三种方法诊断不孕症患者子宫内膜息肉的临床价值研究

目的:探讨单用阴道超声(TVS)、子宫输卵管造影(HSG)、超声子宫水造影(SIS)以及三种方法联合诊断不孕症患者子宫内膜息肉(EP)的临床价值。方法:以206例行宫腔镜联合诊刮或病检的不孕症患者为研究对象,回顾性分析各种检查方法对EP的筛查结果,评价各种检查方法的真实性、可靠性以及预测值。结果:206例不孕症中,共确诊EP患者60例,阳性率29.1%。三种检查方法中,TVS的灵敏度最高(70.0%),特异度最低(73.3%),漏诊率最低(30.0%),误诊率最高(26.7%),正确诊断指数最高(43.3%),阴性似然比最小(0.409),阴性预测值最高(85.6%);SIS检查的灵敏度最低(38.7%),漏诊率最高(61.3%),但是特异性最高(93.3%),误诊率最低(6.7%),阳性似然比最大(4.284),阳性预测值最大(66.6%),正确诊断指数最低(32.0%);HSG检查的上述各项评价指标均介于TVS和SIS之间。TVS和SIS与金标准的符合率低,Kappa值均小于0.4;HSG符合率最高(86.2%),Kappa值0.647。三种检查联合诊断的灵敏度89.3%,漏诊率10.7%,特异度91.4%,误诊率8.6%,正确诊断指数80.7%,阳性似然比10.384,阴性似然比0.117,符合率89.3%,Kappa值0.792,阳性预测值83.3%,阳性预测值94.6%。结论:对于宫腔可能存在内膜息肉的不孕症患者,单一采用阴道超声检查、子宫输卵管造影或超声子宫水造影方法的灵敏度均较低,漏诊率高,与金标准的一致性较差,而三种方法联合用于诊断不孕症患者EP的真实性、可靠性及预测值均较好。

A Study on the Diagnostic Value of Three Examination Methods for Endometrial Polyps in Patients with Infertility

Objective:To investigate the diagnostic value of transvaginal ultrasound (TVS), hysterosalpingography (HSG), saline intrauterine sonohysterograph (SIS) alone and combination of three methods for endometrial polyps (EP) of patients with infertility.Methods:206 cases of patients with infertility inspected by hysteroscopy combined with curettage or pathological examination were selected as the research objective, the screening results of different methods for EP were retrospectively analyzed, and the authenticity, reliability and prediction of different methods were evaluated.Results:60 cases of EP were diagnosed in 206 cases of patients with infertility, the positive rate was 29.1%. In the three kinds of examination methods, the sensitivity of TVS was the highest (70%) with highest misdiagnosis rate (26.7%), the specificity (73.3%) was the lowest with minimum rate of missed diagnosis (30%), and the correct diagnosis index of TVS was the highest (43.3%) with the minimumnegative likelihood ratio (0.409) and highest negative predictive value (85.6%). The sensitivity of SIS detection was minimum (38.7%) with highest rate of missed diagnosis (61.3%), however, the specificity (93.3%) was highest with the lowest (6.7%) misdiagnosis rate, maximum (4.284) positive likelihood ratio and the maximum (66.6%) positive predictive, the correct diagnosis of SIS was the lowest (32%). The above indexes of HSG examination were between TVS and SIS. The coincidence rate of TVS and SIS with the gold standard was low, and Kappa values were less than 0.4. The coincidence rate (86.2%) of HSG was the highest with 0.647 Kappa value. While three kinds of test combined together, sensitivity of results was 89.3% with 10.7%missed diagnosis rate, the specificity was 91.4%with 8.6%misdiagnosis, the correct diagnosis index was 80.7%, the positive likelihood ratio was 10.384 with 0.117 negative likelihood ratio, the coincidence rate was 89.3%and Kappa value was 0.792, the positive predictive value was 83.3%with 94.6% negative predictive value.Conclusion:Using TVS, HSG or SIS alone for the diagnosis of EP in patients with infertility, the sensitivities were all low with high rates of missed diagnosis, and consistency with the gold standard were poor, but the authenticity, reliability and prediction values of combination of three methods for the diagnosis of EP, were better.