Med J Chin PLA, Vol. 42, No. 5, May 1, 2017 439 [ ] (IUA) 2010 1 2017 1 IUA 2 100 March AFS ESGE IUA 2 ESGE IUA (AUC) 0.722 0.754 0.635 MarchAUC 0.652 0.725 AFS IUA IUA ESGE March AFS [ ] Asherman [ ] R711.5 [ ] A [ ] 0577-7402(2017)05-0439-06 [DOI] 10.11855/j.issn.0577-7402.2017.05.14 Predictive efficacy of different intrauterine adhesion (IUA) classification systems on the prognosis of patients with IUA SUN Dong-hua, HE Yuan-li *, ZHANG Dong-mei, HUANG Xiao-bin, CAI Hui-hua, ZENG Li-ying Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China * Corresponding author, E-mail: heyuanli310@163.com This work was supported by the National Natural Science Foundation of China (81270658) [Abstract] Objective To explore the effects of different intrauterine adhesion (IUA) classification systems on predicting the IUA prognosis. Methods One hundred cases were selected as the subjects in present study from those diagnosed with IUA and underwent surgery in Zhujiang Hospital of Southern Medical University from Jan. 2010 to Jan. 2017, and were followed up for two years. According to the actual situation, all patients were scored by March, AFS, ESGE and Chinese classification for comparing the effects of different IUA classification systems on predicting the pregnancy rate, live birth rate and effective rate within 2 years after surgery. Results ESGE classification had a good effect on predicting the postoperative live birth rate and effective rate, and a certain predictive effect on pregnant rate, with the area under curve (AUC) of 0.722, 0.754 and 0.635, respectively. March classification had a certain effect on predicting the postoperative live birth rate and effective rate with AUC of 0.635, 0.754, respectively, but had a poor effect on predicting pregnant rate. AFS classification and China classification had poor effect on predicting the IUA prognosis. Conclusion ESGE classification system is better than the other systems including March, AFS and Chinese classification, on predicting the IUA prognosis, but further verification in large sample size is still required. [Key words] intrauterine adhesion; Asherman syndrome; classification systems; prognosis (intrauterine adhesion IUA) (Asherman syndrome) ( ) ( ) [ ] (81270658) [ ] [ ] 510282 ( ) [ ] E-mail heyuanli310@163.com [1-2] [3] IUA (transcervical resection of adhesions TCRA) IUA [1,4] IUA 1978 March [5] 1988 (American Fertility Society AFS) [6] 1998 (European Society for Gynaecological Endoscopy ESGE) [1]
440 2017 5 1 42 5 IUA 3 2015 IUA [7] IUA 1 1.1 2010 1 2017 1 IUA 137 100 31.9 5.4(20~46) IUA 2 - (IVF-ET) 37 34 7 4 2 3 1 12 1.2 1.2.1 IUA March AFS ESGE [1,5-7] 1.2.2 Hegar 10 B 2~3 1.2.3 2 2 1.3 SPSS 19.0 x±s One-Way ANOVA SNK-q χ 2 Spearman Logistic ROC P<0.05 2 2.1 IUA 100 IUA 2 37 26 2 63 83 17 IUA (BMI) Spearman IUA IUA (P<0.05) IUA (P>0.05) 2.2 IUA IUA Spearman March AFS ESGE ( 1) IUA Spearman March
