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新型宫腔镜评分系统在诊断慢性子宫内膜炎中的应用
作者:张冬香1  马薇薇2 
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
关键词:慢性子宫内膜炎 宫腔镜 评分系统 
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.

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