多囊卵巢综合征合并不孕患者病耻感现状及影响因素研究

doi:10.12280/gjszjk.20230452

摘要/Abstract

摘要：

目的：调查育龄期多囊卵巢综合征（polycystic ovary syndrome，PCOS）合并不孕患者病耻感现状，并分析其影响因素。方法：采用方便抽样的方法，于2022年1月—2023年3月应用一般资料调查问卷、女性不孕症患者病耻感量表（Infertility Stigma Scale，ISS）、生育压力量表（Fertility Problem Inventory，FPI）对北京大学第三医院生殖中心门诊治疗的PCOS合并不孕患者进行调查。结果：本次共发放问卷269份，有效问卷251份，有效率为93.3%。PCOS合并不孕患者的ISS总分为（61.49±23.25）分，FPI总分为（148.32±31.02）分；ISS总分与FPI总分呈强正相关（r=0.719，P<0.001）。分层回归显示，生育压力是PCOS合并不孕患者病耻感的影响因素，生育压力可独立解释病耻感43.5%的变异。结论：PCOS合并不孕患者病耻感呈中度水平，医护人员应重点关注生育压力大的患者，并根据影响因素制定干预措施，降低患者的病耻感水平。

关键词: 多囊卵巢综合征, 不育, 女（雌）性, 影响因素分析, 病耻感, 心理压力

Abstract:

Objective: To investigate the status of stigma and influencing factors in infertile patients with polycystic ovary syndrome (PCOS). Methods: Using the convenience sampling method, infertile patients with PCOS diagnosed and treated in the Reproductive Medicine Center of Peking University Third Hospital were selected from January 2022 to March 2023. A cross-sectional study was conducted using the general information questionnaire, Infertility Stigma Scale (ISS) and Fertility Problem Inventory (FPI). Results: A total of 269 questionnaires were distributed on this occasion, in which 251 were deemed valid, resulting in an effectiveness rate of 93.3%. The total scores of ISS and FPI in infertility patients with PCOS were (61.49±23.25) and (148.32±31.02) respectively, with a positive correlation between ISS and FPI (r=0.719, P<0.001). Hierarchical multiple regression analysis showed that fertility stress was the influencing factor of stigma in infertile patients with PCOS, which explained 43.5% of the total variation. Conclusions: Stigma in infertile patients with PCOS is at the medium level. Clinical medical staff can focus on and identify patients with high fertility stress. Interventions should be developed according to the influencing factors to reduce the level of stigma.

Key words: Polycystic ovary syndrome, Infertility, female, Root cause analysis, Stigma, Psychological stress

罗丽燕, 金叶, 史莉, 韩梅, 于然, 宋东红. 多囊卵巢综合征合并不孕患者病耻感现状及影响因素研究[J]. 国际生殖健康/计划生育杂志, 2024, 43(1): 6-10.

LUO Li-yan, JIN Ye, SHI Li, HAN Mei, YU Ran, SONG Dong-hong. Stigma and Influencing Factors in Infertile Patients with Polycystic Ovary Syndrome[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(1): 6-10.

图/表 4

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量表	项目	条目数	维度评分（分）	各条目平均分（分）
ISS	社会退缩	5	15.73±6.34	3.15±1.27
	自我贬损	7	17.92±8.29	2.56±1.18
	周围人群羞辱	9	19.30±10.04	2.15±1.12
	家庭成员羞辱	6	12.63±6.31	2.11±1.05
FPI	父母角色需求	10	40.29±9.16	4.03±0.92
	无子女压力	8	29.72±7.21	3.72±0.90
	社会压力	10	29.00±8.52	2.90±0.85
	性压力	8	21.93±7.68	2.74±0.96
	夫妻关系	10	27.38±7.84	2.74±0.78

量表	项目	条目数	维度评分（分）	各条目平均分（分）
ISS	社会退缩	5	15.73±6.34	3.15±1.27
	自我贬损	7	17.92±8.29	2.56±1.18
	周围人群羞辱	9	19.30±10.04	2.15±1.12
	家庭成员羞辱	6	12.63±6.31	2.11±1.05
FPI	父母角色需求	10	40.29±9.16	4.03±0.92
	无子女压力	8	29.72±7.21	3.72±0.90
	社会压力	10	29.00±8.52	2.90±0.85
	性压力	8	21.93±7.68	2.74±0.96
	夫妻关系	10	27.38±7.84	2.74±0.78

