血清FS、HE4联合阴道超声对卵巢型子宫内膜异位症的诊断及严重程度评估价值分析

Diagnostic value of serum FS and HE4 combined with transvaginal ultrasound in ovarian endometriosis and its severity evaluation

目的探讨血清卵泡抑素(FS)、人附睾分泌蛋白4(HE4)联合超声对卵巢型子宫内膜异位症的诊断及严重程度评估价值。方法回顾性选择2020年11月至2022年12月来佛山市中医院治疗的120例卵巢型子宫内膜异位症患者作为研究对象,根据r-AFS分期:Ⅰ期20例,Ⅱ期48例,Ⅲ期34例,Ⅳ期18例。选择同期来佛山市中医院体检的健康女性120例作为对照组,所有受试者均行阴道超声检查及血清FS、HE4检测。分析超声对80例卵巢型子宫内膜异位症患者的阳性诊断率,分析观察组、Ⅰ、Ⅱ、Ⅲ、Ⅳ期及对照组的血清FS、HE4水平,分析经阴道超声、血清FS、HE4及三者联合对卵巢型子宫内膜异位症的诊断价值及诊断准确度。结果阴道超声对子宫内膜异位症阳性者100例,阳性率为83.33%(100/120)。观察组的血清FS、HE4水平明显较对照组高,Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期明显较对照组高,Ⅲ期、Ⅳ期明显较Ⅰ、Ⅱ期高,Ⅳ期明显较Ⅲ期高,Ⅰ期明显较对照组高,差异均有统计学意义(P<0.05)。阴道超声检测阳性例数为100例,血清FS检测阳性例数为78例,血清HE4检测阳性例数为93例,三者联合检测阳性例数为115例。三者联合检测对子宫内膜异位症的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值、Youden指数明显较阴道超声、血清FS、HE4单一检测高,差异均有统计学意义(P<0.05)。三者联合检测对子宫内膜异位症的Ⅰ、Ⅱ、Ⅲ、Ⅳ期准确性较阴道超声、血清FS、HE4单一检测高,Ⅰ、Ⅱ、Ⅲ期中差异有统计学意义(P<0.05),Ⅳ期中差异无统计学意义(P>0.05)。结论与血清FS、HE4、阴道超声单一检测相比,三者联合检测对卵巢型子宫内膜异位症的诊断及严重程度评估价值较高,值得临床推广应用。

Objective To investigate the value of serum folliclestatin(FS)and human epididymis secretory protein 4(HE4)combined ultrasound in the diagnosis and severity evaluation of ovarian endometriosis.Methods A total of 120 patients with ovarian endometriosis who came to Foshan Hospital of Traditional Chinese Medicine from November 2020 to December 2022 were retrospectively selected as the research objects,and 120 healthy women who came to Foshan Hospital of Traditional Chinese Medicine for physical examination during the same period were selected as the control group.According to r-AFS staging,there were 20 cases in stage I,48 cases in stageⅡ,34 cases in stageⅢ,and 18 cases in stageⅣ.All subjects underwent transvaginal ultrasonography and serum FS and HE4 detection.To analyze the positive diagnosis rate of ultrasonography in 80 patients with ovarian endometriosis,to analyze the serum FS and HE4 levels in observation group,stageⅠ,Ⅱ,Ⅲ,Ⅳand control group,and to analyze the diagnostic value of transvaginal ultrasonography,serum FS and HE4 and their combination in ovarian endometriosis and the diagnostic accuracy.Results One hundred cases(83.33%,100/120)were positive for endometriosis.The levels of serum FS and HE4 in the observation group were higher than those in control group;the levels in stageⅠ,Ⅱ,Ⅲ,Ⅳwere higher than those in control group;the levels in stageⅣ,stageⅢwere higher than those in stageⅠ,stageⅡ,stageⅣwere higher than those in stageⅢ;the levels in stageⅠwere higher than those in control group,the differences were statistically significant(P<0.05).The number of positive vaginal ultrasound test cases was 100,the number of positive serum FS test cases was 78,the number of positive serum HE4 test cases was 93,and the number of positive combined test cases was 115.The diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index of the three combined tests were higher than those of vaginal ultrasound,serum FS and HE4,the differences were statistically significant(P<0.05).The accuracy of the combined detection of the three in stagesⅠ,Ⅱ,Ⅲ,Ⅳof endometriosis was higher than that of vaginal ultrasound,serum FS,and HE4 single detection,the difference in stages I,II,and III was statistically significant(P<0.05),while the difference in stages IV was not statistically significant(P>0.05).Conclusion Compared with the single detection of serum FS,HE4 and transvaginal ultrasound,the combined detection of FS,HE4 and transvaginal ultrasound has higher value in the diagnosis and severity assessment of ovarian endometriosis,and is worthy of clinical application.