妊娠期子宫肌瘤的自然转归及其影响因素分析

Natural modification of uterine fibroids during pregnancy

目的了解妊娠期子宫肌瘤自然转归的规律。方法采用纵向研究的方法,选取首都医科大学附属北京朝阳医院2011年1月1日至2017年12月31日期间建档、孕期监护的妊娠合并子宫肌瘤孕妇499例,对其子宫肌瘤在不同妊娠时期的最大径进行分析。结果499个入组病例中,子宫肌瘤最大径中孕期较早孕期有显著增长[(3.94±2.02)cm vs(3.05±1.69)cm,t=13.94,P<0.001],晚孕早期较中孕期亦有显著增长[(4.18±2.22)cm vs(4.02±2.23)cm,t=2.96,P=0.003],而晚孕晚期较晚孕早期则无显著变化[(3.91±2.15)cm vs(3.93±2.17)cm,t=-0.81,P=0.417]。子宫肌瘤最大径自早孕期至晚孕晚期有显著增长[(2.94±1.70)cm vs(3.86±2.01)cm,t=-13.43,P<0.001]。175例数据完整的患者中,不同初始最大径的子宫肌瘤孕期肌瘤变化的规律及幅度大致相同,其变化幅度与早孕期子宫肌瘤最大径、孕妇年龄、孕次、产次、肌瘤部位及数目均无关(P>0.05)。子宫肌瘤整个孕期的最大径有38.3%出现在中孕期,33.1%在晚孕早期,21.1%在晚孕晚期,仅7.4%出现在早孕期。兼顾敏感度和特异度的情况下,当早孕期子宫肌瘤最大径超过4 cm时,对孕期子宫肌瘤将会显著增大(>3 cm)的预测效果最好,敏感度为83.33%,特异度为76.07%。结论妊娠期子宫肌瘤在早孕至中孕期有显著增长且增幅最大,至晚孕早期增幅明显放缓,至晚孕晚期大部分肌瘤较前缩小,不同初始最大径的子宫肌瘤表现出大致相似的变化规律。

Objective To explore the natural modification of uterine fibroids during pregnancy.Methods This longitudinal study enrolled a total of 499 cases of uterine fibroids during pregnancy in Beijing Chaoyang Hospital,Capital Medical University from January 1st 2011 to December 31st 2017.The fibroids maximum diameter determined with ultrasound in different trimesters of pregnancy was extracted from medical record and analyzed respectively.Results A significant increase of uterine fibroids in diameter was observed from the first trimester to the second trimester of pregnancy[(3.94±2.02)cm vs(3.05±1.69)cm,t=13.94,P<0.001],and from the second trimester to early third trimester[(4.18±2.22)cm vs(4.02±2.23)cm,t=2.96,P=0.003],while no significant change in size of fibroids was seen between the early and the late third trimester[(3.93±2.17)cm vs(3.91±2.15)cm,t=-0.81,P=0.417].A progressive increase in the diameter of fibroids was detected from the first trimester to the late third trimesters[(2.94±1.70)cm vs(3.86±2.01)cm,t=-13.43,P<0.001].However this kind of growth trend had proved to have no relation to the initial maximum diameter detected in the first trimester,patient age,obstetric history(gravidity,parity),location or number of fibroids(P>0.05).In 175 cases with complete data(ultrasound results in 4 periods of pregnancy respectively),38.3%of the maximum diameter of fibroids throughout pregnancy occurred in the second trimester,while 33.1%in the early third trimester,21.1%in the late third trimester,and only 7.4%occurred in the first trimester.Taking both sensitivity and specificity into consideration,the maximum diameter of fibroid in the first trimester larger than 4 cm showed the most predictive value that the fibroids would be significantly enlarged during pregnancy(>3 cm),with a sensitivity of 83.33%and specificity of 76.07%.Conclusions There was a significant increase,also the largest increment in uterine fibroids during pregnancy from the first to the second trimester.The increase slowed down progressively in the early third trimester,followed by a subsequent decrease in the late third trimester.The growing trend of uterine fibroids with different initial sizes were similar to one another.