Diagnostic Value Of Chronic Endometritis By Hysteroscopy And CD138 Immunohistochemistry And Riskfactors Associated With Chronic Endometritis On Infertility

Objective:To evaluate the diagnostic value ofhysteroscopy and CD138 immunohistochemistry inchronic endometritis(CE)aswellas investigate the risk factors in infertile patients with CE.Method:A total of 307 infertility patients were selected from the reproductive medicine department of affiliated hospital of Qingdao university from July 2018 to November2019.All of them underwent hysteroscopy to observe and record the condition of the uterine cavity.At the same time,endometrial tissues were taken for CD138 immunohistochemical staining,which was a marker of endometria stroma plasmacyte(ESPC)specific monoclonal antibody.The endometrial hyperemia,endometrial interstitial edema,micro-polyps and thickening of blood vessels were regarded as the characteristic performance of CE for hysteroscopy,and CD138 positive as the criteria for pathological diagnosis of CE.The incidence of CE in infertile patients was calculated to evaluate the diagnostic value of CE by hysteroscopy and CD138 immunohistochemical examination and the incidence of CE manifestations under hysteroscopy.Patients’ medical history was collected,and all patients were divided into CD138 positive group(CE group,139 cases)and CD138 negative group(non-CE group,168 cases)according to the results of CD138 immunohistochemical examination.The general and previous pregnancy conditions of the two groups were compared to investigate the relationship between CE and recurrent spontaneous abortion(RSA)and recurrent implantation(RIF).The possible factors of CE occurrence were analyzed by univariate and multivariate unconditional logistic regression analysis to explore the risk factors of CE prevalence.Results:1.TheCEprevalence in infertility patients was 39.74% and 45.28% by hysteroscopy and CD138 immunohistochemical examinationseparately.The diagnostic rate of CE by CD138 immunohistochemical examination was higher than that by hysteroscopy.Using CD138 immunohistochemical results as diagnostic criteria,the accuracy of CE diagnosis by hysteroscopy was 77.52%(95% confidence interval(CI)0.729～0.822),and the sensitivity,specificity,positive predictive value and negative predictive value were69.06%(95%CI 0.605～0.765),84.52%(95%CI 0.780～0.895),78.68%(95%CI0.702～0.857)and 76.76%(95%CI 0.699～0.825)respectively.Among the patients with CE diagnosed by hysteroscopy,the incidence of endometrial hyperemiawas the highest(41.80%),followed by endometrial micro-polyps(17.21%)and thickening of blood vessels(14.75%),and the incidence of endometrial interstitial edema was the lowest(7.37%)(P< 0.05).For patients with one or more CE characteristics under hysteroscopy,the CE positive rate of CD138 immunohistochemical examination was higher than that of patients without CE performance(76.47%,66.67%,90.47%,72.22%,82.60%vs23.24%),the difference was statistically significant(P< 0.05).2.The incidence of previous abortion frequency ≥2 times(15.83%)and the rate of RIF(15.83%)in the CE group were significantly higher than those in the non-CE group(7.74%,8.33%),with statistically significant differences(P<0.05).The results of single factor analysis showed that previous number of abortion ≥2,oviduct obstruction,history of intrauterine device(IUD),endometriosis(EMT)and CE were correlated(P< 0.05).Previous abortion frequency ≥2times(P<0.05,OR=2.133,95%CI 1.007～4.516),oviduct obstruction(P<0.05,OR=1.754,95% CI 1.024～3.002),history of IUD(P<0.05,OR=6.776,95% CI 1.869～24.570)and EMT(P<0.05,OR=2.658,95% CI 1.212～5.827)were independent risk factors for CE.Conclusion:CD138 immunohistochemical examination can improve the diagnostic rate of CE in infertility patients.The characteristic manifestations of CE diagnosed by hysteroscopy are endometrial hyperemia,endometrial interstitial edema,endometrial micro-polyp and endometrial vascular thickenment,which have certain accuracy.At the same time,CE can cause RIF.The number of previous abortions ≥ 2 times,tubal obstruction,history of IUD,and EMT are high risk factors for CE.It should be paid attention in clinical work.Examine the condition of the uterine cavity,and perform endometrial biopsy and CD138 immunohistochemical pathology to confirm the diagnosis and timely treatment to improve pregnancy outcome.