Konrad Lutz, Fruhmann Berger Lea M, Maier Veronica, Horné Fabian, Neuheisel Laura M, Laucks Elisa V, Riaz Muhammad A, Oehmke Frank, Meinhold-Heerlein Ivo, Zeppernick Felix
Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University Giessen, 35392 Giessen, Germany.
J Clin Med. 2023 Jun 23;12(13):4231. doi: 10.3390/jcm12134231.
Are other pain symptoms in addition to dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain correlated to endometriosis and suitable for a clinical prediction model?
We conducted a prospective study from 2016 to 2022, including a total of 269 women with numerous pain symptoms and other parameters. All women filled out two questionnaires and were examined by palpation and transvaginal ultrasound (TVUS). In cases of suspected deep endometriosis, magnetic resonance imaging (MRI) was performed. After the operation, endometriosis was diagnosed by histological examination.
All in all, 30 significant parameters and 6 significant numeric rating scale (NRS) scores associated with endometriosis could be identified: 7 pain adjectives, 8 endometriosis-associated pain symptoms, 5 pain localizations, 6 parameters from the PainDETECT, consumption of analgesics, and allergies. Furthermore, longer pain duration (before, during, and after menstruation) was observed in women with endometriosis compared to women without endometriosis (34.0% vs. 12.3%, respectively). Although no specific pain for endometriosis could be identified for all women, a subgroup with endometriosis reported radiating pain to the thighs/legs in contrast to a lower number of women without endometriosis (33.9% vs. 15.2%, respectively). Furthermore, a subgroup of women with endometriosis suffered from dysuria compared to patients without endometriosis (32.2% vs. 4.3%, respectively). Remarkably, the numbers of significant parameters were significantly higher in women with endometriosis compared to women without endometriosis (14.10 ± 4.2 vs. 7.75 ± 5.8, respectively). A decision tree was developed, resulting in 0.904 sensitivity, 0.750 specificity, 0.874 positive predictive values (PPV), 0.802 negative predictive values (NPV), 28.235 odds ratio (OR), and 4.423 relative risks (RR). The PPV of 0.874 is comparable to the positive prediction of endometriosis by the clinicians of 0.86 (177/205).
The presented predictive model will enable a non-invasive diagnosis of endometriosis and can also be used by both patients and clinicians for surveillance of the disease before and after surgery. In cases of positivety, as evaluated by the questionnaire, patients can then seek advice again. Similarly, patients without an operation but with medical therapy can be monitored with the questionnaire.
除痛经、性交痛、排便困难、排尿困难和慢性盆腔疼痛外，其他疼痛症状是否与子宫内膜异位症相关且适用于临床预测模型？
我们在2016年至2022年进行了一项前瞻性研究，共纳入269名有多种疼痛症状及其他参数的女性。所有女性填写两份问卷，并接受触诊和经阴道超声（TVUS）检查。疑似深部子宫内膜异位症的病例进行磁共振成像（MRI）检查。术后通过组织学检查诊断子宫内膜异位症。
总共可识别出30个与子宫内膜异位症相关的显著参数和6个显著的数字评分量表（NRS）得分：7个疼痛形容词、8个与子宫内膜异位症相关的疼痛症状、5个疼痛部位、来自疼痛检测量表的6个参数、镇痛药使用情况和过敏情况。此外，与无子宫内膜异位症的女性相比，有子宫内膜异位症的女性在月经前、月经期间和月经后的疼痛持续时间更长（分别为34.0%和12.3%）。虽然并非所有女性都能确定与子宫内膜异位症相关的特定疼痛，但有子宫内膜异位症的亚组报告有大腿/腿部放射性疼痛，而无子宫内膜异位症的女性中这一比例较低（分别为33.9%和15.2%）。此外，有子宫内膜异位症的女性亚组存在排尿困难，而无子宫内膜异位症的患者中这一比例较低（分别为32.2%和4.3%）。值得注意的是，与无子宫内膜异位症的女性相比，有子宫内膜异位症的女性的显著参数数量明显更多（分别为14.10±4.2和7.75±5.8）。开发了一个决策树，其灵敏度为0.904，特异度为0.750，阳性预测值（PPV）为0.874，阴性预测值（NPV）为0.802，优势比（OR）为28.235，相对风险（RR）为4.423。0.874的PPV与临床医生对子宫内膜异位症的阳性预测值0.86（177/205）相当。
所提出的预测模型将能够对子宫内膜异位症进行非侵入性诊断，患者和临床医生均可在手术前后使用该模型对疾病进行监测。如果问卷评估为阳性，患者可再次寻求建议。同样，未进行手术但接受药物治疗的患者也可通过问卷进行监测。
