新型宫腔镜评分系统在诊断慢性子宫内膜炎中的应用-现代医学

新型宫腔镜评分系统在诊断慢性子宫内膜炎中的应用

单位：1. 南通市妇幼保健院妇科, 江苏南通 226000;
2. 南通市妇幼保健院助孕中心, 江苏南通 226000

分类号：R711.74

出版年·卷·期（页码）：2022·50·第五期（613-618）

摘要：

目的：探索一种新型宫腔镜形态学评分系统在诊断慢性子宫内膜炎（CE）中的应用价值。方法：回顾性总结2018年9月至2020年9月因不孕不育或反复流产入我院的育龄期女性患者共172例，经宫腔镜组织活检病理确诊CE患者92例和无CE患者80例。比较两组患者的一般临床资料、超声检查以及宫腔镜表现，采用多因素Logistic回归分析筛选主要危险因素，根据权重赋值建立定量宫颈镜评分系统，最后采用受试者工作特征曲线（ROC）分析评估诊断效能并获得最佳临界值。结果：两组患者的一般临床资料比较无明显差异（P>0.05），但CE组宫腔镜下子宫内膜弥漫性充血、局灶性充血、出血点、内膜血管扩张、微孔和内膜息肉发生率明显高于无CE组（P<0.05）。Logistic回归分析显示，子宫内膜弥漫性充血、局灶性充血、出血点、内膜血管扩张、微孔和内膜息肉是CE发生的主要危险因素（P<0.05）。根据筛选主要危险因素权重进行赋值，总评分12分。ROC分析显示，宫腔镜评分系统诊断CE的准确性为0.829，临界值为4.8分，即大于5分可诊断CE。根据该评分系统诊断CE共108例和无CE共64例，与病理结果比较，宫腔镜诊断的准确率为83.7%（86+58/172），敏感性为93.5%（86/92），特异性为72.5%（58/80），阳性预测值为79.6%（86/108），阴性预测值为90.6%（58/64）。结论：宫腔镜定量评分系统对鉴别CE有较好的诊断效能。

Objective:To explore the application value of a new hysteroscopic morphological scoring system in the diagnosis of chronic endometritis(CE). Methods:From September 2018 to September 2020, a total of 172 women during childbearing age treated in our hospital due to infertility or repeated abortion were selected for retrospective study, of whom 92 patients with CE and 80 patients without CE were confirmed by hysteroscopic biopsy. The general clinical data, ultrasound examination and hysteroscopic manifestations between the two groups were compared. Multivariate logistic regression analysis was used to screen the main risk factors. According to the weight assignment, the quantitative cervical endoscopy scoring system was established. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency and finally the optimal cut-off value was obtained. Results:There were no differences of the general clinical data between the two groups(P>0.05), but the incidence of endometrial diffuse hyperemia, focal endometrial hyperemia, hemorrhagic spots, dilated endometrial vessels, micropore and endometrial polyp in CE group was significantly higher than that in non-CE group(P<0.05). Logistic regression analysis showed that endometrial diffuse hyperemia, focal endometrial hyperemia, hemorrhagic spots, dilated endometrial vessels, micropore and endometrial polyp were the main risk factors for CE(P<0.05).The total score was 12 points, ROC analysis showed that the accuracy of hysteroscopic scoring system for CE diagnosis was 0.829, and the cut-off value was 4.8. When the the value was more than 5, it could be diagnosed as CE. There were 108 patients with CE and 64 patients without CE diagnosed by the scoring system. Compared with pathology, the accuracy rate of hysteroscopy was 83.7%(86+58/172) with the sensitivity of 93.5%(86/92) and specificity of 72.5%(58/80). The positive predictive rate and the negative predictive rate were 79.6%(86/108) and 90.6%(58/64) respectively. Conclusion:The hysteroscopic quantitative scoring system has good diagnostic efficacy for the differential diagnosis of CE.

参考文献：

[1] PARK H J,KIM Y S,YOON T K,et al.Chronic endometritis and infertility[J].Clin Exp Reprod Med,2016,43(4):185-192.
[2] HAGGERTY C L,TOTTEN P A,TANG G,et al. Identification of novel microbes associated with pelvic inflammatory disease and infertility[J].Sex Transm Infect,2016,92(10):441-446.
[3] 欧思娴,陈秋月.宫腔镜联合CD138在不孕合并慢性子宫内膜炎诊断中的应用分析[J].中国实用医药,2020,15(27):66-68.
[4] CHEN Y Q,FANG R L,LUO Y N,et al. Analysis of the diagnostic value of CD138 for chronic endometritis,the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy:a cohort study[J]. BMC Womens Health,2016,16(4):60.
[5] 徐敏,王春桃,许丹,等. 宫腔镜电切术治疗子宫内膜息肉的临床疗效分析[J]. 东南大学学报(医学版),2017,36(5):742-745.
[6] IANIERI M M,STANISCIA T,PONTRELLI G,et al. A new hysteroscopic risk scoring system for diagnosing endometrial hyperplasia and adenocarcinoma[J].J Minim Invasive Gynecol,2016,23(7):712-718.
[7] CICINELLI E,VITAGLIANO A,KUMAR A,et al. Unified diagnostic criteria for chronic endometritis at fluid hysteroscopy:proposal and reliability evaluation through an international randomized-controlled observer study[J].Fertil Steril,2019,112(16):162-173.e2.
[8] 宋冬梅,李天照,夏恩兰.宫腔镜检查诊断慢性子宫内膜炎的临床价值[J].中国妇产科临床杂志,2020,21(2):120-124.
[9] 耿婷,谭宗建,张栩.宫腔镜联合子宫内膜浆细胞检查对再次体外受精-胚胎移植妊娠结局的影响[J].中国实用妇科与产科杂志,2018,34(10):1159-1162.
[10] 吴向晖,黄鹏翀,鲍盈帆.宫腔镜手术联合LNG-IUS治疗子宫内膜增生息肉疗效及对血清炎性因子水平影响[J].河南科技大学学报(医学版),2018,36(1):49-52.
[11] 田海英,徐祥波,王蔼明,等.反复移植失败伴慢性子宫内膜炎不同检测方法比较及高危因素分析[J].中国计划生育学杂志,2017,25(4):263-266.
[12] ZARGAR M,GHAFOURIAN M,NIKBAKHT R,et al. Evaluating chronic endometritis in women with recurrent implantation failure and recurrent pregnancy loss by hysteroscopy and immunohistochemistry[J].J Minim Invasive Gynecol,2020,27(1):116-121.
[13] MORENO I,CICINELLI E,GARCIA-GRAU I,et al. The diagnosis of chronic endometritis in infertile asymptomatic women:a comparative study of histology,microbial cultures,hysteroscopy,and molecular microbiology[J].Am J Obstet Gynecol,2018,218(6):602.e1-602.e16.
[14] ALONSO L,CARUGNO J.Chronic endometritis:three-dimensional ultrasound and hysteroscopy correlation[J].J Minim Invasive Gynecol,2020,27(5):993-994.
[15] SONG D,LI TC,ZHANG Y,et al. Correlation between hysteroscopy findings and chronic endometritis[J]. Fertil Steril,2019,111(4):772-779.
[16] LIU H L,SONG J L,ZHANG F F,et al. A new hysteroscopic scoring system for diagnosing chronic endometritis[J].J Minim Invasive Gynecol,2020,27(5):1127-1132.

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