宫腔镜检查后子宫内膜活检+免疫组化对提高子宫内膜炎的检出率的临床应用

Clinical Application of Endometrial Biopsy and Immunohistochemistry after Hysteroscopy to Improve the Detection Rate of Endometritis

目的观察宫腔镜检查后子宫内膜活检联合免疫组化检查用于子宫内膜炎诊断的价值。方法选择2020年6月—2023年6月乌鲁木齐市第一人民医院就诊的不孕症患者,结合其症状、体征、病史等考虑可能为慢性子宫内膜炎患者150例为研究对象。均接受宫腔镜检查、诊断性刮宫,以及子宫内膜活检与免疫组化染色检查,将宫腔镜检查结果作为金标准。比较宫腔镜检查后子宫内膜活检与免疫组化检查单独、结合使用对子宫内膜炎检出率及诊断效能。结果150例疑似子宫内膜炎患者经临床诊断确诊99例,子宫内膜炎检出率为66.00%。子宫内膜活检、免疫组化检查单独及联合对子宫内膜炎的检出率分别为58.67%(88/150)、66.67%(100/150)、73.33%(110/150),联合检出率高于单独检出率,差异有统计学意义(χ^(2)=7.232,P=0.027)。宫腔镜检查后,子宫内膜活检、免疫组化检查单独及联合对子宫内膜炎的灵敏度分别82.83%(82/99)、89.90%(89/99)、96.97%(96/99),联合检出灵敏度高于子宫内膜活检、免疫组化检查单用,差异有统计学意义(χ^(2)=10.901,P=0.004)。子宫内膜活检、免疫组化检查单独及联合诊断子宫内膜炎与金标准的一致性Kappa值分别为0.675、0.687、0.734,联合诊断与金标准的一致性较高。结论宫腔镜检查后子宫内膜活检结合免疫组化检查,对子宫内膜炎的检出率高于二者单用,可提高子宫内膜炎检出率,且具有较高的诊断效能。

Objective To observe the value of endometrial biopsy combined with immunohistochemical examination after hysteroscopy in the diagnosis of endometritis.Methods A total of 150 cases of patients with chronic endometritis were selected from Urumqi First People's Hospital from June 2020 to June 2023 as the study objects,and their symptoms,signs and medical history were considered.All patients underwent hysteroscopy,diagnostic curettage,endometrial biopsy and immunohistochemical staining,and the results of hysteroscopy were taken as the gold standard.To compare the detection rate and diagnostic efficacy of endometrial biopsy and immunohistochemistry after hysteroscopy alone and in combination.Results Among 150 suspected patients with endometritis,99 cases were confirmed by clinical diagnosis,and the detection rate of endometritis was 66.00%.The detection rates of endometrial biopsy,immunohistochemical examination alone and combined were 58.67%(88/150),66.67%(100/150)and 73.33%(110/150),respectively,and the detection rate of combined was higher than that of single,the difference was statistically significant(χ^(2)=7.232,P=0.027).After hysteroscopy,the sensitivity of endometrial biopsy,immunohistochemistry alone and combined were 82.83%(82/99),89.90%(89/99)and 96.97%(96/99),respectively,and the sensitivity of combined detection was higher than that of endometrial biopsy and immunohistochemistry alone,the difference was statistically significant(χ^(2)=10.901,P=0.004).The Kappa values of endometrial biopsy,immunohistochemical examination and combined diagnosis of endometritis were 0.675,0.687 and 0.734,respectively,the combined diagnosis had the highest consistency with the gold standard.Conclusion The detection rate of endometrial biopsy combined with immunohistochemical examination after hysteroscopy is higher than that of the two alone,which can improve the detection rate of endometritis and has higher diagnostic efficacy.