上海交通大学学报(医学版) ›› 2024, Vol. 44 ›› Issue (6): 746-754.doi: 10.3969/j.issn.1674-8115.2024.06.010
奚慧琴1,2(), 田梅梅1, 谢雷1, 徐于睿1, 黄欣1, 徐颖1, 章雅青2()
收稿日期:
2024-01-12
接受日期:
2024-02-07
出版日期:
2024-06-28
发布日期:
2024-06-28
通讯作者:
章雅青
E-mail:xihuiqin@renji.com;zhangyqf@163.com
作者简介:
奚慧琴(1979—),女,主任护师,硕士生;电子信箱:xihuiqin@renji.com。
XI Huiqin1,2(), TIAN Meimei1, XIE Lei1, XU Yurui1, HUANG Xin1, XU Ying1, ZHANG Yaqing2()
Received:
2024-01-12
Accepted:
2024-02-07
Online:
2024-06-28
Published:
2024-06-28
Contact:
ZHANG Yaqing
E-mail:xihuiqin@renji.com;zhangyqf@163.com
摘要:
目的·采用潜在剖面分析法探索辅助生殖技术(assisted reproductive technology,ART)治疗前不孕(育)症夫妻二元应对水平的潜在剖面,并探讨不同剖面间的差异及相关因素。方法·招募2023年9月至11月在上海交通大学医学院附属仁济医院生殖医学中心接受ART治疗的不孕(育)症初诊夫妇,应用一般资料问卷、生育压力量表(Fertility Problem Inventory,FPI)、二元应对评估工具(Dyadic Coping Inventory,DCI)、生育生活质量量表(Fertility Quality of Life Tool,FertiQoL量表)进行评估。采用潜在剖面分析探索不孕(育)症夫妻治疗前二元应对的剖面类型,比较不同剖面之间的一般特征,及FPI和FertiQoL量表得分;采用多元Logistic回归分析不同二元应对剖面的相关因素。结果·共纳入257对不孕(育)症夫妻,女性平均年龄(30.15±3.07)岁,男性平均年龄(31.82±3.82)岁,平均婚龄(3.75±2.16)年,平均不孕(2.90±1.92)年;男方导致不孕118对、女方导致不孕109对、男女共患不孕(育)症30对;男性DCI平均得分(128.25±19.15)分,女性(129.91±18.32)分。根据二元应对水平,257对夫妻可分为4个潜在剖面:共同积极组(153对,59.5%)、共同消极组(85对,33.1%)、男方积极组(12对,4.7%)及男方消极组(7对,2.7%);不同剖面不孕(育)症夫妻的年龄、FPI得分、FertiQoL量表得分、再婚比例间差异均具有统计学意义(均P<0.05)。多元Logistic回归分析结果显示,以共同积极组为参照,共同消极组的男方年龄更大(OR=1.122,95%CI 1.004~1.254,P=0.036)、男女双方FPI得分更高(男:OR=1.019,95%CI 1.003~1.035,P=0.018;女:OR=1.020,95%CI 1.004~1.036,P=0.015)、男方FertiQoL量表得分更低(OR=0.966,95%CI 0.937~0.996,P=0.029)。结论·接受ART治疗前不孕(育)症夫妻的二元应对水平可分为4个剖面类型;与共同积极应对夫妻相比,男性生育压力大、年龄大、感知的生育生活质量低,以及女性生育压力大均是夫妻共同消极应对的危险因素。
中图分类号:
奚慧琴, 田梅梅, 谢雷, 徐于睿, 黄欣, 徐颖, 章雅青. 不孕(育)症夫妻二元应对异质性研究及相关因素分析[J]. 上海交通大学学报(医学版), 2024, 44(6): 746-754.
XI Huiqin, TIAN Meimei, XIE Lei, XU Yurui, HUANG Xin, XU Ying, ZHANG Yaqing. Heterogeneity and related factors of dyadic coping in infertility couples[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(6): 746-754.