Med J Chin PLA, Vol. 42, No. 5, May 1, 2017 441 Variable Preoperative menstruation 1 IUA Tab.1 Correlation of different variables to postoperative IUA prognosis Endometrial thickness Gestational history Curettage history Adhesion range Adhesion properties opening of oviduct Pregnancy rate 0.002 0.023 0.054 0.001 0.137 0.162 0.212 * Live birth rate 0.165 0.069 0.010 0.001 0.215 * 0.238 * 0.289 * Effective rate 0.082 0.056 0.087 0.163 0.343 * 0.240 * 0.273 * * Presents P<0.05 AFS ESGE ( 2) 2 IUA Tab.2 Correlation of different types of score criteria to the prognosis of postoperative IUA Variable Parameter March AFS ESGE Chinese Pregnancy rate Live birth rate γ 0.155 0.086 0.231 0.176 P 0.125 0.393 0.021 0.079 γ 0.244 0.177 0.344 0.219 P 0.014 0.078 0.000 0.028 γ 0.311 0.193 0.338 0.174 Effective rate P 0.012 0.055 0.001 0.083 AFS. American Fertility Society; ESGE. European Society for Gynaecological Endoscopy 2.3 IUA logistic Logistic March AFS ( P=0.124 OR=0.673 95%CI 0.406~1.115 P =0.338 OR=0.800 95%CI 0.482~1.328 P=0.082 OR=0.554 95%CI 0.285~1.079) ESGE (P=0.023 OR=0.707 95%CI 0.524~0.954) AFS (P=0.081 OR=0.599 95%CI 0.337~1.064) March ESGE ( P=0.017 OR=0.491 95%CI 0.274~0.881 P =0.001 OR=0.546 95%CI 0.379~0.786 P=0.030 OR=0.433 95%CI 0.203~0.923) AFS ( P=0.061 OR=0.512 95%CI 0.254~1.030 P=0.085 OR=0.471 95%CI 0.200~1.109) March ESGE ( P=0.004 OR=0.306 95%CI 0.136~0.690 P=0.002 OR=0.466 95%CI 0.286~0.761 3) 2.3 ROC ROC 4 IUA 3 IUA logistic Tab.3 Univariate logistic regression analysis of different score criteria to IUA prognosis Variable Classification β P OR 95%CI March 0.396 0.124 0.673 0.406-1.115 Pregnancy rate AFS 0.223 0.388 0.800 0.482-1.328 ESGE 0.347 0.023 0.707 0.524-0.954 Chinese 0.590 0.082 0.554 0.285-1.079 March 0.712 0.017 0.491 0.274-0.881 Live birth rate AFS 0.513 0.081 0.599 0.337-1.064 ESGE 0.605 0.001 0.546 0.379-0.786 Chinese 0.836 0.030 0.433 0.203-0.923 March 1.185 0.004 0.306 0.136-0.690 Effective rate AFS 0.670 0.061 0.512 0.254-1.030 ESGE 0.763 0.002 0.466 0.286-0.761 Chinese 0.752 0.085 0.471 0.200-1.109 B=ln(OR); OR. Odds ratio; 95%CI. 95% confidence interval ESGE (AUC) 0.635 0.722 0.754 March 0.652 0.725 AFS 4 ESGE AUC ( 4 1) 4 IUA ROC Tab.4 The parameters of ROC curve of different score criteria to IUA prognosis Variable Classification AUC SE P 95%CI March 0.587 0.059 0.147 0.471-0.703 Pregnancy rate AFS 0.549 0.060 0.418 0.431-0.667 ESGE 0.635 0.058 0.024 0.522-0.749 Chinese 0.593 0.059 0.122 0.478-0.708 March 0.652 0.062 0.022 0.529-0.774 Live birth rate AFS 0.610 0.065 0.097 0.482-0.737 ESGE 0.722 0.056 0.001 0.612-0.831 Chinese 0.627 0.061 0.055 0.508-0.746 March 0.725 0.067 0.004 0.593-0.857 Effective rate AFS 0.640 0.073 0.071 0.496-0.784 ESGE 0.754 0.066 0.001 0.625-0.884 Chinese 0.618 0.074 0.127 0.473-0.763 AUC. Area under curve; SE. Standard error
442 2017 5 1 42 5 1.0 1.0 0.8 0.8 Sensitivity 0.6 0.4 Sensitivity 0.6 0.4 0.2 0.2 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1-Specificity A 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1-Specificity B 1.0 0.8 Sensitivity 0.6 0.4 0.2 March AFS ESGE Chinese Line of reference 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1-Specificity C 1 IUA ROC Fig.1 ROC curve of different classification and prognosis of IUA A. Pregnancy rate; B. Live birth rate; C. Effective rate 3 IUA IUA IUA 25%~30% [8] IUA [7] IUA [1] IUA 3 March AFS ESGE 3 (AFS) (ESGE) IUA IUA [7] IUA [9] 148 IUA March AFS ESGE Nasr March March AFS ESGE 100 IUA TCRA 4 ESGE IUA (AUC>0.7) (AUC<0.7) March ESGE ESGE March AFS AFS ESGE IUA
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