高强度聚焦超声治疗子宫腺肌病的免疫学状态改变及影像学评估研究

Study on the Changes of Immunological Status and Imaging Evaluation of Adenomyosis Treated with High Intensity Focused Ultrasound

目的:探讨高强度聚焦超声(HIFU)治疗子宫腺肌病(AM)的免疫学状态改变及影像学评估。方法:选择2020年12月-2021年12月于石家庄市人民医院收治的186例AM患者,HIFU消融术治疗前后行血清补体C3、C4、辅助性T细胞17与调节性T细胞比值(Th17/Treg)检测和磁共振成像(MRI)检查。比较AM患者治疗前后超声特征以及MRI测量参数、血清补体C3、C4、Th17/Treg水平的差异;采用Spearman相关性分析治疗后血清补体C3、C4、Th17/Treg水平与消融率、无灌注区MRI参数的相关性。结果:AM患者HIFU治疗前超声显示子宫壁肌层回声不均匀,肌层血流信号丰富,病灶血运丰富;MRI表现为子宫不均一性体积增大,子宫壁明显增厚,与子宫结合带分界不清,信号不均匀,动态增强扫描病灶表现为不均匀强化,强化程度均略低于附近的正常子宫内肌层。AM患者HIFU治疗后VAS评分显著低于治疗前(P<0.05);超声显示子宫肌层回声不均匀,肌层血运明显减少,MRI显示子宫壁增厚程度减轻,信号不均匀,增强扫描表现为中央无强化的灌注区,周边结节状或不规则形强化即为残余病灶,消融率为90%左右。HIFU治疗后血清补体C3、C4水平、残余病灶ADC值、MSI值显著升高(P<0.05),而HIFU治疗后Th17/Treg、无灌注区ADC值、MSI值显著下降(P<0.05)。HIFU治疗后血清补体C3、C4水平与消融率、无灌注区ADC值以及MSI值存在显著负相关(P<0.05),而Th17/Treg与消融率、无灌注区ADC值以及MSI值存在显著正相关(P<0.05)。结论:HIFU治疗AM患者后的免疫学状态改变以及MRI评估有助于预测AM患者的预后,并指导临床医师对AM患者后续治疗方案的选择提供客观真实的依据。

Objective:To investigate the changes of immunological status and imaging evaluation of high intensity focused ultrasound(HIFU)in the treatment of adenomyosis(AM).Methods:186 patients with AM admitted to Shijiazhuang People's Hospital from December 2020 to December 2021 were selected.Before and after HIFU ablation,serum complement C3,C4,the ratio of helper T cell 17 to regulatory T cell(Th17/Treg)and magnetic resonance imaging(MRI)were detected.Compare the differences of ultrasound characteristics,MRI measurement parameters,serum complement C3,C4,Th17/Treg levels in AM patients before and after treatment;Spearman correlation was used to analyze the correlation between the levels of serum complement C3,C4,Th17/Treg and the ablation rate and MRI parameters of the non-perfusion area after treatment.Results:Before HIFU treatment in AM patients,ultrasound showed that the echo of the myometrium of the uterine wall was uneven,the blood flow signal of the myometrium was rich,and the blood flow of the focus was rich;MRI showed that the uterus was non-uniformly enlarged,the uterine wall was significantly thickened,the boundary with the uterine junction was unclear,and the signal was uneven.The dynamic enhancement scan showed that the focus was non-uniformly enhanced,and the degree of enhancement was slightly lower than that of the normal myometrium nearby.VAS score of AM patients after HIFU treatment was significantly lower than that before treatment(P<0.05);Ultrasound showed that the echo of the myometrium of the uterus was uneven,and the blood supply of the myometrium was significantly reduced.MRI showed that the thickening of the uterine wall was reduced,and the signal was uneven.The enhancement scan showed that the central perfusion area was not enhanced,and the peripheral nodular or irregular enhancement was the residual focus,and the ablation rate was about 90%.After HIFU treatment,the levels of serum complement C3 and C4,ADC value and MSI value of residual lesions increased significantly(P<0.05),while Th17/Treg,ADC value and MSI value of non-perfusion zone decreased significantly(P<0.05).After HIFU treatment,serum complement C3 and C4 levels were significantly negatively correlated with ablation rate,ADC value and MSI value in non-perfusion zone(P<0.05),while Th17/Treg was significantly positively correlated with ablation rate,ADC value and MSI value in non-perfusion zone(P<0.05).Conclusion:The changes of immunologic status and MRI evaluation after HIFU treatment of AM patients can help predict the prognosis of AM patients,and guide clinicians to provide objective and realistic basis for the choice of follow-up treatment plan for AM patients.