左炔诺孕酮宫内节育系统联合地诺孕素治疗子宫腺肌症临床效果的高危因素分析  

High-risk Factor Analysis of Clinical Effect of Levonorgestrel Intrauterine System Combined with Dinorgestrel in the Treatment of Uterine Adenomyosis

作　　者：罗业琳 黄卓华[1] 雷嘉[1] 江布英 黄涛[1] LUO Yelin;HUANG Zhuohua;LEI Jia;JIANG Buying;HUANG Tao(Department of Gynecology,Wuzhou Red Cross Hospital,Wuzhou,Guangxi Zhuang Autonomous Region 543000,China)

机构地区：[1]梧州市红十字会医院妇科,广西壮族自治区梧州543000

出　　处：《临床误诊误治》2023年第9期72-77,共6页Clinical Misdiagnosis & Mistherapy

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z-D20221726)。

摘　　要：目的 探讨左炔诺孕酮宫内节育系统联合地诺孕素治疗子宫腺肌症临床效果的高危因素。方法 选取2020年1月—2022年12月收治的100例子宫腺肌症作为研究对象(有效回收99例调查问卷),均接受左炔诺孕酮宫内节育系统联合地诺孕素治疗。统计疗效,采用多因素Logistic回归分析影响子宫腺肌症疗效的危险因素,构建临床预测模型,由R语言及相关软件包绘制可视化列线图模型。结果 治疗3个月后,子宫腺肌症患者总有效率为79.80%(79/99),且治疗3个月后月经量、子宫体积、子宫内膜厚度、视觉模拟评分法评分优于治疗前(P<0.01)。抗苗勒管激素(AMH)、糖类抗原125(CA125)、红细胞沉降率(ESR)、降钙素原(PCT)、C反应蛋白(CRP)、治疗相关不良反应、合并子宫内膜异位症是左炔诺孕酮宫内节育系统联合地诺孕素对子宫腺肌症患者治疗无效的高危因素(P<0.01)。临床预测模型的预测总体正确率为89.90%,Omnibus检验显示模型全局性检验具有统计学意义(P<0.05)。经R语言3.4.0进行5折交叉验证结果显示,临床预测模型的预测正确率为75.60%,Omnibus检验结果显示该模型总体有意义(P<0.01)。建立子宫腺肌症疗效预测可视化列线图,可用于预测子宫腺肌症治疗无效概率。结论 影响左炔诺孕酮宫内节育系统联合地诺孕素治疗子宫腺肌症临床效果高危因素为AMH、CA125、ESR、PCT、CRP等,基于上述高危因素构建临床预测模型和可视化列线图具有良好预测效能,可作为子宫腺肌症疗效预测工具。Objective To investigate the high-risk factors of clinical effect of Levonorgestrel intrauterine system combined with Dinorgestrel in the treatment of uterine adenomyosis.Methods A total of 100 patients(a total of 99 valid questionnaires were retrieved)with uterine adenomyosis treated from January 2020 to December 2022 were selected as the research subjects.All of them were treated with Levonorgestrel intrauterine system combined with Dinorgestrel.Multivariate Logistic regression was used to analyze the risk factors influencing the efficacy of uterine adenomyosis.The clinical prediction model was constructed.The visualization nomogram model was drawn by R language software and related software packages.Results At 3 months after treatment,the total effective rate of the patients with uterine adenomyosis was 79.80%(79/99),and the menstrual volume,uterine volume,endometrial thickness and scores of visual analogue scale(VAS)at 3 months after treatment were better than those before treatment(P<0.01).Anti-mullerian hormone(AMH),carbohydrate antigen 125(CA125),erythrocyte deposition rate(ESR),procalcitonin(PCT),C reactive protein(CRP),treatment-related adverse reactions,and endometriosis were high risk factors for the treatment failure of adenomyosis in patients with Levinorgestrel intrauterine birth control system combined with Dinorgestrel(P<0.01).The overall accuracy rate of the clinical prediction model was 89.90%,and Omnibus test showed that the global test of the model had statistical significance(P<0.05).The results of 5-fold cross-validation by R language 3.4.0 showed that the prediction accuracy of the clinical prediction model was 75.60%,and the results of Omnibus test showed that the model was generally significant(P<0.01).The visualization nomogram for predicting the efficacy of uterine adenomyosis was established,which could be used to predict the probability of treatment failure of uterine adenomyosis.Conclusion The high-risk factors for the efficacy of Levonorgestrel intrauterine system combined with Dino

关 键 词：子宫腺肌症 左炔诺孕酮宫内节育系统 地诺孕素 抗苗勒管激素 子宫内膜异位症 降钙素原 列线图 危险因素 

分 类 号：R711.71[医药卫生—妇产科学]