高强度聚焦超声消融联合屈螺酮炔雌醇片治疗子宫腺肌病患者的临床疗效及对血管生成因子和子宫动脉血流动力学的影响  

Efficacy of high-intensity focused ultrasound ablation combined with drospirenone ethinylestradiol tablets in treating adenomyosis patients and its impacts on angiogenic factors and uterine artery hemodynamics

作　　者：李莉[1] 刘春桃 刘杨 刘明盛[1] 李丽[1] Li Li;Liu Chuntao;Liu Yang;Liu Mingsheng;Li Li(Department of Obstetrics and Gynecology,The Fifth People's Hospital of Chengdu,Sichuan Province,Chengdu 611130,China)

机构地区：[1]成都市第五人民医院妇产科,611130

出　　处：《疑难病杂志》2024年第5期599-604,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：2022年四川省第一批省级科技计划项目(2022JDRC0141)。

摘　　要：目的探究高强度聚焦超声(HIFU)消融联合屈螺酮炔雌醇片治疗子宫腺肌病(AD)患者的效果及对血管生成因子和子宫动脉血流动力学的影响。方法选取2021年2月—2023年2月成都市第五人民医院妇产科诊治的AD患者104例为研究对象,利用随机数字表法分为单一组(n=52)和联用组(n=52)。单一组采用HIFU消融治疗,联用组在单一组的基础上继续服用屈螺酮炔雌醇片治疗,治疗12周后,比较2组的临床疗效、血清血管生成因子[血管生成素-2(Ang-2)、血管内皮生长因子(VEGF)、脂联素(ADPN)]、卵巢相关指标[雌激素(E_(2))、促卵泡激素(FSH)、抗苗勒管激素(AMH)、黄体生成素(LH)]水平、子宫动脉血流动力学[(血流速度峰值(PSV)、舒张期末血流速度(EDV)、搏动指数(PI)、阻力指数(RI)]、子宫体积、病灶体积及直径、临床症状(月经周期变化、经期延长、经血成块、月经量增多、日间尿频、乏力、痛经、盆腔疼痛、夜间尿频)评分以及不良反应发生率。结果联用组治疗总有效率高于单一组(90.38%vs.75.00%,χ^(2)/P=4.300/0.038);治疗后2组的Ang-2、VEGF、E_(2)、AMH、FSH、LH、PSV、EDV、RI、子宫体积、病灶体积、病灶直径水平、临床症状评分均较治疗前降低,且联用组低于单一组(t/P=3.340/0.001、5.125/<0.001、4.427/<0.001、9.381/<0.001、2.313/0.023、9.795/<0.001、3.149/0.002、3.584/0.001、2.139/0.035、4.151/<0.001、15.493/<0.001、8.814/<0.001、6.605/<0.001、4.583/<0.001、9.112/<0.001、7.522/<0.001、5.427/<0.001、3.425/0.001、4.084/<0.001、8.209/<0.001);治疗后2组的ADPN、PI较治疗前升高,且联用组显著高于单一组(t/P=2.659/0.002、2.801/0.006);2组患者的不良反应总发生率比较差异无统计学意义(P>0.05)。结论AD患者经HIFU消融联合屈螺酮炔雌醇治疗后临床症状显著改善,其血管生成因子、血流动力学水平显著降低,安全性较高。Objective To investigate the efficacy of high-intensity focused ultrasound(HIFU)ablation combined with drospirenone ethinylestradiol tablets in treating adenomyosis(AD)patients and its impacts on angiogenic factors and uterine artery hemodynamics.Methods A total of 104 AD patients diagnosed and treated in the Obstetrics and Gynecology Department of the Fifth People's Hospital of Chengdu from February 2021 to February 2023 were selected as the study objects.They were divided into single group(n=52)and combined group(n=52)by random number table method.The single group was treated with HIFU ablation,while the combination group was treated with drospirenone ethinylestradiol tablets on the basis of the single group.Clinical efficacy,angiogenic factors[serum angiopoietin-2(Ang-2),vascular endothelial growth factor(VEGF),adiponectin(ADPN)],uterine artery hemodynamics[peak blood flow velocity(PSV),end diastolic blood flow velocity(EDV),pulsatile index(PI),resistance index(RI)],ovarian related indicators[estrogen(E_(2)),follicle stimulating hormone(FSH),anti-Mullerian hormone(AMH),luteinizing hormone(LH)]levels,uterine volume,lesion volume and diameter,clinical symptoms(menstrual cycle changes,menstrual prolongation,menstrual blood clotting,increased menstrual flow,daytime urinary frequency,fatigue,pelvic pain,nighttime urinary frequency)scores,and adverse reactions were compared.Results The total effective rate of single group was obviously lower than that of combination group(90.38%vs.75.00%,χ^(2)/P=4.300/0.038).After treatment,the Ang-2,VEGF,E_(2),AMH,FSH,LH,PSV,EDV,RI,uterine volume,lesion volume,lesion diameter level,and clinical symptom score of the two groups were obviously lower than before treatment,and the combination group were obviously lower than the single group(t/P=3.340/0.001,5.125/<0.001,4.427/<0.001,9.381/<0.001,2.313/0.023,9.795/<0.001,3.149/0.002,3.584/0.001,2.139/0.035,4.151/<0.001,15.493/<0.001,8.814/<0.001,6.605/<0.001,4.583/<0.001,9.112/<0.001,7.522/<0.001,5.427/<0.001,3.425/0.001,4.084/<0.001,8.2

关 键 词：子宫腺肌病 高强度聚焦超声消融 屈螺酮炔雌醇 血流动力学 血管生成因子 

分 类 号：R711.74[医药卫生—妇产科学]