目的 探讨三维能量多普勒超声(three-dimensional power Doppler ultrasound,3D-PDUS)血流参数对重度宫腔黏连(intrauterine adhesion,IUA)患者宫腔镜下宫腔黏连分解术后复发的预测价值.方法 选取2021年1月至2022年12月于云南省第三人民医院行宫腔镜下宫腔黏连分解术的100例重度IUA患者为研究对象.分别于术前、术后1个月进行3D-PDUS检查,获得血管指数(vascularization index,VI)、血流指数(flow index,FI)、血管化血流指数(vascularization-flow index,VFI).依据术后 3 个月复发情况将患者分为复发组和未复发组,评价术后复发的影响因素.评价VFI、VI、FI对术后复发的预测价值.统计学方法采用t检验、x2检验、Logistic回归分析及受试者操作特征(receiver operating characteristic,ROC)曲线分析.结果 重度IUA患者术后与术前VI(0.56±0.22与0.14±0.06,t=18.418)、FI(22.67±2.34 与 17.62±2.39,t=15.098)、VFI(0.98±0.47 与 0.07±0.03,t=19.322)比较,术后均高于术前(P＜0.001).术后复发组与未复发组 VI(0.31±0.15 与 0.65±0.24,t=6.869)、FI(15.1±2.1与 25.5±2.5,t=18.930)、VFI(0.67±0.17 与 1.09±0.25,t=8.055)比较,复发组术后均低于未复发组(P＜0.001).随机森林算法显示,重要性评分前5的变量依次为术后VFI、VI、FI、人工流产次数、病程;术后 VFI(OR=0.279,95％CI:0.137～0.569)、VI(OR=0.257,95％CI:0.122～0.541)、FI(OR=0.275,95％CI:0.125～0.603)、人工流产次数(OR=5.702,95％CI:1.258～25.841)、病程(OR=5.976,95％CI:1.301～27.449)为术后复发影响因素(P值均＜0.001).术后1个月VFI、VI、FI单项及联合预测术后复发的曲线下面积(area under the curve,AUC)分别为0.744、0.837、0.799、0.938,且联合预测高于单独指标预测(P＜0.001).结论 重度IUA患者宫腔镜下宫腔黏连分解术后血流参数VI、FI、VFI升高,联合检测各血流参数对术后复发具有一定预测价值.
Prediction value of 3D-PDUS blood flow parameters for recurrence after hysteroscopic adhesion decomposition in patients with severe intrauterine adhesions
Objective To investigate the predictive value of blood flow parameters measured by three-dimensional energy Doppler ultrasound(3D-PDUS)for recurrence after hysteroscopic adhesion decomposition in patients with severe intrauterine adhesions(IUA).Method A total of 100 cases with severe IUA who underwent hysteroscopic adhesion decomposition at the Third People's Hospital of Yunnan Province from January 2021 to December 2022 were selected as the study.3D-PDUS was performed before and one month after surgery to obtain vascularization index(VI)、flow index(FI)、vascularization-flow index(VFI)of blood flow parameters.According to the recurrence situation 3 months after the operation,the patients were divided into recurrence group and non-recurrence group,and the influencing factors of postoperative recurrence were analyzed.The predictive value of VFI,VI,and FI for postoperative recurrence was evaluated.The statistical methods performed by t-test,x2-test,Logistic regression analysis and receiver operating characteristic(ROC)curve analysis.Result VI(0.56±0.22 vs 0.14±0.06,t=18.418),Fl(22.67±2.34 vs 17.62±2.39,t=15.098),and VFI(0.98±0.47 vs 0.07±0.03,t=19.322)in patients with severe IUA was higher after surgery than before surgery(P＜0.001).The patients in recurrence group were lower than those in non-recurrence group in VI(0.31±0.15 vs 0.65±0.24,t=6.869),FI(15.1±2.1 vs 25.5±2.5,t=18.930),VFI(0.67±0.17 vs 1.09±0.25,t=8.055),(P＜0.001).The random forest algorithm showed that the top five variables in importance score were postoperative VFI,VI,FI,number of induced abortions,and disease duration;postoperative VFI(OR=0.279,95％CI:0.137-0.569),VI(OR=0.257,95％CI:0.122-0.541),FI(OR=0.275,95％CI:0.125-0.603),number of induced abortions(OR=5.702,95％CI:1.258-25.841),and disease duration(OR=5.976,95％CI:1.301-27.449)were factors affecting postoperative recurrence,all P＜0.001;the area under the curve(AUC)of single and combined prediction of VFI,VI and FI were 0.744,0.837,0.799 and 0.938,respectively,and the AUC of combined prediction were higher than that of single prediction(P＜0.001).Conclusion Blood flow parameters VI,Fl and VFI increased after hysteroscopic adhesion decomposition in patients with severe IUA.Combined detection of blood flow parameters has certain predictive value for postoperative recurrence.
Intrauterine adhesionThree-dimensional energy Doppler ultrasoundHysteroscopeRelapseVascular indexBlood flow indexVascularization blood flow index
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