高强度聚焦超声治疗南非与中国子宫肌瘤患者的对比研究

High-intensity focused ultrasound in treatment of uterine fibroids in patients in South Africa and China:A comparative analysis

目的:通过同期对照研究,对比南非黑人妇女与中国汉族妇女子宫肌瘤患者的差异性,以及这种差异对高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗疗效及安全性的影响。方法:2015年10月至2016年11月南非Chris Hani Baragwanath教学医院以及新疆医科大学第五附属医院同期接受HIFU治疗的254例患者纳入本研究。其中南非中心132例患者399个肌瘤,新疆中心122例患者177个肌瘤。结果:南非黑人妇女多发性子宫肌瘤患者明显多于中国新疆汉族女性(62.9%vs. 29.5%);BMI[(24.9±2.0)kg/m2 vs.(23.2±2.6)kg/m2]、皮下脂肪厚度[30.9(18.0,40.0)mm vs. 17.0(15.0,23.0)mm]、子宫长径[101.6(87.4,125.7)mm vs. 78.0(75.0,88.0)mm]、子宫体积[379.9(223.1,607.3) cm3 vs. 137.5(104.5,198.5) cm3]以及肌瘤长径[45.3(32.6,63.4) mm vs. 42.0(32.0,58.0) mm]、临床症状发生率(痛经症状,72.0%vs. 9.0%)明显大于中国新疆汉族患者(均P<0.05),而肌瘤体积[36.7(15.3,102.1) cm3 vs. 31.6(13.6,70.3)cm3]不具有统计学差异(P=0.102)。两中心HIFU治疗时使用的最大功率、最小功率、平均功率、治疗时间无统计学差异;但新疆中心的辐照时间、治疗强度及治疗总剂量高于南非中心,具有统计学差异(P<0.05);术后不同时间影像学随访,南非及中国新疆汉族女性子宫肌瘤患者的肌瘤缩小率一致,不具有统计学差异。南非中心术中不良反应发生率高于新疆中心,但均未出现需要处理的严重并发症。结论:虽然南非黑人妇女的体质指数及肌瘤与国内妇女具有统计学异性,但通过制定个体化治疗方案,HIFU能达到安全有效治疗子宫肌瘤的目的,该技术适用于非洲黑人女性。

Objective :To investigate the differences between South African black women and Chinese Han women with uterine fibroids via a control study and the influence of such differences on the safety and efficacy of high-intensity focused ultrasound (HIFU)ablation.Methods :A total of 254patients,who underwent HIFU treatment in Chris Hani Baragwanath Hospital in South Africa or The Fifth Affiliated Hospital of Xinjiang Medical University in China from October 2015 to November 2016were enrolled,and among these patients,there were 132(399uterine fibroids)from South Africa and 122(177uterine fibroids)from Xinjiang.Results:Compared with the Chinese Han patients,the South African black women had a significantly higher proportion of patients with multiple uterine fibroids(62.9%vs.29.5%,P<0.05),a significantly higher body mass index[(24.9±2.0)kg/m^2 vs.(23.2±2.6)kg/m2,P<0.05), a significantly greater subcutaneous fat thickness[30.9(18.0,40.0)mm vs.17.0(15.0,23.0)mm,P<0.05],significantly longer axes of the uterus[101.6(87.4,125.7)mm vs.78.0(75.0,88.0)mm,P<0.05]and fibroids[45.3(32.6,63.4)mm vs.42.0(32.0,58.0)mm,P< 0.05],significantly higher uterine volume[379.9(223.11607.3)cm^3 vs.137.5(104.5,198.5)cm^3,p<0.05],and no significantly differences of uterine fibroids[36.7(15.3,102.1)cm^3 vs.31.6(13.6, 70.3)cm^3](P=0.102),and a significantly higher incidence rate of the clinical symptom of dysmenorrhea(72.0% vs.9.0%,P<0.05). There were no significant differences between the two centers in the maximum power,minimum power,average power,irradiation time,and total therapeutic dose of HIFU treatment;the Xinjiang center had a significantly higher treatment intensity than the South African center(518.3±103.3s/h vs.442.4±143.1s/h,P<0.05), and the South African center had a significantly longer treatment time than the Xinjiang center(86.5±55.0 minutes vs.85.5±45.2 minutes,P<0.05).Imaging examination during follow-up showed that there was no significant difference in fibroid shrinkage rate between the two groups of patients.The South African center had a higher incidence rate of adverse events than the Xinjiang center, but no serious complications requiring treatment were observed in either center.Conclusion :Although there are differences in body mass index and uterine fibroids between South African black women and Chinese Han women,HIFU with an individualized treat- ment regimen can be safe and effective in the treatment of uterine fibroids.HIFU is suitable for African black women with uterine fibroids.