指标	n	ISS总分（分）	t或F	P	指标	n	ISS总分（分）	t或F	P
年龄（岁）					治疗时间（个月）
20~27	53	63.73±22.29	0.555	0.575	<6	128	58.34±22.32	3.138	0.045
28~35	177	60.49±22.77			6~12	15	58.20±17.68
36~45	21	64.24±29.55			>12	108	65.69±24.49
文化程度					BMI（kg/m²）
高中及以下	54	66.46±21.54	3.174	0.044	<18.5	10	52.40±20.30	7.247	0.001
中专、大专	85	63.47±26.02			18.5~23.9	85	54.78±22.39
本科及以上	112	57.59±21.29			≥24.0	156	65.73±22.99
职业状态					腰臀比
在职	208	60.29±23.58	-1.809	0.072	<0.85	191	59.84±24.05	-2.105	0.045
无业	43	67.30±20.91			≥0.85	60	66.73±19.77
居住地					痤疮
农村	83	66.35±22.55	2.348	0.020	是	38	64.84±18.17	-0.965	0.336
城市	168	59.09±23.28			否	213	60.89±24.03
家庭月收入（元）					多毛
<5 000	60	67.12±23.73	3.268	0.040	是	22	63.00±21.14	-0.318	0.751
5 000~10 000	92	62.07±23.08			否	229	61.35±23.48
>10 000	99	57.55±22.59			黑棘皮症
婚姻时长（年）					有	29	69.93±21.83	-2.093	0.037
<2	53	59.30±23.98	2.640	0.073	无	222	60.39±23.25
2~5	110	58.90±20.90			流产史
>5	88	66.05±25.10			有	53	59.79±23.88	-0.598	0.551
不孕时间（年）					无	198	61.94±23.12
<2	95	58.96±22.80	3.840	0.023	月经是否规律
2~5	97	59.57±21.56			是	29	59.03±24.91	-0.604	0.546
>5	59	68.73±25.47			否	222	61.81±23.07

指标	n	ISS总分（分）	t或F	P	指标	n	ISS总分（分）	t或F	P
年龄（岁）					治疗时间（个月）
20~27	53	63.73±22.29	0.555	0.575	<6	128	58.34±22.32	3.138	0.045
28~35	177	60.49±22.77			6~12	15	58.20±17.68
36~45	21	64.24±29.55			>12	108	65.69±24.49
文化程度					BMI（kg/m²）
高中及以下	54	66.46±21.54	3.174	0.044	<18.5	10	52.40±20.30	7.247	0.001
中专、大专	85	63.47±26.02			18.5~23.9	85	54.78±22.39
本科及以上	112	57.59±21.29			≥24.0	156	65.73±22.99
职业状态					腰臀比
在职	208	60.29±23.58	-1.809	0.072	<0.85	191	59.84±24.05	-2.105	0.045
无业	43	67.30±20.91			≥0.85	60	66.73±19.77
居住地					痤疮
农村	83	66.35±22.55	2.348	0.020	是	38	64.84±18.17	-0.965	0.336
城市	168	59.09±23.28			否	213	60.89±24.03
家庭月收入（元）					多毛
<5 000	60	67.12±23.73	3.268	0.040	是	22	63.00±21.14	-0.318	0.751
5 000~10 000	92	62.07±23.08			否	229	61.35±23.48
>10 000	99	57.55±22.59			黑棘皮症
婚姻时长（年）					有	29	69.93±21.83	-2.093	0.037
<2	53	59.30±23.98	2.640	0.073	无	222	60.39±23.25
2~5	110	58.90±20.90			流产史
>5	88	66.05±25.10			有	53	59.79±23.88	-0.598	0.551
不孕时间（年）					无	198	61.94±23.12
<2	95	58.96±22.80	3.840	0.023	月经是否规律
2~5	97	59.57±21.56			是	29	59.03±24.91	-0.604	0.546
>5	59	68.73±25.47			否	222	61.81±23.07

变量	具体赋值
文化程度	高中及以下=1，中专、大专=2，本科及以上=3
居住地	农村=1，城市=2
家庭月收入（元）	<5 000=1，5 000~10 000=2，>10 000=3
不孕时间（年）	<2=1，2~5=2，>5=3
治疗时间（个月）	<6=1，6~12=2，>12=3
BMI（kg/m²）	<18.5=1，18.5~23.9=2，≥24.0=3
腰臀比	<0.85=1，≥0.85=2
黑棘皮症	有=1，无=2