子宫腺肌症磁共振影像特征与妊娠结局的相关性分析

Correlation analysis between MRI features of adenomyosis and pregnancy outcome

目的探讨子宫腺肌症合并不孕患者的子宫磁共振影像特征与生育结局的相关性。方法收集2012年1月至2021年7月期间在北京协和医院妇科内分泌与生殖中心就诊的子宫腺肌症(AM)合并不孕症且具备本院盆腔磁共振成像(MRI)影像学信息的患者70例,随访妊娠结局至2021年7月,根据妊娠结局分为“妊娠”和“妊娠失败”两组,针对年龄、病史时间、症状程度、CA125水平、MRI影像相关的变量(包括子宫径线、子宫体积、宫腔形态、MRI分型等)采用SPSS 22.0统计软件进行分组的单因素分析和多因素分析。结果70例AM合并不孕症患者中6例失访,最终64例纳入统计学分析。患者年龄26~44岁,总体妊娠率为26.6%。宫腔形态正常的病例妊娠率为43.3%(13/30),而宫腔形态失常的病例妊娠率仅为11.8%(4/34),两者比较有显著性差异(P=0.004);子宫肌层厚度对称的患者中妊娠率为56.3%(9/16),肌层厚度不对称患者妊娠率为16.7%(8/48),两者比较有显著差异(P=0.007);子宫体积正常(≤60 ml)的患者中妊娠率为53.8%(7/13),子宫体积明显增大(>60 ml)者妊娠率为19.6%(10/51),两者比较有显著差异(P=0.03)。妊娠组子宫前后径显著低于妊娠失败组[(45.2±9.0)mm vs.(56.8±18.2)mm,P=0.005]。多因素分析提示子宫前后径过大、子宫形态异常及Bazot A~K分型中的D/E型为AM合并不孕患者妊娠失败的危险因素(P<0.05)。结论子宫肌壁增厚、子宫体积增大(≥60 ml)和宫腔形态异常的AM合并不孕患者妊娠预后不良。

Objective:To explore the correlation between uterine magnetic resonance imaging(MRI)characteristics and pregnancy outcome in infertile patients with adenomyosis.Methods:The medical records of 70 infertile patients with adenomyosis who had treatment and pelvic MRI examination in the Center of Gynecological Endocrinology and Reproduction of Peking Union Medical College Hospital from January 2012 to July 2021 were collected.The pregnancy outcome was followed-up until July 2021.The patients were divided into“pregnant group”and“pregnancy failure group”based on their pregnant outcomes.SPSS 22.0 statistical software was used for univariate and multivariate analysis with the variables of age,duration of disease,symptoms,CA125 level and MRI features including uterine diameter,uterine volume,uterine cavity morphology and MRI classification,etc.Results:Among 70 infertile patients with adenomyosis,6 patients were lost to follow-up and the remaining 64 patients were included in statistical analysis.The patients’age ranged from 26 to 44 years.The overall pregnancy rate was 26.6%.The pregnancy rate of patients with normal uterine cavity morphology was significantly higher than that of patients with abnormal uterine cavity morphology[43.3%(13/30)vs.11.8%(4/34),P=0.004].The pregnancy rate in patients with symmetrical myometrial thickness was significantly higher than that in patients with asymmetric myometrial thickness[56.3%(9/16)vs.16.7%(8/48),P=0.007].The pregnancy rate of patients with normal uterine volume(≤60 ml)was 53.8%(7/13),while that of patients with increased uterine volume(>60 ml)was 19.6%(10/51),and there was significant difference between the two groups(P=0.03).The anteroposterior diameter of uterus in pregnant group was significantly smaller than that in pregnancy failure group[(45.2±9.0)mm vs.(56.8±18.2)mm,P=0.005].Multivariate analysis showed that increased diameter of uterus,abnormal uterine morphology and D/E types in Bazot A-K classification were the risk factors of infertile patients with adenomyosis(P<0.05).Conclusions:The pregnancy outcome in infertile patients with adenomyosis complicated by uterus enlargement,muscle wall thickening and abnormal uterine cavity morphology was poor.