Variable | x±s | P5 | P25 | P50 | P75 | P90 |
---|---|---|---|---|---|---|
Female DCI score/point | 129.91±18.32 | 100.90 | 118.00 | 131.00 | 142.00 | 152.00 |
Male DCI score/point | 128.25±19.15 | 99.90 | 113.50 | 131.00 | 141.00 | 149.20 |
表1 不孕(育)症夫妻DCI得分分布
Tab 1 Summary of statistics of infertility couples' DCI scores
Variable | x±s | P5 | P25 | P50 | P75 | P90 |
---|---|---|---|---|---|---|
Female DCI score/point | 129.91±18.32 | 100.90 | 118.00 | 131.00 | 142.00 | 152.00 |
Male DCI score/point | 128.25±19.15 | 99.90 | 113.50 | 131.00 | 141.00 | 149.20 |
Number of profiles | AIC | BIC | aBIC | Entropy | P value | Profile probability | |
---|---|---|---|---|---|---|---|
LMRT | BLRT | ||||||
1 | 4 476.72 | 4 490.92 | 4 478.24 | 1 | ‒ | ‒ | ‒ |
2 | 4 429.10 | 5 553.95 | 4 431.75 | 0.571 2 | 0.000 | 0.010 | 0.420/0.580 |
3 | 4 429.78 | 4 465.28 | 4 433.57 | 0.488 3 | 0.000 | 0.158 | 0.534/0.228/0.238 |
4 | 4 413.71 | 4 459.85 | 4 418.64 | 0.815 1 | 0.000 | 0.010 | 0.595/0.331/0.047/0.027 |
5 | 4 419.51 | 4 476.29 | 4 425.57 | 0.605 7 | 0.000 | 0.020 | 0.368/0.323/0.053/0.036/0.219 |
表2 不孕(育)症夫妻二元应对水平潜在剖面模型拟合指数
Tab 2 Fitting indicators of latent profile models of infertility couples' dyadic coping
Number of profiles | AIC | BIC | aBIC | Entropy | P value | Profile probability | |
---|---|---|---|---|---|---|---|
LMRT | BLRT | ||||||
1 | 4 476.72 | 4 490.92 | 4 478.24 | 1 | ‒ | ‒ | ‒ |
2 | 4 429.10 | 5 553.95 | 4 431.75 | 0.571 2 | 0.000 | 0.010 | 0.420/0.580 |
3 | 4 429.78 | 4 465.28 | 4 433.57 | 0.488 3 | 0.000 | 0.158 | 0.534/0.228/0.238 |
4 | 4 413.71 | 4 459.85 | 4 418.64 | 0.815 1 | 0.000 | 0.010 | 0.595/0.331/0.047/0.027 |
5 | 4 419.51 | 4 476.29 | 4 425.57 | 0.605 7 | 0.000 | 0.020 | 0.368/0.323/0.053/0.036/0.219 |
Item | Cluster | χ2/F value | P value | |||
---|---|---|---|---|---|---|
Common positive coping group (153 couples) | Common negative coping group (85 couples) | Male positive coping group (12 couples) | Male negative coping group (7 couples) | |||
Female age/year | 29.78±3.13 | 30.82±2.94① | 29.42±2.97 | 31.29±1.89 | 2.722 | 0.045 |
Male age/year | 31.20±3.45 | 32.91±4.07② | 31.58±5.47 | 32.57±2.30 | 3.888 | 0.010 |
Marriage time/year | 3.79±2.16 | 3.93±2.24 | 2.75±1.54 | 2.36±1.11 | 2.072 | 0.104 |
Infertility time/year | 2.92±1.96 | 3.09±1.92 | 1.92±1.31 | 1.57±0.79 | 2.516 | 0.059 |
Female education level/n(%) | 11.544 | 0.073 | ||||
Below university degree | 33 (21.57) | 22 (25.88) | 0 (0) | 1 (14.28) | ||
University degree | 102 (66.67) | 55 (64.71) | 11 (91.67) | 3 (42.86) | ||
