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目的探究子宫内膜异位症生育指数(EFI)在预测中重度(Ⅲ~Ⅳ期)内异症相关不孕术后非辅助生殖技术(ART)妊娠结局的价值。方法选取新疆医科大学附属中医医院在2013年12月至2014年12月期间收治的、符合纳入标准的中重度内异症者60例,均行腹腔镜治疗。分析患者术后不同时期非ART妊娠率情况;随访2年,分析促排卵、EFI评分等与非ART妊娠率的相关性;绘制EFI的ROC曲线,判断其预测价值。结果随访2年,术后非ART总妊娠率为55.00%(33/66);术后半年、1年、2年的非ART妊娠率分别为36.67%(22/60)、15.00%(9/60)、3.33%(2/60),差异具有统计学意义(χ~2=38.23,P<0.01);非ART妊娠率与促排卵治疗、EFI评分有关(χ~2值分别为10.09、27.81,均P<0.01);EFI评分的ROC曲线下面积为0.70,其约登指数最大值、特异度、敏感度分别为5.9、72.41%(21/29)、30.00%(12/40)。结论 EFI能较好的预测中重度内异症相关不孕术后非ART妊娠结局。
Objective To investigate the value of fertility index (EFI) of endometriosis in predicting the outcome of non-assisted reproductive technology (ART) pregnancy after moderate to severe endometriosis-related infertility (stage Ⅲ-Ⅳ). Methods Sixty cases of moderate-severe endometriosis who met the inclusion criteria were selected from the Chinese Medicine Hospital Affiliated to Xinjiang Medical University between December 2013 and December 2014. All patients underwent laparoscopy. The incidence of non-ART pregnancies at different stages of postoperative follow-up was analyzed. The follow-up was 2 years. The correlation between ovulation induction, EFI score and non-ART pregnancy rate was analyzed. The ROC curve of EFI was plotted to determine its predictive value. Results The overall non-ART pregnancy rate was 55.00% (33/66) after 2 years of follow-up. The non-ART pregnancy rates at 6 months, 1 year and 2 years after operation were 36.67% (22/60) and 15.00% (Χ ~ 2 = 38.23, P <0.01). The rate of non-ART pregnancy was related to ovulation induction treatment and EFI score (χ ~ 2 = 10.09,27.81 , All P <0.01). The area under the ROC curve of EFI score was 0.70. The maximum, specificity and sensitivity of the Youden index were 5.9, 72.41% (21/29) and 30.00% (12/40), respectively. Conclusion EFI can better predict the outcome of non-ART pregnancy related to endometriosis-related infertility.