中国全科医学2017，Vol.20Issue(21)：2665-2671,7.DOI:10.3969/j.issn.1007-9572.2017.21.021
子宫内膜异位症早期综合评分临床诊断模型研究
Study of Clinical Diagnostic Model of Early Comprehensive Score of EMs
摘要
Abstract
Background Endometriosis(EMs) seriously affects the quality of life of patients.It is important to explore a safe and effective early diagnostic method of EMs for improving the accuracy of clinical diagnosis and avoiding laparoscopic surgery.Objective To establish a clinical diagnostic model of early comprehensive score of EMs based on dysmenorrhea,chronic pelvic pain,results of gynaecological examination,ultrasound results,serum epithelial ovarian cancer antigen(CA125) test results,and aromatase cytochrome(P450arom) test results of endometrial tissue of EMs patients as variables.And to investigate the early diagnostic value of the model for EMs in order to explore a safe,effective,economical and practical diagnostic method for improving the accuracy for early diagnosis of EMs and reducing the possibility of laparoscopic operation.Methods A total of 150 patients with clinical diagnosis of pelvic EMs met the inclusion criteria were selected as study subjects,who were on the waiting list to undergo the laparoscopic operation in the Department of Gynecology and Obstetrics of the Central Hospital of Lishui from January 2015 to October 2016.These patients were divided into modeling group(n=100) and validation group(n=50) by simple random sampling.General data of patients were collected,including medical history,critical symptoms,gynaecological examination results.The results of ultrasound examination,serum CA125 test,and P450arom test of endometrium tissue were recorded.Laparoscopic surgery combined with histopathological findings was the gold diagnostic standard for EMs.Clinical diagnostic model of early comprehensive score of EMs was established by using multivariate stepwise Logistic regression analysis.The receiver operating characteristic(ROC) curve of clinical diagnostic model of early comprehensive score of EMs for diagnosing EMs was drawn.The area under the ROC curve(AUC),sensitivity and specificity were calculated.Results There were 78 positive cases diagnosed as EMs by the gold standard and 22 negative cases in modeling group.Meanwhile,24 positive cases and 26 negative cases in validation group.In modeling group,the positive rate were 91.0%(91/100),64.0%(64/100) and 76.0%(76/100) by ultrasonic examination,serum CA125 test and P450arom test of endometrium tissue,respectively.A clinical diagnosis model of early comprehensive score of EMs was established by multivariate stepwise Logistic regression analysis:y=-10.77+4.96×dysmenorrheal+1.88×chronic pelvic pain+3.02×positive signs of gynecological examination+3.68×positive ultrasound examination+1.41×positive serum CA125 test+4.56×positive P450arom test of endometrium tissue.AUC of diagnosing EMs by serum CA125 test in modeling group was 0.735,95%CI(0.614,0.857),sensitivity was 74.4% and specificity was 72.7%.AUC of diagnosing EMs by P450arom test of endometrium tissue in modeling group was 0.841,95%CI(0.732,0.951),sensitivity was 91.0% and specificity was 77.3%.AUC of diagnosing EMs by clinical diagnosis model of early comprehensive score of EMs in modeling group was 0.969,95%CI(0.936,1.000),diagnosis cutoff value was 0.833,sensitivity was 93.6% and specificity was 86.4%.The clinical diagnosis model of early comprehensive score of EMs was used in validation group,AUC was 0.881,95%CI(0.777,0.985),sensitivity was 91.7% and specificity was 88.5%.Conclusion The clinical diagnosis model of early comprehensive score of EMs established by this study has improved the accuracy of early diagnosis of EMs to a certain extent.As a minimally invasive diagnostic method,the model can be used in the early clinical diagnosis of EMs.关键词
子宫内膜异位症/早期诊断/模型Key words
Endometriosis/Early diagnosis/Model分类
医药卫生引用本文复制引用
周赞华,董海娜,卫哲,施倩,周丽红,毛雪梅..子宫内膜异位症早期综合评分临床诊断模型研究[J].中国全科医学,2017,20(21):2665-2671,7.基金项目
浙江省科技厅公益技术应用计划项目(2014C33249) （2014C33249）
浙江省自然科学基金资助项目(LY15H040009) （LY15H040009）
