经阴道超声联合血清VEGF-A,Cyr61鉴别诊断子宫腺肌病价值

Value of transvaginal ultrasound combined with the levels of serum vascular endothelial growth factor A and cysteine rich protein 61 for differential diagnosing adenomyosis of patients

目的:探讨经阴道超声(TVUS)联合血清血管内皮生长因子-A(VEGF-A)、高半胱氨酸蛋白61(Cyr61)诊断子宫腺肌病(AM)价值。方法:选取本院2020年6月-2023年11月收治AM患者106例(AM组),其中增殖期49例、分泌期57例;同期入院的子宫肌瘤患者106例(子宫肌瘤组)。均行TVUS检查及测定血清VEGF-A、Cyr61水平;多因素logistic回归分析影响AM发生的因素;受试者工作特征(ROC)曲线分析TVUS联合血清VEGF-A、Cyr61水平对AM的诊断价值。结果:TVUS共检出AM患者96例(90.6%),AM组血清VEGF-A(195.24±55.68 pg/ml)、Cyr61(241.34±71.52μg/L)水平均高于子宫肌瘤组(143.57±37.35 pg/ml、172.59±46.88μg/L),且AM增殖期高于分泌期;TVUS检查病灶周围血流舒张期最大流速、收缩期最大流速、血流阻力指数及血流搏动指数均高于子宫肌瘤组(均P<0.05)。多因素分析显示,VEGF-A、Cyr61升高是AM发生的危险因素(P<0.05);ROC曲线分析显示,TVUS、VEGF-A、Cyr61及三者联合诊断AM的曲线下面积(AUC)分别为0.533、0.769、0.799及0.860,联合诊断AUC最高(Z=11.314、2.999、2.832,均P<0.05)。结论:AM患者血清VEGF-A、Cyr61水平升高,TVUS联合VEGF-A、Cyr61可提高AM的鉴别诊断价值。

Objective:To explore the value of transvaginal ultrasound(TVUS)combined with the levels of serum vascular endothelial growth factor A(VEGF-A)and cysteine rich protein 61(Cyr61)for differential diagnosing adenomyosis(AM)of patients.Methods:A total of 106 patients with AM in study group were selected and were divided in group A(49 cases in the proliferative phase)and group B(57 cases in the secretory phase)according to the different stage of AM of the patients from June 2020 to November 2023.In addition,106 patients with uterine fibroids were selected in control group during the same period.The patients in these groups were given transvaginal ultrasound(TVUS)examination.The serum VEGF-A and Cyr61 levels of the patients in these groups were detected.Multiple factor logistic regression analysis was used to analyze the factors that affected the occurrence of AM of the patients.Receiver operating characteristic(ROC)curve was used to analyze the value of TVUS combined with serum VEGF-A and Cyr61 levels of the patients for diagnosing their AM occurrence.Results:A total of 96(90.6%)patients with AM were detected by TVUS.The levels of serum VEGF-A(195.24±55.68 pg/ml)and Cyr61(241.34±71.52μg/L)of the patients in the study group were significantly higher than those(143.57±37.35 pg/ml and 172.59±46.88μg/L)of the patients in the control group.The levels of serum VEGF-A and Cyr61 of the patients in group A were significantly higher than those of the patients in group B.The values of the maximum velocity of blood flow in diastole,the maximum velocity of blood flow in systole,the resistance index of blood flow and the pulsatility index of blood flow around the lesion by TVUS examination of the patients in the study group were significantly higher than those of the patients in the control group(all P<0.05).Multivariate analysis showed that the increase of the serum VEGF-A and Cyr61levels of the patients were the risk factors of their AM occurrence(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the TVUS,the VEGF-A level,the Cyr61level,and the combination of the TVUS and the VEGF-A and Cyr61levels of the patients for diagnosing their AM occurrence were 0.533,0.769,0.799 and 0.860,respectively.The AUC of the combined TVUS and the VEGF-A and Cyr61levels of the patients for diagnosing their AM occurrence were the highest(Z=11.314,2.999,2.832,all P<0.05).Conclusion:The levels of VEGF-A and Cyr61of the patients with AM increase.The TVUS examination combined with the VEGF-A and Cyr61levels of the patients can improve the differential diagnosis value of their AM.