经阴道子宫输卵管四维超声造影联合抗HCG抗体评估不孕症输卵管通畅程度的临床研究

Assessment of tubal patency in infertility via four-dimensional hysterosalpingo-contrast sonography combined with anti-HCG antibody

摘要:

目的 分析经阴道子宫输卵管四维超声造影（TVS4D-HyCoSy）联合抗人绒膜促性腺激素（HCG）抗体评估不孕症输卵管通畅程度的效果。方法 选取2019年1月—2021年3月就诊于阜阳市人民医院的98例不孕症患者。患者接受TVS4D-HyCoSy检查，造影3个月后接受腹腔镜通液术，使用酶联免疫吸附试验测定血清抗HCG抗体水平。不同输卵管系统检测患者血清抗HCG抗体阳性率，将腹腔镜通液术结果作为金标准，评估TVS4D-HyCoSy、抗HCG抗体及两者联合检测不孕症输卵管通畅的诊断效能。结果 不同输卵管系统评分患者血清抗HCG抗体阳性率比较，差异有统计学意义（P <0.05），Ⅲ度抗HCG抗体阳性率高于Ⅱ度，Ⅰ度最低。98例不孕症患者共检查193条输卵管（其中1例单角子宫，2例一侧输卵管切除），其中通畅40条，通而不畅73条，阻塞80条。联合诊断的敏感性、特异性、准确率高于TVS4D-HyCoSy、抗HCG抗体（P <0.05）。结论 TVS4D-HyCoSy联合抗HCG抗体在评估不孕症输卵管通畅程度中具有较高的敏感性、特异度及准确率，可指导临床诊治。

Abstract:

Objective To analyze the effect of transvaginal four-dimensional hysterosalpingo-contrast sonography (TVS4D-HyCoSy) combined with anti-human chorionic gonadotropin (HCG) antibody on the evaluation of tubal patency in infertility.Methods A total of 98 infertile patients who were admitted to Fuyang People's Hospital from January 2019 to March 2021 were selected. All patients underwent TVS4D-HyCoSy examination followed by laparoscopic hydrotubation after 3 months, and enzyme-linked immunosorbent assay was applied to determine serum anti-HCG antibody levels. The positive rate of serum anti-HCG antibodies was determined in patients with different evaluation scores of fallopian tubes, and the results of laparoscopic hydrotubation were established as the gold standard to evaluate the diagnostic efficacy of TVS4D-HyCoSy, anti-HCG antibodies and the combined detection of the two for tubal patency in infertility.Results The positive rate of serum anti-HCG antibody was significantly different among infertile patients with distinct evaluation scores of fallopian tubes (P < 0.05), and was higher in degree Ⅲ patients than in degree Ⅱ patients but lowest in degree I patients. A total of 193 fallopian tubes were examined in 98 infertile patients, among which 40 were unobstructed, 73 were obstructed and 80 were blocked. The sensitivity (92.50%), specificity (88.24%) and accuracy (89.12%) for evaluating tubal patency in infertility of TVS4D-HyCoSy combined with anti-HCG antibody were higher than those of TVS4D-HyCoSy (75.00%, 81.05%, and 79.79%, respectively) or anti-HCG antibody (62.50%, 76.47%, and 73.58%, respectively) alone (P < 0.05).Conclusions TVS4D-HyCoSy combined with anti-HCG antibody exhibits high sensitivity, specificity and accuracy in the assessment of tubal patency in infertility, and may therefore guide clinical diagnosis and treatment.