影响子宫肌瘤HIFU治疗效果相关因素及列线图模型

Related factors influencing effect of HIFU treatment in uterine fibroids:nomogram development

目的探讨影响子宫肌瘤高强度聚焦超声(HIFU)治疗效果的相关因素,构建列线图模型。方法回顾性分析2017年1月~2019年10月于我院行HIFU治疗的717例子宫肌瘤患者的临床资料,随机分为模型组(478例)和验证组(239例),收集术后3个月子宫肌瘤体积缩小情况、月经减少情况,在模型组内分析影响因素,构建列线图模型并进行内部验证及外部验证。结果模型组患者治疗前子宫肌瘤为(90.24±25.68)cm^(3),治疗3个月后为(38.45±7.45)cm^(3),子宫肌瘤体积缩小有效率为60.04%(287/478);月经减少有效率为62.97%(301/478)。Logistic多因素分析示,肌瘤体积≥50 cm^(3)、肌瘤T2WI等/高信号、T1明显强化、靶皮距≥5 cm是体积缩小无效、月经减少无效的独立危险因素(P<0.05)。采用R软件建立子宫肌瘤体积减少无效模型、月经减少无效模型,采用Bootstrap自抽样法进行内部验证,在模型组内,子宫肌瘤体积减少无效模型、月经减少无效模型C-index为0.722、0.733,曲线下面积分别为0.830、0.852;在验证组中,子宫肌瘤体积减少无效模型、月经减少无效模型C-index为0.710、0.701,曲线下面积分别为0.796、0.802;Hosmer-Lemeshow拟合优度检验进行评价,体积减少模型在模型组及验证组中检验差异均无统计学意义(P>0.05)。结论子宫肌瘤患者肌瘤大小、血供、靶皮距等因素与HIFU治疗病灶缩小、月经减少效果相关,采用列线图模型可评估患者治疗效果,为治疗方式的选择提供重要参考。

Objective This study was aimed to explore related factors affecting the effect of high-intensity focused ultrasound(HIFU)treatment for uterine fibroids,and construct a nomogram model.Methods We retrospectively analyzed the clinical data of 717 patients with uterine fibroids who received HIFU treatment in our hospital between January 2017 and October 2019.The patients were randomly divided into the model group(478 cases)and the validation group(239 cases).The volume reduction of uterine fibroids and reduction of menstrual at 3 months after operation were recorded,and influencing factors in the model group were analyzed.A nomogram model was constructed and verified internally and externally.Results In this study,the volume of uterine fibroids was(90.24±25.68)cm^(3) before treatment,and(38.45±7.45)cm^(3) after 3 months of treatment,with an effective uterine fibroids reduction rate of 60.04%(287/478).The effective rate of menstrual reduction was 62.97%(301/478).Multivariate Logistic analysis showed that fibroids volume≥50cm^(3),fibroids T2WI etc./high signal,T1 obviously enhanced,target skin distance≥5cm were independent risk factors for ineffective volume reduction and ineffective menstrual reduction(P<0.05).The ineffective uterine fibroids volume reduction model and the ineffective menstrual reduction model constructed using R software were verified internally by Bootstrap self-sampling method.In the model group,the C-index of the 2 models was 0.722 and 0.733,and areas under the ROC curves were 0.830 and 0.852 respectively.In the validation group,the C-index of the 2 models was 0.710 and 0.701,and the area under the curve was 0.796 and 0.802,respectively.The Hosmer-Lemeshow goodness-of-fit test was evaluated,and P values of the volume reduction model in the module and verification group were both higher than 0.05.Conclusion Size,blood supply and target skin distance of uterine fibroids are related to focal reduction and reduction of menstrual after HIFU treatment.The nomogram model can be used to evaluate the treatment effect,thus providing reference for the choice of treatment method.