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目的:探讨单用阴道超声(TVS)、子宫输卵管造影(HSG)、超声子宫水造影(SIS)以及三种方法联合诊断不孕症患者子宫内膜息肉(EP)的临床价值。方法:以206例行宫腔镜联合诊刮或病检的不孕症患者为研究对象,回顾性分析各种检查方法对EP的筛查结果,评价各种检查方法的真实性、可靠性以及预测值。结果:206例不孕症中,共确诊EP患者60例,阳性率29.1%。三种检查方法中,TVS的灵敏度最高(70.0%),特异度最低(73.3%),漏诊率最低(30.0%),误诊率最高(26.7%),正确诊断指数最高(43.3%),阴性似然比最小(0.409),阴性预测值最高(85.6%);SIS检查的灵敏度最低(38.7%),漏诊率最高(61.3%),但是特异性最高(93.3%),误诊率最低(6.7%),阳性似然比最大(4.284),阳性预测值最大(66.6%),正确诊断指数最低(32.0%);HSG检查的上述各项评价指标均介于TVS和SIS之间。TVS和SIS与金标准的符合率低,Kappa值均小于0.4;HSG符合率最高(86.2%),Kappa值0.647。三种检查联合诊断的灵敏度89.3%,漏诊率10.7%,特异度91.4%,误诊率8.6%,正确诊断指数80.7%,阳性似然比10.384,阴性似然比0.117,符合率89.3%,Kappa值0.792,阳性预测值83.3%,阳性预测值94.6%。结论:对于宫腔可能存在内膜息肉的不孕症患者,单一采用阴道超声检查、子宫输卵管造影或超声子宫水造影方法的灵敏度均较低,漏诊率高,与金标准的一致性较差,而三种方法联合用于诊断不孕症患者EP的真实性、可靠性及预测值均较好。
Objective: To investigate the clinical value of single vaginal ultrasound (TVS), hysterosalpingography (HSG), ultrasonic uterine hydrography (SIS) and three methods in the diagnosis of infertility patients with endometrial polyps (EP). Methods: Totally 206 infertility patients who underwent hysteroscopy combined with curettage or pathological examination were selected as the research objects. The screening results of various examination methods were analyzed retrospectively to evaluate the authenticity, reliability and prediction of various examination methods value. Results: Among 206 infertility cases, 60 cases were diagnosed as EP, the positive rate was 29.1%. TVS had the highest sensitivity (70.0%), the lowest specificity (73.3%), the lowest misdiagnosis rate (30.0%), the highest misdiagnosis rate (26.7%), the highest correct diagnostic index (43.3% The lowest (0.409) and negative (85.6%); the lowest SIS (38.7%), the highest misdiagnosis rate (61.3%), the highest specificity (93.3%) and the lowest misdiagnosis rate (6.7% , The positive likelihood ratio (4.284), the highest positive predictive value (66.6%) and the lowest correct diagnostic index (32.0%). The above indexes of HSG examination ranged from TVS to SIS. TVS and SIS meet the gold standard with low Kappa values of less than 0.4; HSG highest coincidence rate (86.2%) and Kappa value of 0.647. The diagnostic sensitivity of the three tests was 89.3%, the misdiagnosis rate was 10.7%, the specificity rate was 91.4%, the misdiagnosis rate was 8.6%, the correct diagnosis index was 80.7%, the positive likelihood ratio was 10.384, the negative likelihood ratio was 0.117, the coincidence rate was 89.3% 0.792, positive predictive value 83.3%, positive predictive value 94.6%. Conclusions: The sensitivity of single vaginal ultrasound examination, uterine tubal angiography or ultrasound uterine hydrographic method is low, the rate of misdiagnosis is high, and the consistency with the gold standard is poor for patients with infertility who may have endometrial polyps in the uterine cavity. The three methods combined for the diagnosis of infertility EP authenticity, reliability and predictability are good.