Department of OB/GYN and REI (UniKiD), Medical Center, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Department of OB/GYN, Medical Center, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
BMC Womens Health. 2021 Sep 20;21(1):336. doi: 10.1186/s12905-021-01474-3.
To date, there is no reliable non-invasive marker for the early detection and diagnosis of endometriosis available possibly resulting in a delayed diagnosis and consequently an unnecessary long ordeal for the individual woman. Therefore, the primary objective of the current study was to evaluate whether the combination of a thyroid-stimulating hormone (TSH) level > 2.5 µlU/ml and premenstrual spotting could serve as non-invasive markers of endometriosis. A secondary objective was to determine whether typical symptoms of endometriosis like dysmenorrhea and/or dyspareunia could increase the diagnostic reliability.
We conducted a retrospective, case-control study with 167 female patients at the Department of OB/GYN and REI (UniKiD) of the medical center of the University of Düsseldorf, between January 2015 and December 2016. 107 women with surgically confirmed endometriosis were compared to 60 without endometriosis (controls). To evaluate the diagnostic accuracy, we considered sensitivity, specificity and predictive values. In order to assess the association between the non-invasive markers and endometriosis an odds ratio (OR) with a 95% confidence interval was calculated.
In our cohort, diagnosis of endometriosis with non-invasive markers according to their sensitivity yielded the following ranking: increased TSH level, premenstrual spotting, combination of both previous parameters, addition of dysmenorrhea, addition of dyspareunia and combination of all parameters.
The existence of endometriosis should be taken into consideration when a patient suffers from thyroid dysfunction and premenstrual spotting. Apart from an increased TSH level, the presence of premenstrual spotting underlines the possible diagnosis of endometriosis with non-invasive markers and therefore, the patient´s history needs to be taken into account carefully. Trial registration The retrospective study was approved by the Ethics Committee of the medical faculty of the Heinrich-Heine University, Düsseldorf, Germany, Registration number Düsseldorf: 5371R (approved: April 04th, 2016). Since the design of the study was retrospective no written informed consent was necessary.
迄今为止，尚无可靠的非侵入性标志物可用于早期检测和诊断子宫内膜异位症，这可能导致诊断延迟，进而使个体女性遭受不必要的长期痛苦。因此，本研究的主要目的是评估促甲状腺激素（TSH）水平>2.5 µlU/ml 和经前点滴出血是否可作为子宫内膜异位症的非侵入性标志物。次要目的是确定子宫内膜异位症的典型症状，如痛经和/或性交困难是否可以提高诊断的可靠性。
我们在杜塞尔多夫大学医学中心妇产科和生殖内分泌科（UniKiD）进行了一项回顾性病例对照研究，时间为 2015 年 1 月至 2016 年 12 月，共纳入 167 名女性患者。将 107 名经手术证实患有子宫内膜异位症的女性与 60 名无子宫内膜异位症的女性（对照组）进行比较。为了评估诊断准确性，我们考虑了敏感性、特异性和预测值。为了评估非侵入性标志物与子宫内膜异位症之间的相关性，计算了比值比（OR）及其 95%置信区间。
在我们的队列中，根据敏感性对子宫内膜异位症进行非侵入性标志物诊断的结果如下：TSH 水平升高、经前点滴出血、上述两个参数的组合、痛经、性交困难以及所有参数的组合。
当患者患有甲状腺功能障碍和经前点滴出血时，应考虑存在子宫内膜异位症。除 TSH 水平升高外，经前点滴出血也强调了使用非侵入性标志物诊断子宫内膜异位症的可能性，因此需要仔细考虑患者的病史。
该回顾性研究得到了德国杜塞尔多夫海因里希-海涅大学医学系伦理委员会的批准，注册号为 Düsseldorf: 5371R（批准日期：2016 年 4 月 4 日）。由于研究设计为回顾性，因此无需书面知情同意。
