Diagnosis of endometriosis by detection of nerve fibres in an endometrial biopsy: a double blind study
Diagnosis of endometriosis by detection of nerve fibres in an endometrial biopsy: a double blind study
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DOI：
10.1093/humrep/dep275
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发表时间：
2009-12-01
影响因子：
6.1
通讯作者：
Fraser, I. S.
中科院分区：
文献类型：
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作者：
Al-Jefout, M.;Dezarnaulds, G.;Fraser, I. S.
子宫内膜异位症的诊断目前需要腹腔镜检查，这种需要可能会导致相当大的平均延误诊断。我们曾报道子宫内膜异位症妇女子宫内膜功能层中存在神经纤维，这可用作诊断试验。我们的目的是评估神经纤维检测在子宫内膜活检中诊断子宫内膜异位症的有效性，并与专家诊断性腹腔镜检查进行双盲比较。子宫内膜活检，采用蛋白质基因产物9.5作为标记物进行免疫组化神经纤维检测，来自99名连续女性，表现为盆腔疼痛和/或不孕症，由经验丰富的妇科腹腔镜医生进行诊断性腹腔镜检查，在腹腔镜诊断为子宫内膜异位症的女性中（n = 64），子宫内膜活检功能层的平均神经纤维密度为2.7神经纤维/mm（2）（+/- 3.5 SD）。只有一名患有子宫内膜异位症的妇女没有检测到神经纤维。腹腔镜检查发现6例子宫内膜神经纤维增生，但未见活动性子宫内膜异位症。特异性和敏感性分别为83%和98%，阳性预测值为91%，阴性预测值为96%。神经纤维密度在不同的月经周期阶段之间没有差异。有子宫内膜异位症和疼痛症状的妇女与不孕但没有疼痛的妇女相比，神经纤维密度明显更高（每平方毫米分别有2.3和0.8根神经纤维，P = 0.005）。子宫内膜活检，检测神经纤维，提供了子宫内膜异位症诊断的可靠性，其准确性接近经验丰富的妇科腹腔镜医师的腹腔镜评估。在澳大利亚临床试验注册中心（ACTR）注册00082242（注册日期：2007年12月12日）。本研究获得了悉尼西南地区卫生服务伦理审查委员会（RPAH区）（方案编号X 05 -0345）和悉尼大学人类研究伦理委员会（参考编号10761）的批准，所有女性均签署了参与的知情同意书。
Diagnosis of endometriosis currently requires a laparoscopy and this need probably contributes to the considerable average delay in diagnosis. We have reported the presence of nerve fibres in the functional layer of endometrium in women with endometriosis, which could be used as a diagnostic test. Our aim was to assess efficacy of nerve fibre detection in endometrial biopsy for making a diagnosis of endometriosis in a double-blind comparison with expert diagnostic laparoscopy.Endometrial biopsies, with immunohistochemical nerve fibre detection using protein gene product 9.5 as marker, taken from 99 consecutive women presenting with pelvic pain and/or infertility undergoing diagnostic laparoscopy by experienced gynaecologic laparoscopists, were compared with surgical diagnosis.In women with laparoscopic diagnosis of endometriosis (n = 64) the mean nerve fibre density in the functional layer of the endometrial biopsy was 2.7 nerve fibres per mm(2) (+/- 3.5 SD). Only one woman with endometriosis had no detectable nerve fibres. Six women had endometrial nerve fibres but no active endometriosis seen at laparoscopy. The specificity and sensitivity were 83 and 98%, respectively, positive predictive value was 91% and negative predictive value was 96%. Nerve fibre density did not differ between different menstrual cycle phases. Women with endometriosis and pain symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 and 0.8 nerve fibre per mm(2), respectively, P = 0.005).Endometrial biopsy, with detection of nerve fibres, provided a reliability of diagnosis of endometriosis which is close to the accuracy of laparoscopic assessment by experienced gynaecological laparoscopists.This study was registered with the Australian Clinical Trials Registry (ACTR) 00082242 (registered: 12/12/2007). The study was approved by the Ethics Review Committee (RPAH Zone) of the Sydney South West Area Health Service (Protocol number X05-0345) and The University of Sydney Human Research Ethics Committee (Ref. No. 10761) and all women gave their informed consent for participation.