生育指数评分对子宫内膜异位症不孕患者术后妊娠方式选择的预测价值

目的：分析不同子宫内膜异位症（endometriosis，EMs）生育指数（endometriosis fertility index，EFI）患者的术后自然妊娠率，探讨EFI评分对腹腔镜术后妊娠方式选择的预测价值。方法：回顾性分析2013年1月-2014年12月于郑州大学第一附属医院就诊并行腹腔镜手术治疗的EMs不孕患者的完整资料，共148例，电话随访其术后的妊娠情况。按EFI评分标准对患者进行评分，计算不同分值患者术后的自然妊娠率，采用受试者工作特征（ROC）曲线评价EFI评分对EMs不孕患者术后妊娠率的预测价值。结果：术后36个月内EMs患者的自然妊娠率与EMs分期呈负相关（rs=-0.535，P＜0.001），且各期EMs患者术后6个月内的自然妊娠率均高于术后7～12个月、13～24个月及25～36个月。术后36个月EMs患者的自然妊娠率与EFI评分呈正相关（rs=0.617，P＜0.001），且EFI评分分别为9～10分、7～8分和5～6分的患者，在术后6个月内的妊娠率均高于其他时间段。EFI评分的ROC曲线下面积（AUC）为0.854（95%CI：0.794～0.915，P＜0.001）。通过ROC曲线确定的EFI预测术后1年内自然妊娠的临界值为6.5分（约登指数最大），其预测的敏感度为73.42%，特异度为82.61%。结论：EFI评分与EMs不孕患者腹腔镜术后的自然妊娠率呈正相关，能够较好地预测EMs不孕患者术后1年内的自然妊娠。术后1年是妊娠的最佳时期，应积极试孕，把握时机。

Fertility Index as a Predictor of Pregnancy Pattern Selection for Patients with Endometriosis after Laparoscopic Surgery

Objective：To assess the value of endometriosis fertility index (EFI) in predicting the choice of pregnancy in those infertile patients with endometriosis after laparoscopic surgery. Methods: Clinical data of 148 infertile patients with endometriosis underwent laparoscopic surgery were retrospectively studied from Jan. 2013 to Dec. 2014. The pregnancy outcome was followed up by telephone. The EFI score was calculated. Accordingly, patients were grouped, and the pregnancy rate was compared. The receiver operating characteristic (ROC) curve was used to evaluate the value of EFI in predicting the nature pregnancy. Results: The negative correlation between the rate of natural pregnancy and the EMs stage was found in 36 months after operation（rs=-0.535，P＜0.001）. The rate of natural pregnancy in EMs patients in 6 months after operation was significantly higher than those in 7-12, 13-24 and 25-36 months after operation. There was a positive correlation between the rate of natural pregnancy and the EFI score in EMs patients in 36 months after operation（rs=0.617，P＜0.001）. The rates of pregnancy in those patients with the EFI scores of 9-10, 7-8 and 5-6 were significantly higher in 6 months after operation. The area under curve (AUC) of the ROC curve of EFI was 0.854（95%CI：0.794-0.915，P＜0.001）. The critical value of the EFI score predicted by AUC was 6.5 in one year of operation, with the sensitivity of 73.42% and the specificity of 82.61%. Conclusions: EFI score was positively correlated with the rate of natural pregnancy in those EMs patients after laparoscopic surgery, suggesting that EFI score can be tried to predict the natural pregnancy in one year after operation. One year after surgery is the best duration for the patient to have a pregnancy.