多模态超声在评估子宫动脉栓塞术后子宫内膜容受性变化中的应用价值

Application value of multimodal ultrasound in assessing endometrial receptivity after uterine fibroid surgery

摘要:

目的 探讨经阴道彩色多普勒超声（TVCDU）、动态对比增强磁共振成像（DCE-MRI）联合血清生化指标在评估子宫肌瘤术后子宫内膜容受性方面的应用价值。方法 选取2020年6月—2023年6月在泰州市人民医院行动脉栓塞术的子宫肌瘤患者98例为研究对象。根据患者术后子宫内膜相容性情况分为预后良好组（63例）与预后不良组（35例），采用TVCDU检查患者术前（T₀）、术后3 d（T₁）、术后1个月（T₂）子宫动脉与肌瘤的血流动力指标［子宫动脉最大流速、子宫动脉最小流速、子宫动脉脉冲指数（PI）、阻力指数（RI）、血流量（Q）、肿瘤大小、子宫内膜厚度、子宫内膜PI）］。采用DCE-MRI检查患者T₀、T₁、T₂时转移常数（K^trans）、外排率常数（K_ep）、细胞外间隙体积比（Vc）。采用酶联免疫吸附试验检测血清分泌性糖蛋白Dickkopf-1、癌抗原125（CA125）、癌抗原199（CA199）水平。采用全自动血液分析仪检测并计算中性粒细胞与淋巴细胞比值（NLR）。结果 预后良好与不良组T₀、T₁、T₂的血流动力学指标及肿瘤大小、子宫内膜厚度、子宫内膜PI比较，结果 ①不同时间点子宫动脉V_max、V_min、PI、RI、Q、肿瘤大小、子宫内膜厚度、子宫内膜PI比较，差异均有统计学意义（P <0.05）。②预后良好组与预后不良组子宫动脉RI、肿瘤大小比较，差异均有统计学意义（P <0.05）；预后良好组与预后不良组子宫动脉V_max、V_min、PI、Q、子宫内膜厚度、子宫内膜PI比较，差异均无统计学意义（P >0.05）。③两组子宫动脉V_max、肿瘤大小变化趋势比较，差异均有统计学意义（P <0.05）；两组子宫动脉V_min、PI、RI、Q、子宫内膜厚度、子宫内膜PI变化趋势比较，差异均无统计学意义（P >0.05）。预后良好与不良组T₀、T₁、T₂的DCE-MRI征象比较，结果 ①不同时间点K^trans、K_ep、Vc比较，差异均有统计学意义（P <0.05）。②预后良好组与预后不良组K^trans、K_ep比较，差异均有统计学意义（P <0.05）；预后良好组与预后不良组Vc比较，差异均无统计学意义（P >0.05）。③两组K_ep变化趋势比较，差异均有统计学意义（P <0.05）；两组K^trans、Vc变化趋势比较，差异均无统计学意义（P >0.05）。预后良好与不良组T₀、T₁、T₂的血清生化指标比较，结果 ①不同时间点血清Dickkopf-1、CA125、CA199、NLR水平比较，差异均有统计学意义（P <0.05）。②预后良好组与预后不良组CA125、CA199比较，差异均有统计学意义（P <0.05）；预后良好组与预后不良组Dickkopf-1、NLR比较，差异均无统计学意义（P >0.05）。③两组CA125、CA199变化趋势比较，差异均有统计学意义（P <0.05）；两组Dickkopf-1、NLR变化趋势比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示，TVCDU征象［O^R=76.662（95% CI：3.238，1 814.851）］、DCE-MRI征象［O^R=130.748（95% CI：1.071，15 966.340）］、Dickkopf-1 ［O^R=46.341（95% CI：1.403，1 530.367）］、高CA125水平［O^R=23.045（95% CI：1.097，484.183）］、高CA199水平［O^R=24.377（95% CI：1.182，502.954）］、高NLR水平［O^R=15.855（95% CI：1.158，217.028）］均为子宫肌瘤患者动脉栓塞术后子宫内容容受性预后不良的危险因素（P <0.05）。结论 综合多模态超声技术与血清生化指标评估可以更准确地预测子宫肌瘤术后的子宫内膜容受性，这一新颖的综合评估方法对于指导子宫肌瘤患者的术后恢复和生育规划具有重要价值。

