生育指数预测子宫内膜异位症相关不孕患者保守性手术后妊娠预后的价值

The value of endometriosis fertility index in predicting the pregnancy outcome after conservative surgery for endometriosis-associated infertility

目的探讨子宫内膜异位症（内异症）生育指数（EFI）预测相关不孕患者保守性手术后妊娠预后的价值。方法回顾性分析2008年1月至2011年9月中山大学孙逸仙纪念医院170例行保守性手术治疗的内异症性不孕患者的I临床资料，电话随访其术后妊娠情况。根据EFI评分标准逐项进行评分并计算所有患者的EFI，统计术后的妊娠情况；分析EFI与术后累积妊娠率的关系；评价EFI预测术后2年内妊娠的价值；探讨影响术后妊娠的因素。结果术后总妊娠率为60．0％（102／170），所有102例妊娠者中1年内妊娠者占82．3％。总体而言，术后不同时间的累积妊娠率随EFI的增加而上升。1～5分、6分及7—10分患者术后总的累积妊娠率差异有统计学意义（x^2=9．33，P=0．009），进一步两两比较，7～10分患者术后累积妊娠率高于1～5分患者，其余两两比较结果差异均无统计学意义（P〉0．05）。EFI评分预测术后2年内妊娠的ROE曲线下面积（AUC）为0．712（95％CIO．604～0．821），界值为6．5分。EFI各项评分指标的COX回归分析结果表明，患者的年龄、不孕年限和r—AFS病灶评分与术后妊娠有关。双附件功能评分（LF）对不同病理类型内异症术后累积妊娠率的影响可能不同。结论保守性手术或联合药物治疗后患者首次妊娠多发生在治疗后的1年内，术后或停药后应尽快受孕。EFI与内异症相关不孕患者保守性手术后的妊娠率相关，其对术后2年内妊娠的预测价值中等。

Objective To assess the value of endometriosis fertility index （EFI） in predicting the pregnancy outcome af- ter conservative surgery for endometriosis-associated infertility. Methods Medical documents of 170 infertile patients due to cndometriosis undergoing conservative surgery were retrospectively studied from Jan. 2008 to Sep. 2011. Pregnan- cy outcomes were followed up by telephone. EFI was calculated based on the EFI standard items. Calculating pregnancy rate after conservative surgery ; analyzing the relationship between EFI and postoperative cumulative pregnancy rate ; eval- uating the prediction value of EFI for the pregnancy within 2 years after surgery and assessing the factors affecting the postoperative pregnancy rate. Results The crude pregnancy rate after surgery was 60.0% （102/170）. For all the 102 cases, 82. 3% get pregnancy in the first year after treatment. Overall, the postoperative cumulative pregnancy rate was increased along with the raise of the EFI within different time after surgery. As for EFI score of 1 - 5,6 and 7 - 10, total cumulative pregnancy rate was significantly different （ X2 = 9.33, P = 0. 009）. Further, patients with EFI score 7 - 10 had a higher postoperative cumulative pregnancy rate than those with 1 ~ 5, the remaining comparison results showed no significant difference （P 〉 0. 05 ）. ROC curve analysis of EFI showed that the area under curve was 0. 712 （95% CI 0. 604 - 0. 821 ）. The critical value of pregnancy predicted by EFI within 2 years after the operation was 6. 5. COX re- gression analysis demonstrated that the points of age, years infertile and AFS endometriosis score were independently fac- tors for the postoperative pregnancy. The impact of LF on different endometriosis pathological types for postoperative cu- mulative pregnancy rate may be various. Conclusion The patients get the first pregnancy mostly in the first year after conservative surgery or combined with medical therapy. Thus, it is recommended for the infertile patients with endometri- osis to get pregnancy as soon as possible. There is relationship between EFI and postoperative pregnancy rate in patients with endometriosis related infertility. The predictive ability of EFI on the pregnancy within 2 years after operation was in- termediate.