Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, 410013, China.
Central South University Xiangya School of Medicine, Changsha, Hunan, 410013, China.
Hum Reprod. 2021 Mar 18;36(4):965-975. doi: 10.1093/humrep/deaa377.
Can the density of endometrial glandular openings (DEGO) be a reliable and simple new variable in the prediction of live birth after hysteroscopic adhesiolysis?
The DEGO grade at follow-up hysteroscopy outperforms American Fertility Society (AFS) score in predicting the live birth rate after hysteroscopic adhesiolysis for patients with intrauterine adhesions (IUAs).
Several methods, such as endometrial thickness and AFS score, have been proposed for predicting the live birth rate in patients with IUAs who undergo hysteroscopic adhesiolysis.
STUDY DESIGN, SIZE, DURATION: A test cohort of 457 patients with IUAs who underwent hysteroscopic adhesiolysis and had satisfactory follow-up hysteroscopy videos were retrospectively enrolled between January 2016 and January 2017. A validation cohort comprising 285 IUA patients was prospectively enrolled from March 2018 to August 2018.
PARTICIPANTS/MATERIALS, SETTING, METHODS: An automated counting software tested the follow-up hysteroscopy videos to calculate the DEGO grade of all the 742 patients with IUAs after hysteroscopic adhesiolysis. The AFS score for each patient was also calculated at the same follow-up hysteroscopy. Logistic regression analysis was performed to develop prediction models to predict the live birth rate following hysteroscopic adhesiolysis. The performance of each of these prediction models was compared by calculating the AUC.
In the test cohort (n = 457), 231 patients had a live birth, but 226 patients failed. In the validation cohort (n = 285), 117 patients had a live birth, while 168 patients did not. The logistic regression analysis revealed that both the DEGO grade and AFS score at follow-up hysteroscopy were closely correlated with the live birth rate in patients with IUAs (P = 0). The AUCs of AFS score and DEGO grade in the test cohort were 0.7112 and 0.8498, respectively (P < 0.0001). The AUCs of AFS score and DEGO grade in the prospective external validation cohort were 0.6937 and 0.8248, respectively (P < 0.0001).
LIMITATIONS, REASONS FOR CAUTION: Further well-designed prospective clinical studies with a multicentric larger sample size should be needed to confirm the feasibility and efficacy of DEGO.
The DEGO grade is an accurate predictor factor of live birth rate in patients with IUAs following hysteroscopic adhesiolysis and can represent in the future an important and promising tool for assessing obstetric outcomes in IUAs.
STUDY FUNDING/COMPETING INTEREST(S): This study is supported by National Key Research and Development Program of China (Grant No. 2018YFC1004800), Natural Science Foundation of China (Grant No. 81671492), Natural Science Foundation of Hunan (Grant No. 2020JJ5859). B.G. is supported by Chinese Scholarship Council (File number. 201806370178). The authors have no conflicts of interest to declare.
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在宫腔镜粘连松解术后，子宫内膜腺开口密度（DEGO）能否成为预测活产的可靠且简单的新变量？
在预测宫腔镜粘连松解术后活产率方面，随访宫腔镜检查中的 DEGO 分级优于美国生育协会（AFS）评分。
已经提出了几种方法，例如子宫内膜厚度和 AFS 评分，用于预测接受宫腔镜粘连松解术的宫腔粘连患者的活产率。
研究设计、大小和持续时间：回顾性纳入了 2016 年 1 月至 2017 年 1 月间接受宫腔镜粘连松解术且随访宫腔镜检查视频满意的 457 例宫腔粘连患者作为测试队列。前瞻性纳入了 2018 年 3 月至 2018 年 8 月间的 285 例宫腔粘连患者作为验证队列。
参与者/材料、设置和方法：使用自动化计数软件对所有接受宫腔镜粘连松解术的 742 例宫腔粘连患者的随访宫腔镜检查视频进行检测，以计算 DEGO 分级。在同一随访宫腔镜检查中还计算了每位患者的 AFS 评分。采用逻辑回归分析建立预测模型，以预测宫腔镜粘连松解术后的活产率。通过计算 AUC 来比较这些预测模型的性能。
在测试队列（n=457）中，231 例患者活产，226 例患者未活产。在验证队列（n=285）中，117 例患者活产，168 例患者未活产。逻辑回归分析显示，随访宫腔镜检查中的 DEGO 分级和 AFS 评分均与宫腔粘连患者的活产率密切相关（P=0.0001）。在测试队列中，AFS 评分和 DEGO 分级的 AUC 分别为 0.7112 和 0.8498（P<0.0001）。在前瞻性外部验证队列中，AFS 评分和 DEGO 分级的 AUC 分别为 0.6937 和 0.8248（P<0.0001）。
局限性、谨慎的理由：需要进一步设计良好的前瞻性多中心大样本量临床研究来确认 DEGO 的可行性和疗效。
DEGO 分级是预测宫腔粘连患者宫腔镜粘连松解术后活产率的准确预测因素，未来可能成为评估宫腔粘连患者产科结局的重要且有前途的工具。
研究资金/竞争利益：本研究得到了中国国家重点研发计划（编号：2018YFC1004800）、国家自然科学基金（编号：81671492）和湖南省自然科学基金（编号：2020JJ5859）的支持。B.G. 得到了中国国家留学基金委（资助编号：201806370178）的支持。作者没有利益冲突需要声明。
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