Above university degree | 18 (11.76) | 8 (9.41) | 1 (8.33) | 3 (42.86) | ||
Male education level/n(%) | 7.374 | 0.288 | ||||
Below university degree | 37 (24.18) | 21 (24.71) | 2 (16.67) | 1 (14.29) | ||
University degree | 97 (63.40) | 59 (69.41) | 10 (83.33) | 4 (57.14) | ||
Above university degree | 19 (12.42) | 5 (5.88) | 0 (0) | 2 (28.57) | ||
Female income/n(%) | 8.855 | 0.182 | ||||
<5 000 yuan/month | 50 (32.68) | 31 (36.47) | 1 (8.33) | 2 (28.57) | ||
5 000‒10 000 yuan/month | 66 (43.14) | 36 (42.35) | 6 (50.00) | 1 (14.29) | ||
>10 000 yuan/month | 37 (24.18) | 18 (21.18) | 5 (41.67) | 4 (57.14) | ||
Male income/n(%) | 5.962 | 0.427 | ||||
<5 000 yuan/month | 16 (10.46) | 12 (14.12) | 0 (0) | 0 (0) | ||
5 000‒10 000 yuan/month | 73 (47.71) | 34 (40.00) | 7 (58.33) | 2 (28.57) | ||
>10 000 yuan/month | 64 (41.83) | 39 (45.88) | 5 (41.67) | 5 (71.43) | ||
Female with jobs/n(%) | 130 (84.97) | 75 (88.24) | 11 (91.67) | 6 (85.71) | 0.796 | 0.850 |
Male with jobs/n(%) | 149 (97.39) | 84 (98.82) | 11 (91.67) | 7 (100.00) | 2.614 | 0.455 |
Remarriage/couple(%) | 1 (0.65) | 3 (3.53) | 1 (8.33) | 1 (14.29) | 8.707 | 0.033 |
Cause of infertility/n(%) | 6.935 | 0.327 | ||||
Male | 72 (47.06) | 36 (42.35) | 6 (50.00) | 4 (57.14) | ||
Female | 66 (43.14) | 39 (45.88) | 3 (25.00) | 1 (14.29) | ||
Both spouses | 15 (9.80) | 10 (11.76) | 3 (25.00) | 2 (28.57) | ||
Treatment/n(%) | 3.922 | 0.687 | ||||
IVF | 84 (54.90) | 49 (57.65) | 8 (66.67) | 2 (28.57) | ||
ICSI | 45 (29.41) | 26 (30.59) | 2 (16.67) | 3 (42.86) | ||
PGT | 24 (15.69) | 10 (11.76) | 2 (16.67) | 2 (28.57) |
表3 不同二元应对剖面不孕(育)症夫妻一般资料分析(257对)
Tab 3 General information analysis in different dyadic coping clusters of infertility couples (257 couples)
Item | Cluster | χ2/F value | P value | |||
---|---|---|---|---|---|---|
Common positive coping group (153 couples) | Common negative coping group (85 couples) | Male positive coping group (12 couples) | Male negative coping group (7 couples) | |||
Female age/year | 29.78±3.13 | 30.82±2.94① | 29.42±2.97 | 31.29±1.89 | 2.722 | 0.045 |
Male age/year | 31.20±3.45 | 32.91±4.07② | 31.58±5.47 | 32.57±2.30 | 3.888 | 0.010 |
Marriage time/year | 3.79±2.16 | 3.93±2.24 | 2.75±1.54 | 2.36±1.11 | 2.072 | 0.104 |
Infertility time/year | 2.92±1.96 | 3.09±1.92 | 1.92±1.31 | 1.57±0.79 | 2.516 | 0.059 |
Female education level/n(%) | 11.544 | 0.073 | ||||
Below university degree | 33 (21.57) | 22 (25.88) | 0 (0) | 1 (14.28) | ||
University degree | 102 (66.67) | 55 (64.71) | 11 (91.67) | 3 (42.86) | ||
Above university degree | 18 (11.76) | 8 (9.41) | 1 (8.33) | 3 (42.86) | ||
