子宫内膜异位症早期综合评分临床诊断模型研究  

Study of Clinical Diagnostic Model of Early Comprehensive Score of EMs

作　　者：周赞华[1] 董海娜[1] 卫哲 施倩[2] 周丽红[3] 毛雪梅[3] ZHOU Zan-hua DONG Hai-na WEI Zhe SHI Qian ZHOU Li-hong MAO Xue-mei(College of Medicine and Health, Lishui University, Lishui 323000, China Department of Pathology, the Central Hospital of Lishui City, Lishui 323000, China Department of Gynaecology and Obstetrics, the Central Hospital of Lishui City, Lishui 323000, China)

机构地区：[1]丽水学院医学与健康学院,浙江省丽水市323000 [2]浙江省丽水市中心医院病理科,323000 [3]浙江省丽水市中心医院妇产科,323000

出　　处：《中国全科医学》2017年第21期2665-2671,共7页Chinese General Practice

基　　金：浙江省科技厅公益技术应用计划项目(2014C33249);浙江省自然科学基金资助项目(LY15H040009)

摘　　要：背景子宫内膜异位症(EMs)严重影响患者生活质量,探讨EMs早期安全有效的诊断方法,对提高其临床诊断正确率、避免腹腔镜手术有重要意义。目的以EMs患者的痛经、慢性盆腔痛、妇科检查结果、超声检查结果、血清上皮性卵巢癌抗原(CA125)检测结果、子宫内膜组织细胞色素芳香化酶(P450arom)检测结果为变量,构建EMs早期综合评分临床诊断模型,并探讨该模型对EMs的早期诊断价值,以期探寻安全有效﹑经济实用的诊断方法,提高EMs的早期诊断正确率,降低腹腔镜手术的可能性。方法选择2015年1月—2016年10月在丽水市中心医院妇产科住院的符合纳入标准的临床诊断为盆腔EMs的拟行腹腔镜手术患者150例为研究对象。采用单纯随机抽样法将患者分为建模组(100例)和验证组(50例)。收集患者一般资料,包括病史、主要症状、妇科检查结果;记录患者超声检查、血清CA125检测、子宫内膜组织P450arom检测结果。以腹腔镜手术结合组织病理学诊断结果为金标准。利用多因素Logistic回归分析构建EMs早期综合评分临床诊断模型,绘制其诊断EMs的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)、灵敏度、特异度。结果建模组中,金标准诊断阳性78例,阴性22例;验证组中,金标准诊断阳性24例,阴性26例。建模组中,超声检查阳性率为91.0%(91/100),血清CA125检测阳性率为64.0%(64/100),子宫内膜组织P450arom检测阳性率为76.0%(76/100)。采用多因素逐步Logistic回归分析构建EMs早期综合评分临床诊断模型:y=-10.77+4.96×痛经+1.88×慢性盆腔痛+3.02×妇科检查体征阳性+3.68×超声检查阳性+1.41×血清CA125检测阳性+4.56×子宫内膜组织P450arom检测阳性。血清CA125检测诊断建模组EMs的AUC为0.735,95%CI(0.614,0.857),灵敏度为74.4%,特异度为72.7%;子宫内膜组织P450arom检测诊断建模组EMs的AUC为0.841,95%CI(0.732,0.951),灵敏度为91.0%,特异度为77.3%;Background Endometriosis（ EMs） seriously affects the quality of life of patients. It is important to explore a safe and effective early diagnostic method of EMs for improving the accuracy of clinical diagnosis and avoiding laparoscopic surgery. Objective To establish a clinical diagnostic model of early comprehensive score of EMs based on dysmenorrhea,chronic pelvic pain,results of gynaecological examination,ultrasound results,serum epithelial ovarian cancer antigen（ CA125） test results, and aromatase cytochrome（ P450 arom） test results of endometrial tissue of EMs patients as variables. And to investigate the early diagnostic value of the model for EMs in order to explore a safe,effective,economical and practical diagnostic method for improving the accuracy for early diagnosis of EMs and reducing the possibility of laparoscopic operation. Methods A total of 150 patients with clinical diagnosis of pelvic EMs met the inclusion criteria were selected as study subjects,who were on the waiting list to undergo the laparoscopic operation in the Department of Gynecology and Obstetrics of the Central Hospital of Lishui from January 2015 to October 2016. These patients were divided into modeling group（ n = 100） and validation group（ n = 50） by simple random sampling. General data of patients were collected, including medical history,critical symptoms,gynaecological examination results. The results of ultrasound examination,serum CA125 test,and P450 arom test of endometrium tissue were recorded. Laparoscopic surgery combined with histopathological findings was the gold diagnostic standard for EMs. Clinical diagnostic model of early comprehensive score of EMs was established by using multivariate stepwise Logistic regression analysis. The receiver operating characteristic（ ROC） curve of clinical diagnostic model of early comprehensive score of EMs for diagnosing EMs was drawn. The area under the ROC curve（ AUC）, sensitivity and specificity were calculated. Results There were 78 positive cases dia

关 键 词：子宫内膜异位症 早期诊断 模型 

分 类 号：R711.71[医药卫生—妇产科学]