Abstract:

Objective To investigate the application value of transvaginal color Doppler ultrasound (TVCDU) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with serum biochemical markers in assessing endometrial receptivity after uterine fibroid surgery.Methods Ninety-eight patients who underwent arterial embolization for uterine fibroids at Taizhou People's Hospital from June 2020 to June 2023 were selected. Based on the prognosis in terms of endometrial receptivity, patients were divided into a good prognosis group (63 cases) and a poor prognosis group (35 cases). The TVCDU was used to measure the hemodynamic indicators [maximum and minimum flow velocities of the uterine artery, pulsatility index (PI), resistance index (RI), flow volume (Q), tumor size, endometrial thickness, and endometrial PI] of the uterine artery and fibroids before surgery (T₀), 3 days post-surgery (T₁), and one month post-surgery (T₂). The DCE-MRI was employed to measure the transfer constant (Ktrans), rate constant (Kep), and extravascular extracellular space fractional volume (Vc) at T₀, T₁, and T₂. Serum levels of the secretory glycoprotein Dickkopf-1, cancer antigen 125 (CA-125), and cancer antigen 199 (CA-199) were detected via the enzyme-linked immunosorbent assay. The neutrophil-to-lymphocyte ratio (NLR) was calculated based on the results of an automated hematology analyzer.Results Comparison of hemodynamic indicators, tumor size, endometrial thickness, and endometrial PI at T₀, T₁, and T₂ in the good and poor prognosis groups was conducted using the repeated measures analysis of variance. The results showed that they were all different among the time points (P < 0.05), and that the RI and tumor size (P < 0.05) but not the maximum and minimum flow velocities of the uterine artery, PI, Q, endometrial thickness or endometrial PI (P > 0.05) were different between the groups. The change trends of maximum flow velocities of the uterine artery and the tumor size were different between the two groups (P < 0.05), whereas the change trends of minimum flow velocities of the uterine artery, PI, RI, Q, endometrial thickness or endometrial PI were not different between the groups (P > 0.05). The comparison of DCE-MRI findings at T₀, T₁, and T₂ in the good and poor prognosis groups was conducted using the repeated measures analysis of variance. The results showed that Ktrans, Kep, and Vc showed statistically significant differences among the time points (P < 0.05), and that Ktrans and Kep (P < 0.05) but not Vc (P > 0.05) were different between the two groups. The change trend of Kep (P < 0.05) rather than that of Ktrans and Vc (P > 0.05) was different between the groups. The comparison of serum biochemical markers at T₀, T₁, and T₂ in the good and poor prognosis groups was also conducted using the repeated measures analysis of variance, which demonstrated that serum levels of Dickkopf-1, CA-125, and CA-199 as well as the NLR were significantly different among the time points (P < 0.05) and that the levels of CA-125 and CA-199 (P < 0.05) but not the level of Dickkopf-1 and the NLR (P > 0.05) were different between the groups. The change trends of CA-125 and CA-199 levels were different between the good and poor prognosis groups (P < 0.05), while those of Dickkopf-1 levels and the NLR were not different between the two groups (P > 0.05). The multivariable Logistic regression analysis exhibited that TVCDU signs [O^R = 76.662 (95% CI: 3.238, 1814.851) ], DCE-MRI signs [O^R = 130.748 (95% CI: 1.071, 15966.340) ], high levels of Dickkopf-1 [O^R = 46.341 (95% CI: 1.403, 1530.367) ], CA125 [O^R = 23.045 (95% CI: 1.097, 484.183) ], CA199 [O^R = 24.377 (95% CI: 1.182, 502.954) ], and NLR [O^R = 15.855 (95% CI: 1.158, 217.028) ] were all identified as risk factors for poor endometrial receptivity after uterine artery embolization in patients with uterine fibroids (P < 0.05).Conclusions Integrating multimodal ultrasound with serum biochemical markers provides a more accurate prediction of endometrial receptivity after uterine fibroid surgery. This novel comprehensive assessment method holds significant values in guiding postoperative recovery and fertility planning for patients with uterine fibroids.