Male education level/n(%) | 7.374 | 0.288 | ||||
Below university degree | 37 (24.18) | 21 (24.71) | 2 (16.67) | 1 (14.29) | ||
University degree | 97 (63.40) | 59 (69.41) | 10 (83.33) | 4 (57.14) | ||
Above university degree | 19 (12.42) | 5 (5.88) | 0 (0) | 2 (28.57) | ||
Female income/n(%) | 8.855 | 0.182 | ||||
<5 000 yuan/month | 50 (32.68) | 31 (36.47) | 1 (8.33) | 2 (28.57) | ||
5 000‒10 000 yuan/month | 66 (43.14) | 36 (42.35) | 6 (50.00) | 1 (14.29) | ||
>10 000 yuan/month | 37 (24.18) | 18 (21.18) | 5 (41.67) | 4 (57.14) | ||
Male income/n(%) | 5.962 | 0.427 | ||||
<5 000 yuan/month | 16 (10.46) | 12 (14.12) | 0 (0) | 0 (0) | ||
5 000‒10 000 yuan/month | 73 (47.71) | 34 (40.00) | 7 (58.33) | 2 (28.57) | ||
>10 000 yuan/month | 64 (41.83) | 39 (45.88) | 5 (41.67) | 5 (71.43) | ||
Female with jobs/n(%) | 130 (84.97) | 75 (88.24) | 11 (91.67) | 6 (85.71) | 0.796 | 0.850 |
Male with jobs/n(%) | 149 (97.39) | 84 (98.82) | 11 (91.67) | 7 (100.00) | 2.614 | 0.455 |
Remarriage/couple(%) | 1 (0.65) | 3 (3.53) | 1 (8.33) | 1 (14.29) | 8.707 | 0.033 |
Cause of infertility/n(%) | 6.935 | 0.327 | ||||
Male | 72 (47.06) | 36 (42.35) | 6 (50.00) | 4 (57.14) | ||
Female | 66 (43.14) | 39 (45.88) | 3 (25.00) | 1 (14.29) | ||
Both spouses | 15 (9.80) | 10 (11.76) | 3 (25.00) | 2 (28.57) | ||
Treatment/n(%) | 3.922 | 0.687 | ||||
IVF | 84 (54.90) | 49 (57.65) | 8 (66.67) | 2 (28.57) | ||
ICSI | 45 (29.41) | 26 (30.59) | 2 (16.67) | 3 (42.86) | ||
PGT | 24 (15.69) | 10 (11.76) | 2 (16.67) | 2 (28.57) |
Scale | Cluster | F value | P value | |||
---|---|---|---|---|---|---|
Common positive coping group (153 couples) | Common negative coping group (85 couples) | Male positive coping group (12 couples) | Male negative coping group (7 couples) | |||
FPI score/point | ||||||
Female | 120.67±23.55 | 137.93±23.19① | 111.00±20.81② | 124.14±36.31 | 11.378 | 0.000 |
Male | 129.77±23.60 | 151.06±27.83① | 116.08±32.97② | 145.86±12.76③ | 15.842 | 0.000 |
FertiQoL score/point | ||||||
Female | 74.13±12.46 | 67.37±12.58① | 82.55±6.71②④ | 72.47±11.44 | 8.491 | 0.000 |
Male | 76.58±12.37 | 66.59±12.63① | 89.32±6.66①② | 63.10±11.92⑤⑥ | 20.568 | 0.000 |
表4 不同二元应对剖面不孕(育)症夫妻FPI及FertiQol量表得分分析(257对)
Tab 4 Analysis of FPI and FertiQol scores in different dyadic coping clusters of infertility couples (257 couples)
Scale | Cluster | F value | P value | |||
---|---|---|---|---|---|---|
Common positive coping group (153 couples) | Common negative coping group (85 couples) | Male positive coping group (12 couples) | Male negative coping group (7 couples) | |||
FPI score/point | ||||||
