3D-PDUS 血流参数对宫腔镜下重度宫腔黏连分解术后复发的预测价值

Prediction value of 3D-PDUS blood flow parameters for recurrence after hysteroscopic adhesion decomposition in patients with severe intrauterine adhesions

目的探讨三维能量多普勒超声(three-dimensional power Doppler ultrasound,3D-PDUS)血流参数对重度宫腔黏连(intrauterine adhesion,IUA)患者宫腔镜下宫腔黏连分解术后复发的预测价值。方法选取2021年1月至2022年12月于云南省第三人民医院行宫腔镜下宫腔黏连分解术的100例重度IUA患者为研究对象。分别于术前、术后1个月进行3D-PDUS检查,获得血管指数(vascularization index,VI)、血流指数(flow index,FI)、血管化血流指数(vascularization-flow index,VFI)。依据术后3个月复发情况将患者分为复发组和未复发组,评价术后复发的影响因素。评价VFI、VI、FI对术后复发的预测价值。统计学方法采用t检验、χ^(2)检验、Logistic回归分析及受试者操作特征(receiver operating characteristic,ROC)曲线分析。结果重度IUA患者术后与术前VI(0.56±0.22与0.14±0.06,t=18.418)、FI(22.67±2.34与17.62±2.39,t=15.098)、VFI(0.98±0.47与0.07±0.03,t=19.322)比,术后均高于术前(P<0.001)。术后复发组与未复发组VI(0.31±0.15与0.65±0.24,t=6.869)、(15.1±2.1与25.5±2.5,t=18.930)、VFI(0.67±0.17与1.09±0.25,t=8.055)比较,复发组术后均低于未复发组(P<0.001)。随机森林算法显示,重要性评分前5的变量依次为术后VFI、VI、FI、人工流产次数、病程;术后VFI(OR=0.279,95%CI:0.137~0.569)、VI(OR=0.257,95%CI:0.122~0.541)、FI(OR=0.275,95%CI:0.125~0.603)、人工流产次数(OR=5.702,95%CI:1.258~25.841)、病程(OR=5.976,95%CI:1.301~27.449)为术后复发影响因素(P值均<0.001)。术后1个月VFI、VI、FI单项及联合预测术后复发的曲线下面(areaunder the curve,AUC)分别为0.744、0.837、0.799、0.938,且联合预测高于单独指标预测(P<0.001)。结论重度IUA患者宫腔镜下宫腔黏连分解术后血流参数VI、FI、VFI升高,联合检测各血流参数对术后复发具有一定预测价值。

Objective To investigate the predictive value of blood flow parameters measured by threedimensionalenergy Doppler ultrasound(3D-PDUS)for recurrence after hysteroscopic adhesion decompositionin patients with severe intrauterine adhesions(IUA).Method A total of 100 cases with severe IUAwho underwent hysteroscopic adhesion decomposition at the Third People's Hospital of Yunnan Province fromJanuary 2021 to December 2022 were selected as the study.3D-PDUS was performed before and one month aftersurgery to obtain vascularization index(VI)、flow index(FI)、vascularization-flow index(VFI)of bloodflow parameters.According to the recurrence situation 3 months after the operation,the patients were dividedinto recurrence group and non-recurrence group,and the influencing factors of postoperative recurrence wereanalyzed.The predictive value of VFI,VI,and FI for postoperative recurrence was evaluated.The statisticalmethods performed by t-test,χ^(2)-test,Logistic regression analysis and receiver operating characteristic(ROC)curve analysis.Result VI(0.56±0.22 vs 0.14±0.06,t=18.418),FI(22.67±2.34 vs 17.62±2.39,t=15.098),and VFI(0.98±0.47 vs 0.07±0.03,t=19.322)in patients with severe IUA was higher after surgery than beforesurgery(P<0.001).The patients in recurrence group were lower than those in non-recurrence group in VI(0.31±0.15 vs 0.65±0.24,t=6.869),FI(15.1±2.1 vs 25.5±2.5,t=18.930),VFI(0.67±0.17 vs 1.09±0.25,t=8.055),(P<0.001).The random forest algorithm showed that the top five variables in importance score werepostoperative VFI,VI,FI,number of induced abortions,and disease duration;postoperative VFI(OR=0.279,5%CI:0.137-0.569),VI(OR=0.257,95%CI:0.122-0.541),FI(OR=0.275,95%CI:0.125-0.603),number ofnduced abortions(OR=5.702,95%CI:1.258-25.841),and disease duration(OR=5.976,95%CI:1.301-27.449)were factors affecting postoperative recurrence,all P<0.001;the area under the curve(AUC)of single andcombined prediction of VFI,VI and FI were 0.744,0.837,0.799 and 0.938,respectively,and the AUC of combinedprediction were higher than that of single prediction(P<0.001).Conclusion Blood flow parameters VI,FI andVFI increased after hysteroscopic adhesion decomposition in patients with severe IUA.Combined detection ofblood flow parameters has certain predictive value for postoperative recurrence.