摘要
目的探讨不同临床指标在鉴别盆腔炎性疾病(PID)后遗症与盆腔子宫内膜异位症(EM)中的作用。方法回顾性分析29例临床误诊为子宫内膜异位症的盆腔炎性疾病后遗症患者的临床资料,并以同期72例子宫内膜异位症患者为对照,单变量和多变量分析不同临床指标在鉴别诊断中的作用。结果无继发痛经、无性交痛、无骶韧带痛性结节、慢性腹痛和初潮年龄≥14岁诊断PID的敏感性分别为72.4%、96.6%、86.2%、65.5%和69.0%,特异性分别为58.3%、20.8%、59.7%、62.5%和54.2%。组合指标中,敏感性较高的为无继发痛经或无性交痛、无骶韧带痛性结节或无性交痛、慢性腹痛或无性交痛、初潮年龄≥14岁或无性交痛、慢性腹痛或无骶韧带痛性结节,其敏感性分别为100%、100%、96.6%、96.6%和96.3%;特异性较高的组合指标有慢性腹痛和无骶韧带痛性结节、慢性腹痛和无继发性痛经、慢性腹痛和初潮年龄≥14岁,其特异性为88.9%、86.1%和83.3%。多变量分析慢性盆腔痛、初潮年龄和骶韧带痛性结节3项指标选入了最终方程,回归方程式为:子宫内膜异位症的可能性=1/[1+e-(5.591-1.75×慢性盆腔痛有/无-0.355×初潮年龄+2.482×骶韧带痛性结节有/无)],以0.5为判别分界点,公式的准确率为82.3%。结论规范的临床检查有助于减少子宫内膜异位症的误诊。
Objective To investigate the clinical methods of differential diagnosis between pelvic inflammato- ry disease （PID） and endometriosis （EM）. Methods The clinical data of 29 cases of PID who were misdiagnosed as EM and 72 cases of EM were analyzed retrospectively. Results The sensitivity for symptoms such as non- secon- dum dysmenorrhea, non - dyspareunia, non - tenderness nodules at uterosacral ligament, chronic pelvic pain and menarche age older than 14 years to diagnose PID were 72.4%, 96.6~, 86.2~, 65.5% and 69.0%, respectively, and the specificity for that were 58.3%, 20. 8%, 59.7%0, 62.5% and 54.2%. Among the factor- combinations, the ones having higher sensitivity were non- secondum dysmenorrhea or non - dyspareunia, non - dyspareunia or non - tenderness nodules at uterosacral ligament, chronic pelvic pain or non- dyspareunia, menarche age older than 14 years or non- dyspareunia, chronic pelvic pain or non- tenderness nodules at uterosacral ligament, with the sensi- tivity of 100%, 100%, 96.6%, 96.6% and 96.3%, respectively; the ones having higher specificity were chronic pelvic pain and non- tenderness nodules at uterosacral ligament, chronic pelvic pain and non- secondum dysmenor- rhea, chronic pelvic pain and menarche age older than 14 years, with the specificity of 88. 9%. 86. 1%. 83. 3%, respec- tively. From the multivariate analysis, three factors entered the final formula, they were menarehe age, tenderness nodules at uterosacral ligament and chronic pelvic pain. The formula for the potentiality of EM was. 1/ [1 ＋ e-（5. 591-1.75×chronic pelvic pain yes/no-0. 355× he age ＋2.482×ende nodules at uterosacral ligament yes/no）] . With the cut value of 0. 5, the accu- racy of this formula was 82. 3 %. Conclusions Correct clinical examination will reduce the misdiagnosis rate of endometriosis.
出处
《中国妇产科临床杂志》
2009年第5期326-329,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
子宫内膜异位症
盆腔炎性疾病
鉴别诊断
慢性盆腔痛
endometriosis
pelvic inflammatory disease
differential diagnosis
chronic pelvic pain