Female | 120.67±23.55 | 137.93±23.19① | 111.00±20.81② | 124.14±36.31 | 11.378 | 0.000 |
Male | 129.77±23.60 | 151.06±27.83① | 116.08±32.97② | 145.86±12.76③ | 15.842 | 0.000 |
FertiQoL score/point | ||||||
Female | 74.13±12.46 | 67.37±12.58① | 82.55±6.71②④ | 72.47±11.44 | 8.491 | 0.000 |
Male | 76.58±12.37 | 66.59±12.63① | 89.32±6.66①② | 63.10±11.92⑤⑥ | 20.568 | 0.000 |
Profile | Variable | β | SE | P value | OR(95%CI) |
---|---|---|---|---|---|
Common negative coping group | Constant | 3.545 | |||
Female age | 0.070 | ||||
Female FertiQoL score | 0.015 | ||||
Female FPI score | 0.008 | ||||
Male age | 0.057 | ||||
Male FertiQoL score | 0.016 | ||||
Male FPI score | 0.008 | ||||
Not remarried | 1.365 | ||||
Male positive coping group | Constant | ||||
Female age | |||||
Female FertiQoL score | |||||
Female FPI score | |||||
Male age | |||||
Male FertiQoL score | |||||
Male FPI score | |||||
Not remarried | |||||
Male negative coping group | Constant | 2.420 | 8.576 | 0.778 | |
Female age | 0.151 | 0.216 | 0.484 | 1.163 (0.761 | |
Female FertiQoL score | 0.020 | 0.039 | 0.612 | 1.019 (0.945 | |
Female FPI score | 0.022 | 0.693 | 0.998 (0.949 | ||
Male age | 0.015 | 0.168 | 0.931 | 1.042 (0.730 | |
Male FertiQoL score | 0.044 | 0.017 | 0.901 (0.827 | ||
Male FPI score | 0.020 | 0.906 | 0.998 (0.959 | ||
Not remarried | 1.749 | 0.044 | 0.030 (0.001 |
表5 不孕(育)症夫妻二元应对剖面相关因素的多元Logistic回归分析
Tab 5 Multinomial Logistic regression analysis of factors related to the binary coping profiles of infertile couples
Profile | Variable | β | SE | P value | OR(95%CI) |
---|---|---|---|---|---|
Common negative coping group | Constant | 3.545 | |||
Female age | 0.070 | ||||
Female FertiQoL score | 0.015 | ||||
Female FPI score | 0.008 | ||||
Male age | 0.057 | ||||
Male FertiQoL score | 0.016 | ||||
Male FPI score | 0.008 | ||||
Not remarried | 1.365 | ||||
Male positive coping group | Constant | ||||
Female age | |||||
Female FertiQoL score | |||||
Female FPI score | |||||
Male age | |||||
Male FertiQoL score | |||||
Male FPI score | |||||
Not remarried | |||||
Male negative coping group | Constant | 2.420 | 8.576 | 0.778 | |
Female age | 0.151 | 0.216 | 0.484 | 1.163 (0.761 | |
Female FertiQoL score | 0.020 | 0.039 | 0.612 | 1.019 (0.945 | |
Female FPI score | 0.022 | 0.693 | 0.998 (0.949 | ||
Male age | 0.015 | 0.168 | 0.931 | 1.042 (0.730 | |
Male FertiQoL score | 0.044 | 0.017 | 0.901 (0.827 | ||
Male FPI score | 0.020 | 0.906 | 0.998 (0.959 | ||
Not remarried | 1.749 | 0.044 | 0.030 (0.001 |
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