Meikle S F, Zhang X, Marine W M, Calonge B N, Hamman R F, Betz G
Department of Preventive Medicine and Biometrics, University of Colorado, Denver.
Fertil Steril. 1994 Aug;62(2):305-12. doi: 10.1016/s0015-0282(16)56883-6.
To determine if the number of diagnostic laparoscopies done on women without tubal adhesive disease could be reduced by testing for tubal disease with Chlamydia trachomatis antibody titers and hysterosalpingography (HSG), either singly or together.
Historical prospective chart review.
The Colorado Kaiser Permanente Reproductive Endocrinology Clinic.
All 703 infertility patients who had C. trachomatis antibody titers done from March 2, 1988 to April 30, 1992. The final study group was comprised of 218 patients who had antibody titers, HSG, and laparoscopy.
None.
Sensitivity, negative predictive value, and false-positive rate were the test characteristics of interest. Tubal disease was identified by laparoscopy.
For HSG testing, the sensitivity was 78% and the negative predictive value was 85%. For C. trachomatis titers, the sensitivity was also 78% and the negative predictive value was 82%. Ninety-five percent confidence intervals for sensitivity and negative predictive value overlapped, indicating that there was no significant difference. However, false-negative rates were the same for the two tests, but false-positive rates were lowest for HSG and series testing.
To minimize false-positive tests and thus, to minimize unnecessary laparoscopies, HSG testing either alone or combined with the C. trachomatis antibody titer as series tests yielded a significantly lower false-positive rate. In our study group, if both tests were negative, tubal disease was identified on laparoscopy in only 5% of cases. Choice of most cost-effective test sequence will depend on who bears the cost. Further studies of cost-benefit using well-defined testing sequences are needed to determine if C. trachomatis antibody titers in series with HSG would be more cost effective than HSG alone in detecting tubal disease.
通过单独或联合检测沙眼衣原体抗体滴度和子宫输卵管造影（HSG）来检测输卵管疾病，以确定能否减少对无输卵管粘连疾病女性进行诊断性腹腔镜检查的次数。
历史前瞻性图表回顾。
科罗拉多州凯撒永久医疗生殖内分泌诊所。
1988年3月2日至1992年4月30日期间进行沙眼衣原体抗体滴度检测的所有703例不孕患者。最终研究组由218例进行了抗体滴度检测、HSG检测和腹腔镜检查的患者组成。
无。
敏感性、阴性预测值和假阳性率是感兴趣的检测特征。通过腹腔镜检查确定输卵管疾病。
对于HSG检测，敏感性为78%，阴性预测值为85%。对于沙眼衣原体滴度检测，敏感性也为78%，阴性预测值为82%。敏感性和阴性预测值的95%置信区间重叠，表明无显著差异。然而，两种检测的假阴性率相同，但HSG检测和系列检测的假阳性率最低。
为了将假阳性检测降至最低，从而将不必要的腹腔镜检查降至最低，单独进行HSG检测或与沙眼衣原体抗体滴度联合作为系列检测，产生的假阳性率显著更低。在我们的研究组中，如果两项检测均为阴性，腹腔镜检查中仅5%的病例发现输卵管疾病。最具成本效益的检测顺序选择将取决于谁承担费用。需要使用明确的检测顺序对成本效益进行进一步研究，以确定在检测输卵管疾病方面，与单独进行HSG检测相比，沙眼衣原体抗体滴度与HSG联合进行系列检测是否更具成本效益。
