不孕患者慢性子宫内膜炎宫腔镜评分系统的构建及验证  

Establishment and verification of hysteroscopic scoring system for chronic endometritis in infertile patients

作　　者：吴小华 牛淑芳 赵婷婷[1] WU Xiaohua;NIU Shufang;ZHAO Tingting(Reproductive Medicine Center,Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University,Shijiazhuang 050035,China)

机构地区：[1]河北医科大学附属石家庄市妇产医院生殖医学中心,河北石家庄050035

出　　处：《浙江大学学报（医学版）》2023年第1期46-53,共8页Journal of Zhejiang University(Medical Sciences)

基　　金：河北省重点研发计划(213777102D)。

摘　　要：目的:探索不孕患者中慢性子宫内膜炎(CE)的临床病理和宫腔镜下高危特征,建立宫腔镜诊断CE的评分系统并评估其价值。方法:对2019年10月1日至12月31日在河北医科大学附属石家庄市妇产医院生殖医学中心行宫腔镜检查和内膜活检的238例不孕患者进行病例对照研究,根据CD138免疫组织化学染色结果分为CE组(73例)和非CE组(165例),使用单因素和二元logistic回归分析筛选CE的独立危险因素,建立宫腔镜评分系统,绘制列线图,分别采用受试者操作特征(ROC)曲线、校准曲线对评分系统进行评价,采用Bootstrap法重抽样进行内部验证。结果:单因素及二元logistic回归分析结果显示,充血面积2级及以上、微小息肉、子宫内膜息肉样增生、异位妊娠史是CE的独立危险因素(均P<0.05)。基于上述因素构建的宫腔镜评分系统诊断CE的ROC曲线下面积为0.801(95%CI:0.742~0.861),敏感度为74.0%,特异度为73.9%,表明该系统预测能力中等;校准曲线显示该评分系统的预测值和实际值具有较高的一致性。在内部验证中,C-index指数为0.7811,校准曲线中验证组的预测值和实际值基本一致,表明该评分系统具有较好的稳定性。结论:由充血面积、微小息肉、子宫内膜息肉样增生、异位妊娠史构成的宫腔镜评分系统能有效、简便、直观地预测不孕患者发生CE,有助于完善宫腔镜CE诊断标准,有效弥补组织学诊断不足。Objective:To establish and verify a hysteroscopic scoring system for the diagnosis of chronic endometritis(CE) in infertile patients.Method:A total of 238infertile patients who underwent hysteroscopy and endometrial biopsy in the Reproductive Medicine Center,Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University from October 1 to December 31,2019 were enrolled in the study.According to the results of CD138 immunohistochemistry,the patients were divided into CE group(n=73) and non-CE group(n=165).Univariate and binary logistic regression analyses were used to screen the risk factors of CE and a nomogram was establish for hysteroscopic scoring.Receiver operating characteristic(ROC) curve,calibration curve and Bootstrap resampling method were used to evaluate and verify the system.Results:Univariate and binary logistic regression analyses showed that hyperemia area(HA) degree ≥2,micropolyps,polypoid hyperplasia of endometrium and history of ectopic pregnancy were independent risk factors for CE(all P<0.05).A nomogram was generated to establish a hysteroscopy scoring system based on the above four factors.The area under ROC curve of the hysteroscopy scoring system for predicting CE was 0.801(95%CI:0.742-0.861),the sensitivity was 74.0% and the specificity was 73.9%.The calibration curve showed that the predicting value of the scoring system was highly consistent with the actual value.In the internal verification,the C-index was 0.7811.The predicting value of the verification group in the calibration curve was basically consistent with the actual value,indicating that the scoring system had good stability.Conclusion:The hysteroscopic scoring system composed of HA,micropolyp,polypoid hyperplasia of endometrium and history of ectopic pregnancy can effectively and intuitively predict CE,which is conducive to improving the diagnosis of CE.

关 键 词：慢性子宫内膜炎 宫腔镜检查 子宫内膜活检 充血面积 微小息肉 子宫内膜息肉样增生 异位妊娠 

分 类 号：R711.71[医药卫生—妇产科学]