CSGE与AFS宫腔粘连评分标准临床应用比较研究  

Comparative analysis of clinical diagnosis application of two intrauterine adhesion scoring criteria

作　　者：彭燕蓁[1] 汪沙[1] 甘露[1] 刘雨声[1] 段华[1] Peng Yanzhen;Wang Sha;Gan Lu;Liu Yusheng;Duan Hua(Gynecological Minimally Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院、北京妇幼保健院妇科微创中心,北京100006

出　　处：《中华妇产科杂志》2023年第3期185-190,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2018YFC1004803)。

摘　　要：目的比较中华医学会妇产科学分会妇科内镜学组(CSGE)与1988年美国生育学会(AFS)的宫腔粘连(IUA)评分标准对IUA分级诊断的异同及其对生殖预后的预测价值。方法2016年1月至2019年1月在首都医科大学附属北京妇产医院妇科微创中心门诊行宫腔镜检查确诊IUA的患者共1249例,选取其中进行CSGE与AFS双标准评分并且临床资料完整的378例患者为观察对象,对两种标准的诊断分级结果进行对比分析;并随访2年,统计分析妊娠率及活产率。结果(1)CSGE与AFS标准诊断的IUA分级(轻度、中度、重度)一致性较差(κ=0.295,P<0.001)。与AFS标准相比,CSGE标准诊断为重度IUA的占比明显降低[分别为45.8%(173/378)、15.1%(57/378)],差异有统计学意义(RR=0.22,95%CI为0.15~0.30,P<0.01);诊断为轻度及中度IUA的占比均明显高于AFS标准,差异均有统计学意义(RR=4.16,95%CI为2.38~7.14;RR=2.38,95%CI为1.75~3.23;P均<0.01)。(2)最终完成生殖预后随访的患者共263例,总妊娠率为62.7%(165/263),总活产率为53.6%(141/263)。(3)依据CSGE标准诊断为轻度、中度、重度IUA的患者妊娠率分别为11/13、64.5%(147/228)和31.8%(7/22),活产率分别为11/13、54.8%(125/228)和22.7%(5/22),差异均有统计学意义(P均<0.01);依据AFS标准诊断为轻度、中度、重度IUA的患者妊娠率分别为3/3、66.9%(97/145)和56.5%(65/115),差异无统计学意义(P>0.05)。(4)CSGE标准及AFS标准诊断的IUA分级与妊娠率及活产率均呈显著负相关(CSGE标准:r=-0.210,r=-0.226;AFS标准:r=-0.130,r=-0.147;P均<0.05);单因素logistic回归分析显示,AFS标准预测妊娠率及活产率的OR值分别为1.657(P=0.045)及1.554(P=0.087),CSGE标准预测妊娠率及活产率的OR值分别为3.889(P=0.005)及3.983(P=0.009),CSGE标准较AFS标准有更高的OR值。结论与AFS标准相比,CSGE标准诊断的IUA分级与生殖预后有更好的相关性,更为客观全面,对生殖预后具有更好的预测价值,可避免过度诊断及过度治疗Objective To explore the similarities and differences of China Society of Gynecology Endoscopy(CSGE)and American Fertility Society(AFS)intrauterine adhesion(IUA)scoring criteria on IUA grading and their predictive value of reproductive prognosis.Methods From January 2016 to January 2019,a total of 1249 patients were diagnosed with IUA by hysteroscopy at Beijing Obstetrics and Gynecology Hospital.Totally,378 patients with complete clinical data were enrolled,and the results diagnosed by CSGT and AFS scoring criteria were compared and analyzed.And follow-up for 2 years,the pregnancy rate and live birth rate were statistical analysis.Results(1)The grade of IUA according to AFS and CSGE scoring criteria was less consistent(κ=0.295,P<0.001).Compared with AFS,the proportion of severe IUA cases diagnosed by CSGE was significantly lower[45.8%(173/378)vs 15.1%(57/378);RR=0.22,95%CI:0.15-0.30,P<0.01);the proportions of both mild and moderate IUA cases were significantly higher(RR=4.16,95%CI:2.38-7.14;RR=2.38,95%CI:1.75-3.23;both P<0.01).(2)The pregnancy rates of mild,moderate and severe IUA diagnosed according to CSGE were 11/13,64.5%(147/228),31.8%(7/22),live birth rates were 11/13,54.8%(125/228)and 22.7%(5/22),respectively;there were statistically significant differences between the groups(all P<0.01).The pregnancy rates of mild,moderate and severe IUA diagnosed based on AFS were 3/3,66.9%(97/145)and 56.5%(65/115),respectively,with no statistically significant difference between the groups(P>0.05).(3)IUA grades based on both CSGE and AFS criteria were significantly negatively correlated with pregnancy rates and live birth rates(CSGE:r=-0.210,r=-0.226;AFS:r=-0.130,r=-0.147;all P<0.05).Univariate logistic regression analysis showed that CSGE had higher OR for both pregnancy rates and live birth rates compared to AFS(3.889 vs 1.657,3.983 vs 1.554,respectrvely).Conclusions Compared with AFS,the IUA grade based on CSGE is better related with reproductive prognosis,suggesting that the CSGE standard might be more objective and

关 键 词：宫腔镜检查 疾病严重程度指数 对比研究 预测 宫腔粘连 

分 类 号：R711.74[医药卫生—妇产科学]