Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.
Goto Ladies Clinic, 4-13 Hakubaicho, Takatsuki, Osaka, 569-1116, Japan.
BMC Womens Health. 2021 Mar 4;21(1):94. doi: 10.1186/s12905-021-01239-y.
The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients.
A prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated.
A total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%).
Chronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.
慢性子宫内膜炎的诊断标准在治疗不孕患者时仍存在争议。
这是一项单中心前瞻性观察研究，于 2014 年 6 月至 2017 年 9 月进行。纳入经组织学检查发现存在慢性子宫内膜炎并行激素替代周期冻融单囊胚移植的患者。根据同一组患者中浆细胞的数量，使用 4 种标准来定义慢性子宫内膜炎：每 10 个高倍视野中 1 个或更多（≥1）浆细胞、2 个或更多（≥2）、3 个或更多（≥3）或 5 个或更多（≥5）。计算非慢性子宫内膜炎和根据每种标准定义的慢性子宫内膜炎组的妊娠率、活产率和流产率。使用 7 种不孕因素和慢性子宫内膜炎这 8 个解释变量对活产进行逻辑回归分析。绘制受试者工作特征曲线并计算最佳截断值。
共登记 69 例患者，排除后最终分析 53 例。当诊断标准指定为每 10 个高倍视野中存在 1 个或更多子宫内膜间质浆细胞时，非慢性子宫内膜炎和慢性子宫内膜炎组的妊娠率、活产率和流产率分别为 63.0%比 30.8%、51.9%比 7.7%和 17.7%比 75%。该标准在非慢性子宫内膜炎组中获得了最高的妊娠率和活产率，且非慢性子宫内膜炎组和慢性子宫内膜炎组之间的妊娠率、活产率和流产率的 P 值最小。在逻辑回归分析中，仅当每 10 个高倍视野中诊断为慢性子宫内膜炎存在≥1 或≥2 个浆细胞时，慢性子宫内膜炎才是影响活产这一客观变量的解释变量。当在 10 个高倍视野中发现 1 个或更多浆细胞时，获得最佳截断值（灵敏度 87.5%，特异性 64.9%）。
应将每 10 个高倍视野中存在 1 个或更多浆细胞定义为慢性子宫内膜炎。根据这一诊断标准，慢性子宫内膜炎对妊娠率和活产率有不利影响。
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