Establishment And Effect Analysis Of Hysteroscopic Scoring System For Chronic Endometritis In Infertile Patients

Objective:To explore the value of hysteroscopy in the diagnosis of chronic endometritis（CE）,to find and determine the high-risk features of hysteroscopy in CE,and to establish a hysteroscopic scoring system to guide clinical practice,and to study the effect of this system instead of histological reexamination of CE on pregnancy outcome.Methods:1 From October 1,2019 to December 31,2019,238 female patients who met the inclusion criteria were examined by hysteroscopy and endometrial biopsy in the Reproductive Center of Shijiazhuang Obstetrics and Gynecology Hospital of Hebei Province because of infertility.According to the gold standard of endometrial stromal CD138+cells≥5 in at least one high power visual field（HPF）of CD138,73 cases were diagnosed as CE（CE group）and165 cases were diagnosed as NCE（NCE group）.General clinical data（age,body mass index,basal luteinizing hormone,basal follicle stimulating hormone,etc.）,possible related risk factors（secondary infertility,history of tubal obstruction,history of cesarean section,history of abortion,history of ectopic pregnancy,repeated implantation failure,recurrent abortion,etc.）,suspicious CE manifestations of hysteroscopy（punctate hemorrhage,flaky hyperemia,tiny polyps,interstitial edema,Polypoid hyperplasia,etc.）were recorded.According to the six equal divisions of uterine cavity area,the description of hyperemia area（HA）was divided into five grades（HA=0,0<HA<1/6,1/6≤HA<1/3,1/3≤HA<1/2,HA≥1/2）,which were expressed as 0,1,2,3 and 4,respectively.The independent risk factors affecting CE were analyzed by univariate and bivariate Logistic regression analysis.Under the action of multiple independent risk factors X,the probability of CE occurrence was expressed by Logistic regression model as:P=eⁿ/（1+eⁿ）,n=β₀+β₁X1+……+βp Xp.The higher theβvalue,the higher the risk of CE.Therefore,according to theβregression coefficient,the corresponding score of independent risk factors was set up,and the hysteroscopic scoring system was established.The diagnostic value of the system was evaluated by Receiver Operating Characteristic Curve（ROC）,Hosmer-Lemeshow goodness-of-fit test and Kappa test.2 Based on the fact that CE reexamination was negative to improve pregnancy outcome and patients’resistance to repeated biopsies,hysteroscopy was used instead of biopsy during reexamination.CE patients who underwent hysteroscopy reexamination in the same period were collected.According to the results of hysteroscopy,the patients treated with CE were divided into CE cured group（group B,n=30）and persistent CE group（group C,n=16）.The pregnancy outcome of the first resuscitation and transplantation cycle was compared with hysteroscopic scoring system and CD138 immunohistoch-emical negative group（group A,n=31）.Results:1 Univariate and binary Logistic regression analysis showed that history of ectopic pregnancy,micropolyps,Polypoid hyperplasia,HA2 grade,HA3grade and HA4 grade were independent risk factors for CE.These six factors constituted hysteroscopic scoring system.According to theβregression coefficient of Logistic regression analysis,the independent factors were divided into ectopic pregnancy history（1 point）,tiny polyps（1.5 points）,Polypoid hyperplasia（2 points）,HA2 grade（2 points）,HA3 grade（2.5 points）and HA4 grade（3 points）,with a total of 12 points.The area under the ROC of the scoring system is 0.79,the best cutoff value is 1.25,the sensitivity and specificity are 74.0%and 73.9%respectively,and the positive predictive value and negative predictive value are 55.7%and 86.5%respectively.P value of Hosmer-Lemeshow goodness-of-fit test is 0.914,Kappa value=0.439.The prevalence rate of CE in CD138 immunohistochemistry was 30.67%（73/238）,and the prevalence rate of CE under hysteroscopic scoring system was 40.76%（97/238）.2 In the resuscitation transplantation cycle,the clinical pregnancy rate in group B（66.67%）was higher than that in group A（48.39%）and group C（50.00%）,the early abortion rate in group B（10.00%）was higher than that in group A（6.67%）and C（0%）,but the difference was not statistically significant（P>0.05）.Conclusions:HA≥2 grade,small polyps,Polypoid hyperplasia and history of ectopic pregnancy are independent risk factors affecting CE.The hysteroscopic scoring system established according to Logistic regression analysis has high sensitivity and specificity,and has high predictive value for CE.When endometrial biopsy does more harm than good,CD138 immunohistochemical results are not ideal,and patients refuse endometrial biopsy,hysteroscopy is the most valuable alternative.Hysteroscopic reexamination of CE cured patients can effectively improve the pregnancy outcome.