子宫内膜异位症早期综合评分临床诊断模型研究
发布时间：2019-05-10 20:32
【摘要】：背景子宫内膜异位症(EMs)严重影响患者生活质量,探讨EMs早期安全有效的诊断方法,对提高其临床诊断正确率、避免腹腔镜手术有重要意义。目的以EMs患者的痛经、慢性盆腔痛、妇科检查结果、超声检查结果、血清上皮性卵巢癌抗原(CA125)检测结果、子宫内膜组织细胞色素芳香化酶(P450arom)检测结果为变量,构建EMs早期综合评分临床诊断模型,并探讨该模型对EMs的早期诊断价值,以期探寻安全有效经济实用的诊断方法,提高EMs的早期诊断正确率,降低腹腔镜手术的可能性。方法选择2015年1月—2016年10月在丽水市中心医院妇产科住院的符合纳入标准的临床诊断为盆腔EMs的拟行腹腔镜手术患者150例为研究对象。采用单纯随机抽样法将患者分为建模组(100例)和验证组(50例)。收集患者一般资料,包括病史、主要症状、妇科检查结果;记录患者超声检查、血清CA125检测、子宫内膜组织P450arom检测结果。以腹腔镜手术结合组织病理学诊断结果为金标准。利用多因素Logistic回归分析构建EMs早期综合评分临床诊断模型,绘制其诊断EMs的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)、灵敏度、特异度。结果建模组中,金标准诊断阳性78例,阴性22例;验证组中,金标准诊断阳性24例,阴性26例。建模组中,超声检查阳性率为91.0%(91/100),血清CA125检测阳性率为64.0%(64/100),子宫内膜组织P450arom检测阳性率为76.0%(76/100)。采用多因素逐步Logistic回归分析构建EMs早期综合评分临床诊断模型:y=-10.77+4.96×痛经+1.88×慢性盆腔痛+3.02×妇科检查体征阳性+3.68×超声检查阳性+1.41×血清CA125检测阳性+4.56×子宫内膜组织P450arom检测阳性。血清CA125检测诊断建模组EMs的AUC为0.735,95%CI(0.614,0.857),灵敏度为74.4%,特异度为72.7%;子宫内膜组织P450arom检测诊断建模组EMs的AUC为0.841,95%CI(0.732,0.951),灵敏度为91.0%,特异度为77.3%;EMs早期综合评分临床诊断模型诊断建模组EMs的AUC为0.969,95%CI(0.936,1.000),诊断截断值为0.833,灵敏度为93.6%,特异度为86.4%。将EMs早期综合评分临床诊断模型用于验证组,AUC为0.881,95%CI(0.777,0.985),灵敏度为91.7%,特异度为84.6%。结论本研究所建立的EMs早期综合评分临床诊断模型,一定程度上提高了EMs的早期诊断正确率,作为一种微创性检查手段,该模型可应用于临床EMs的早期诊断。
[Abstract]:Background Endometriosis (EMs) seriously affects the quality of life of patients. It is of great significance to explore the early safe and effective diagnostic methods of EMs in order to improve the accuracy of clinical diagnosis and avoid laparoscopic surgery. Objective to study the results of dysmenorrhea, chronic pelvic pain, gynecological examination, ultrasound, serum epithelial ovarian cancer antigen (CA125) and endometrial tissue cytochrome aromatase (P450arom) in patients with EMs. To construct the clinical diagnosis model of EMs early comprehensive score, and to explore the value of this model in the early diagnosis of EMs, in order to explore the safety and effectiveness of the model. An economical and practical diagnostic method can improve the accuracy of early diagnosis of EMs and reduce the possibility of laparoscopic surgery. Methods from January 2015 to October 2016, 150 patients who met the inclusion criteria in obstetrics and gynaecology of Lishui Central Hospital were enrolled in this study. The patients were divided into model group (100 cases) and verification group (50 cases) by simple random sampling. The general data of the patients were collected, including medical history, main symptoms, gynecological examination results, ultrasonic examination, serum CA125 test, endometrial tissue P450arom test results. The results of laparoscopic surgery combined with histopathological diagnosis were taken as the gold standard. The clinical diagnosis model of EMs early comprehensive score was constructed by multivariate Logistic regression analysis. The (ROC) curve of the subjects' working characteristics in the diagnosis of EMs was drawn, and the sensitivity and specificity of area (AUC), under ROC curve were calculated. Results in the model group, 78 cases were positive and 22 cases were negative by gold standard, and 24 cases were positive and 26 cases were negative by gold standard in the verification group. In the model group, the positive rate of ultrasound was 91.0% (91 鈮，
本文编号：2473966
[Abstract]:Background Endometriosis (EMs) seriously affects the quality of life of patients. It is of great significance to explore the early safe and effective diagnostic methods of EMs in order to improve the accuracy of clinical diagnosis and avoid laparoscopic surgery. Objective to study the results of dysmenorrhea, chronic pelvic pain, gynecological examination, ultrasound, serum epithelial ovarian cancer antigen (CA125) and endometrial tissue cytochrome aromatase (P450arom) in patients with EMs. To construct the clinical diagnosis model of EMs early comprehensive score, and to explore the value of this model in the early diagnosis of EMs, in order to explore the safety and effectiveness of the model. An economical and practical diagnostic method can improve the accuracy of early diagnosis of EMs and reduce the possibility of laparoscopic surgery. Methods from January 2015 to October 2016, 150 patients who met the inclusion criteria in obstetrics and gynaecology of Lishui Central Hospital were enrolled in this study. The patients were divided into model group (100 cases) and verification group (50 cases) by simple random sampling. The general data of the patients were collected, including medical history, main symptoms, gynecological examination results, ultrasonic examination, serum CA125 test, endometrial tissue P450arom test results. The results of laparoscopic surgery combined with histopathological diagnosis were taken as the gold standard. The clinical diagnosis model of EMs early comprehensive score was constructed by multivariate Logistic regression analysis. The (ROC) curve of the subjects' working characteristics in the diagnosis of EMs was drawn, and the sensitivity and specificity of area (AUC), under ROC curve were calculated. Results in the model group, 78 cases were positive and 22 cases were negative by gold standard, and 24 cases were positive and 26 cases were negative by gold standard in the verification group. In the model group, the positive rate of ultrasound was 91.0% (91 鈮，
本文编号：2473966
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