摘要
目的评估子宫动脉栓塞治疗子宫腺肌症(adenomyosis,AM)的疗效,并探讨其疗效预测因素。方法回顾性分析2020年1月至2022年8月在苏州大学附属第二医院接受子宫动脉栓塞治疗的44例AM患者的病历资料,从MRI表现、血CA125水平以及痛经评分随访等,探讨子宫动脉栓塞治疗AM疗效预测因素。结果44例AM患者均接受1次子宫动脉栓塞治疗,术后12个月MRI随访显示,子宫体积由术前(299.60±182.42)cm^(3)降至术后(173.14±104.00)cm^(3),缩小36.64%(P<0.05),患者痛经评分从(7.70±2.60)分降至(2.20±2.37)分,痛经缓解率达88.64%(P<0.05),且无严重不良反应发生。增强MRI显示30例患者(68.18%)的病灶表现为完全坏死,术前病灶完全坏死患者的血清CA125水平(101.97±60.30)、表观扩散系数(apparent diffusion coefficient,ADC)值(1.012±0.271),明显低于病灶不完全坏死患者(P<0.05);术前病灶完全坏死患者的T2信号比(T2SR)值(0.582±0.198)明显高于病灶不完全坏死患者(P<0.05)。根据ROC曲线结果分析,术前CA125的曲线下面积、灵敏度、特异度分别是0.844、60%、80%,术前ADC值的曲线下面积、灵敏度、特异度分别是0.760、80%、65%,术前T2SR值的曲线下面积、灵敏度、特异度分别是0.760、80%、70%,并显示ADC<1.116×10^(-3)mm^(2)/s、T2SR>0.479、CA125<109.10可以作为子宫动脉栓塞治疗AM疗效的有力预测因素。结论子宫动脉栓塞治疗AM能有效缓解患者痛经症状,且安全有效,ADC、T2SR、CA125可以作为子宫动脉栓塞治疗AM疗效的有力预测因素,对于预测病灶反应具有重要价值,有助于为患者治疗方案的选择提供参考。
Objective To evaluate the efficacy of uterine artery embolization(UAE)for the treatment of adenomyosis(AM)and to discuss the factors predicting efficacy.Methods The clinical data of 44 patients with AM,who received UAE at The Second Affiliated Hospital of Soochow University from January 2020 to August 2022,were retrospectively analyzed.Based on the MRI findings,serum CA125 levels and follow-up dysmenorrhea scores,the efficacy of UAE and the factors predicting efficacy were analyzed.Results A single UAE treatment was performed in all 44 patients with AM.Follow-up check with MRI at 12 months after treatment showed that the mean uterine volume decreased from preoperative(299.60±182.42)cm^(3) to postoperative(173.14±104.00)cm^(3),with a volume reduction of 36.64%(P<0.05).The dysmenorrhea score decreased from preoperative(7.70±2.60)points to postoperative(2.20±2.37)points,with a relief rate of 88.64%(P<0.05),and no severe adverse reactions occurred.Enhanced MRI demonstrated that in 30 patients(68.18%)the AM lesions presented as complete necrosis foci.In the patients whose preoperative lesions were completely necrotic,the mean preoperative serum CA125level was(101.97±60.30)U/mL,the mean ADC value was(1.012±0.271)mm^(2)/s,which were obviously lower than those in the patients whose preoperative lesions were incompletely necrotic(P<0.05).The mean T2 signal ratio(T2SR)value in the patients whose preoperative lesions were completely necrotic was(0.582±0.198),which was significantly higher than that in the patients whose preoperative lesions were incompletely necrotic(P<0.05).The analysis of receiver operating characteristic(ROC)curve showed that the preoperative area under the curve(AUC),sensitivity,and specificity for preoperative CA125 were 0.844,60%and 80%respectively;the AUC,sensitivity,and specificity for preoperative ADC were 0.760,80%and 65%respectively;and the AUC,sensitivity,and specificity for preoperative T2SR were 0.760,80%and 70%respectively.ADC<1.116×10^(-3)mm^(2)/s,T2SR>0.479,and CA125<109.10 U/mL could be used as the reliable predictive factors for the efficacy of UAE treatment for AM.Conclusion UAE can effectively alleviate dysmenorrhea symptoms in patients with AM,and it is clinically safe and effective.ADC,T2SR,and CA125 can be used as the reliable predictive factors for the efficacy of UAE treatment for AM,which are helpful in predicting the lesion response and selecting the reasonable therapeutic options for patients.
作者
张昊
马金连
孙兴伟
王明瑶
靳勇
ZHANG Hao;MA Jinlian;SUN Xingwei;WANG Mingyao;JIN Yong(The Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215004,China)
出处
《介入放射学杂志》
北大核心
2025年第7期766-771,共6页
Journal of Interventional Radiology
关键词
子宫动脉栓塞术
子宫腺肌症
疗效
预测因素
uterine artery embolization
adenomyosis
efficacy
predictive factor
