternal and Child Health Hospital, Wuhan 430062, China
    3. Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China
  • Received:2026-02-13 Revised:2026-04-28 Published:2026-12-15 Online:2026-10-26
  • Contact: ZHANG Zhijiang

摘要: 背景 肌壁间子宫肌瘤与生育力的关系一直备受关注,但目前关于社区人群中肌壁间子宫肌瘤对自然受孕影响的相关研究鲜有报道。 目的 分析肌壁间子宫肌瘤对自然受孕的影响,并探索年龄、BMI、流产史的效应修饰作用。 方法 以武汉市武昌区2023年参加国家免费孕前优生健康检查项目且近期有妊娠计划的1 687例育龄女性为研究对象。其中190例有肌壁间子宫肌瘤备孕女性为暴露组,1 497例无肌瘤备孕女性为对照组。收集研究对象的基本信息,并由专科医生每3个月对研究对象进行电话随访,询问是否妊娠,随访至1年期满或出现妊娠。采用Kaplan-Meier法绘制各组累积妊娠率曲线,使用多因素Cox回归分析探究肌壁间子宫肌瘤直径、数目与自然受孕之间的关联,同时评估年龄、BMI、流产史与肌瘤特征之间的交互作用。 结果 在1年的随访期内,暴露组妊娠率为56.8%(108/190),对照组妊娠率为63.1%(944/1 497),两组妊娠率比较,差异无统计学意义(χ2=2.777,P=0.096)。多因素Cox回归分析结果显示,肌壁间子宫肌瘤直径>1.5 cm(HR=0.37,95%CI=0.20~0.70)、肌壁间子宫肌瘤数量≥2个(HR=0.41,95%CI=0.22~0.76)是育龄女性自然受孕的危险因素(P<0.05)。肌壁间子宫肌瘤数量与年龄之间存在交互作用(P=0.045),肌壁间子宫肌瘤数量≥2个对年龄≥30岁女性自然受孕有影响(HR=0.26,95%CI=0.11~0.63,P<0.05),而对年龄<30岁女性自然受孕的影响无统计学意义(HR=0.91,95%CI=0.37~2.22,P>0.05)。 结论 肌壁间子宫肌瘤直径>1.5 cm或数量≥2个是影响自然受孕的重要危险因素,且多发性肌壁间子宫肌瘤对年龄≥30岁女性自然受孕的负面影响更为明显。因此,对于高龄备孕女性,应高度重视多发性肌壁间子宫肌瘤的存在,及时转诊至生殖专科进行个体化评估与干预决策。

关键词: 肌壁间子宫肌瘤, 自然受孕, 效应修饰因子, 队列研究

Abstract:

Background

The association between intramural uterine fibroids and fertility has been long attracted attention. However, studies on the effect of intramural uterine fibroids on natural conception in community populations remain scarce.

Objective

To analyze the impact of intramural uterine fibroids on natural conception and to explore the effect-modifying roles of age, BMI, and history of miscarriage.

Methods

The study population consisted of 1 687 fertile women from Wuchang District, Wuhan City, who participated in the National Free Preconception Health Examination Program in 2023 and had a recent pregnancy plan. Among them, 190 women preparing for pregnancy with intramural uterine fibroids were assigned to the exposure group, and 1 497 women without fibroids were assigned to the control group. Basic information was collected from all participants, and specialist physicians conducted telephone follow-up every 3 months to inquire about pregnancy status until 1 year of follow-up was completed or pregnancy occurred. Kaplan-Meier curves were used to plot the cumulative pregnancy rates in each group. Multivariate Cox regression was applied to assess the associations between intramural uterine fibroid diameter, number, and natural conception, and to evaluate interactions among age, BMI, history of miscarriage, and fibroid characteristics.

Results

During the 1-year follow-up period, the pregnancy rate was 56.8% (108/190) in the exposure group and 63.1% (944/1 497) in the control group. The difference in pregnancy rates between the two groups was not statistically significant (χ2=2.777, P=0.096). Multivariate Cox regression analysis showed that an intramural uterine fibroid diameter >1.5 cm (HR=0.37, 95%CI=0.20-0.70) and the presence of ≥2 intramural uterine fibroids (HR=0.41, 95%CI=0.22-0.76) were risk factors for natural conception in women of reproductive age (P<0.05). An interaction was observed between fibroid number and age (P=0.045). The presence of ≥2 intramural uterine fibroids affected natural conception in women aged ≥30 years (HR=0.26, 95%CI=0.11-0.63, P<0.05), whereas the effect was not statistically significant in women aged <30 years (HR=0.91, 95%CI=0.37-2.22, P>0.05).

Conclusion

An intramural uterine fibroid diameter >1.5 cm or a fibroid number ≥2 is an important risk factor affecting natural conception, and multiple intramural uterine fibroids have a more pronounced adverse effect on fertility in women aged ≥30 years. Therefore, for older women planning pregnancy, the presence of multiple intramural uterine fibroids should be given high attention, and timely referral to a reproductive specialist is necessary for individualized assessment and intervention planning.

Key words: Intramural uterine fibroids, Spontaneous conception, Effect modifier, Cohort study