不同评分标准对宫腔粘连预后的预测作用

Predictive effect of different scoring criteria on the prognosis of intrauterine adhesions

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.