Polisseni Fernanda, Bambirra Eduardo A, Camargos Aroldo F
Department of Obstetrics and Gynecology, Faculty of Medicine, Federal University of Minas Gerais, Rua dos Odoni 881/403, Santa Efigênia, 30 150-027 Belo Horizonte MG, Brazil.
Gynecol Obstet Invest. 2003;55(4):205-10. doi: 10.1159/000072075.
Chronic endometritis has been related to infertility and recurrent abortion. It is usually asymptomatic, and the diagnosis is rarely clinically suspected. We performed a prospective study to evaluate both the role of diagnostic hysteroscopy in the detection of chronic endometritis in infertile patients and Chlamydia trachomatis is a potential etiologic factor. Fifty consecutive patients who sought treatment for infertility in a tertiary academic hospital were submitted to diagnostic hysteroscopy and an endometrial biopsy for histopathological study and for diagnosis of C. trachomatis by polymerase chain reaction. The patients' mean age was 33.7 +/- (SD) 5.4 years, and the duration of the couples' infertility ranged from 1 to 18 years. The overall prevalence of chronic endometritis was 12% (6 patients). Among all patients, no cases of chlamydial infection were detected by polymerase chain reaction. In the detection of chronic endometritis, with 95% confidence intervals, the hysteroscopy sensitivity was 16.7% (range 0.9-63,5%), the specificity was 93.2% (range 80.3-98.2%), the positive predictive value was 25% (range 1.3-78.1%), and the negative predictive value was 89.1% (range 65.6-95.9%). These data suggest that hysteroscopy is not useful in the screening for chronic endometritis in asymptomatic infertile women. Further studies are needed to establish the etiology of endometritis in infertile patients.
慢性子宫内膜炎与不孕及反复流产有关。它通常无症状，临床上很少怀疑其诊断。我们进行了一项前瞻性研究，以评估诊断性宫腔镜检查在检测不孕患者慢性子宫内膜炎中的作用，并且沙眼衣原体是一个潜在的病因。在一家三级学术医院连续有50名寻求不孕症治疗的患者接受了诊断性宫腔镜检查及子宫内膜活检，用于组织病理学研究以及通过聚合酶链反应诊断沙眼衣原体。患者的平均年龄为33.7±（标准差）5.4岁，夫妻不孕的时间范围为1至18年。慢性子宫内膜炎的总体患病率为12%（6例患者）。在所有患者中，聚合酶链反应未检测到衣原体感染病例。在慢性子宫内膜炎的检测中，95%置信区间下，宫腔镜检查的敏感性为16.7%（范围0.9 - 63.5%），特异性为93.2%（范围80.3 - 98.2%），阳性预测值为25%（范围1.3 - 78.1%），阴性预测值为89.1%（范围65.6 - 95.9%）。这些数据表明，宫腔镜检查对无症状不孕女性慢性子宫内膜炎的筛查无用。需要进一步研究以确定不孕患者子宫内膜炎的病因。
