不同评分标准对宫腔粘连预后的预测作用
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摘要
目的探讨不同评分标准对宫腔粘连(IUA)术后预后的预测作用。方法选择2015年1月至2017年3月在郑州大学第三附属医院就诊,并行宫腔粘连分离术患者61例,其中介入栓塞术后宫腔粘连患者15例为病例组(介入组),未行介入手术或无明显诱因的宫腔粘连患者46例为对照组。对两组患者均分别采用AFS(1988)评分、ESGE评分(1998)、Nasr评分、March评分、中国评分进行宫腔粘连评分,并随访2～3 a统计其月经改善率、妊娠率和活产率。结果 ESGE评分和中国评分与妊娠率(r=-0.350,P=0.017;r=-0.374,P=0.010)相关,与活产率(r=0.079,P=0.755;r=-0.117,P=0.025)、月经改善率(r=0.171,P=0.496;r=-0.072,P=0.634)无显著相关性。AFS(1988)评分、Nasr评分、March评分与妊娠率、活产率及月经改善率无显著相关性(均P>0.05)。ESGE评分对妊娠率(AUC=0.679,P=0.047)有预测作用,灵敏度最高。结论 ESGE及中国评分与妊娠率显著相关,其中ESGE对妊娠率有预测作用,优于中国评分。ESGE更适合用于宫腔粘连术后患者预后的评估。
Objective To explore the predictive effect of different scoring criteria on the prognosis of intrauterine adhesion(IUA).Methods Fifteen cases of IUA after embolization and forty-six cases of IUA without embolization were enrolled for intervention group and control group, respectively. They underwent transcervical rection of adhensions(TCRA) in the Third Affiliated Hospital of Zhengzhou University from January 2015 to March 2017, and were followed up for 2-3 years. All patients were scored by AFS(1988) score, ESGE score(1998), Nasr grading, March score, Chinese score before surgery, menstrual improvement rates, pregnancy rates and live birth rates were recorded.Results ESGE and Chinese scores were significantly correlated with pregnancy rate(r=-0.350, P=0.017; r=-0.374, P=0.010), but had no correlation with live birth rate(r=0.079, P=0.755; r=-0.117, P=0.025) and menstrual improvement rate(r=0.171,P=0.496 and r=-0.072,P=0.634). AFS(1988) score, Nasr score and March score were not significantly correlated with pregnancy rate, live birth rate and menstrual improvement(all P>0.05). ESGE score had the highest predictive sensitivity for pregnancy rate(AUC=0.679, P=0.047).Conclusion ESGE and Chinese score have predictive value for pregnancy rate, ESGE score predicts prenancy rate better. Therefore, ESGE score is more suitable for evaluating prognosis of patients with IUA.
Objective To explore the predictive effect of different scoring criteria on the prognosis of intrauterine adhesion(IUA).Methods Fifteen cases of IUA after embolization and forty-six cases of IUA without embolization were enrolled for intervention group and control group, respectively. They underwent transcervical rection of adhensions(TCRA) in the Third Affiliated Hospital of Zhengzhou University from January 2015 to March 2017, and were followed up for 2-3 years. All patients were scored by AFS(1988) score, ESGE score(1998), Nasr grading, March score, Chinese score before surgery, menstrual improvement rates, pregnancy rates and live birth rates were recorded.Results ESGE and Chinese scores were significantly correlated with pregnancy rate(r=-0.350, P=0.017; r=-0.374, P=0.010), but had no correlation with live birth rate(r=0.079, P=0.755; r=-0.117, P=0.025) and menstrual improvement rate(r=0.171,P=0.496 and r=-0.072,P=0.634). AFS(1988) score, Nasr score and March score were not significantly correlated with pregnancy rate, live birth rate and menstrual improvement(all P>0.05). ESGE score had the highest predictive sensitivity for pregnancy rate(AUC=0.679, P=0.047).Conclusion ESGE and Chinese score have predictive value for pregnancy rate, ESGE score predicts prenancy rate better. Therefore, ESGE score is more suitable for evaluating prognosis of patients with IUA.
引文
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[8] MARCH C M .Asherman’s syndrome[J].Semin Reprod Med,2011,29(2):83-94.
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[11] 宋冬梅,刘玉环,夏恩兰.子宫动脉栓塞术后宫腔粘连的临床分析[J].山东医药,2012,52(12):26-27.
[2] HANSTEDE M M,DER MEIJ E V,GOEDEMANS L,et al.Results of centralized Asherman surgery,2003—2013[J].Fertil Steril,2015,104(6):1561-1568.
[3] KASIUS A,SMIT J G,TORRANCE H L,et al.Endometrial thickness and pregnancy rates after IVF:a systematic review and meta-analysis[J].Hum Reprod Update,2014,20(4):530.
[4] 王明凯,王蔼明.宫腔粘连的诊断及分类[J].生殖医学杂志,2014,23(4):334-338.
[5] 中华医学会妇产科学分会.宫腔粘连临床诊疗中国专家共识[J].中华妇产科杂志,2015,50(12):881-887.
[6] IBRAHIM M I,RAAFAT T A,ELLAITHY M I,et al.Risk of postpartum uterine synechiae following uterine compression suturing during postpartum haemorrhage[J].Aust N Z J Obstet Gynaecol,2013,53(1):37-45.
[7] CHEN L,ZHANG H,WANG Q,et al.Reproductive outcomes in patients with intrauterine adhesions following hysteroscopic adhesiolysis:experience from the largest women’s hospital in China[J].J Minim Invasive Gynecol,2017,24(2):299-304.
[8] MARCH C M .Asherman’s syndrome[J].Semin Reprod Med,2011,29(2):83-94.
[9] 吴敬妮.比较不同宫腔粘连分类系统提示妊娠预后的价值[D].杭州:浙江大学,2015.
[10] 孙冬华,何援利,张冬梅,等.不同宫腔粘连评分标准对宫腔粘连疾病预后的预测作用分析[J].解放军医学杂志,2017,42(5):439-444.
[11] 宋冬梅,刘玉环,夏恩兰.子宫动脉栓塞术后宫腔粘连的临床分析[J].山东医药,2012,52(12):26-27.