Yu Huaying, Li Baijia, Li TinChiu, Zhang Songying, Lin Xiaona
Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.
Department of Obstetrics & Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Honk Kong.
Medicine (Baltimore). 2019 Aug;98(31):e16695. doi: 10.1097/MD.0000000000016695.
This study means to investigate a combination of noninvasive methods in diagnosis of minimal or mild endometriosis expecting to narrow down the range of laparoscopic exploration for female infertility.It is a retrospective case control study of totally 447 patients suspected unexplained infertility before surgery were eligible from May 2012 to February 2017. Of these, 299 patients were laparoscopy-proved minimal or mild endometriosis group, the remaining 148 patients served as control group (normal pelvis). Preoperative age, duration of infertility, type of infertility, body mass index, baseline follicle-stimulating hormone, anti-Müllerian hormone, serum CA125, clinical symptoms, findings on vagino-recto-abdominal examinations and pregnancy prognosis had been recorded. Every variable and their combinations were evaluated.Any single factor had limited diagnostic value. The cut-off value for CA125 was 19.25 IU/L. Parallel testing had a higher sensitivity at 81.3%. Serial tests of vagino-recto-abdominal examination combined with dysmenorrhea or positive CA125 got reasonable sensitivity (51.4% and 49%), remarkable high specificities (95.7% and100%) and Positive Predictive Value (96.4% and 100%). Multivariate logistic regression identified the following factors in decreasing order of importance: (1) vagino-recto-abdominal examinations, (2) CA125, (3) dysmenorrhea, their ORs being 16.148, 3.796, and 2.809, respectively. The spontaneous pregnancy rate (50.8%) in minimal or mild endometriosis was higher than control (35.6%, P = .043).A combination of noninvasive diagnostic methods had certain preoperative diagnostic value of minimal or mild endometriosis, which might benefit some patients from avoiding laparoscopic surgery.
本研究旨在探讨多种非侵入性方法联合用于诊断轻微或轻度子宫内膜异位症，以期缩小女性不孕症腹腔镜探查的范围。这是一项回顾性病例对照研究，2012年5月至2017年2月期间，共有447例术前疑似不明原因不孕症的患者符合条件。其中，299例患者经腹腔镜证实为轻微或轻度子宫内膜异位症组，其余148例患者作为对照组（盆腔正常）。记录了术前年龄、不孕时间、不孕类型、体重指数、基础促卵泡生成素、抗苗勒管激素、血清CA125、临床症状、阴道直肠腹部检查结果及妊娠预后。对每个变量及其组合进行了评估。任何单一因素的诊断价值都有限。CA125的临界值为19.25 IU/L。平行检测的敏感性较高，为81.3%。阴道直肠腹部检查联合痛经或CA125阳性的系列检测具有合理的敏感性（分别为51.4%和49%）、显著较高的特异性（分别为95.7%和100%）及阳性预测值（分别为96.4%和100%）。多因素logistic回归确定了以下重要性递减的因素：（1）阴道直肠腹部检查，（2）CA125，（3）痛经，其比值比分别为16.148、3.796和2.809。轻微或轻度子宫内膜异位症患者的自然妊娠率（50.8%）高于对照组（35.6%，P = .043）。多种非侵入性诊断方法联合对轻微或轻度子宫内膜异位症具有一定的术前诊断价值，这可能使一些患者避免接受腹腔镜手术。
