Coppus S F P J, Verhoeve H R, Opmeer B C, van der Steeg J W, Steures P, Eijkemans M J C, Hompes P G A, Bossuyt P M M, van der Veen F, Mol B W J
Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
Hum Reprod. 2007 Oct;22(10):2685-92. doi: 10.1093/humrep/dem251. Epub 2007 Aug 4.
The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred.
Data on 3716 women who underwent tubal patency testing as a part of their routine fertility workup were used to relate elements in their medical history to the presence of tubal pathology. With multivariable logistic regression, we constructed two diagnostic models. One in which tubal disease was defined as occlusion and/or severe adhesions of at least one tube, whereas in a second model, tubal disease was defined as the presence of bilateral abnormalities.
Both models discriminated moderately well between women with and women without tubal disease with an area under the receiver-operating characteristic curve (AUC) of 0.65 (95% CI: 0.63-0.68) for any tubal pathology and 0.68 (95% CI: 0.65-0.71) for bilateral tubal pathology, respectively. However, the models could make an almost perfect distinction between women with a high and a low probability of tubal pathology. A decision rule in the form of a simple diagnostic score chart was developed for application of the models in clinical practice.
In conclusion, the present study provides two easy to use decision rules that can accurately express a woman's probability of (severe) tubal pathology at the couple's first consultation. They could be used to select women for tubal testing more efficiently.
输卵管检查的目的是及时识别双侧输卵管病变的女性，以便她们能够接受体外受精（IVF）或输卵管手术治疗。目前，尚不清楚哪些女性需要早期进行输卵管检查，哪些女性可以推迟检查。
对3716名作为常规生育检查一部分接受输卵管通畅性检查的女性的数据进行分析，以将她们病史中的因素与输卵管病变的存在情况相关联。通过多变量逻辑回归，我们构建了两个诊断模型。一个模型中，输卵管疾病定义为至少一侧输卵管阻塞和/或严重粘连；另一个模型中，输卵管疾病定义为双侧异常。
两个模型对有输卵管疾病和无输卵管疾病的女性的区分度中等，对于任何输卵管病变，受试者工作特征曲线（AUC）下面积为0.65（95%CI：0.63 - 0.68），对于双侧输卵管病变，AUC为0.68（95%CI：0.65 - 0.71）。然而，这些模型几乎可以完美地区分输卵管病变概率高和低的女性。制定了一个简单诊断评分表形式的决策规则，以便在临床实践中应用这些模型。
总之，本研究提供了两个易于使用的决策规则，可在夫妻首次咨询时准确表达女性（严重）输卵管病变的概率。它们可用于更有效地选择进行输卵管检查的女性。
