预测子宫腺肌症动脉栓塞后病灶治疗应答的多因素Logistic回归分析

摘要

Objective To identify the prognostic factors for the therapeutic response of adenomyosis after uterine artery embolization (UAE).Methods 68 patients with adenomyosis who underwent UAE in our hospital were divided into two groups based on their therapeutic responses of complete or incomplete necrosis of lesions,pre-and post-procedural pelvic MRI data.Patients were followed-up for 12 months after UAE to monitor symptom relief.Logistic regression analysis was used to identify the predisposing factors.The receiver operating characteristic (ROC) curve of identified factors was drawn to determine the predictive value.Results 46 patients showed complete necrosis after UAE;the other 22 patients showed incomplete necrosis.59 patients completed the 12-month follow-up after UAE and nine patients were lost to follow-up.45 of 56 (80.36％) patients with dysmenorrhea reported improvement after UAE with complete (94.74％) and incomplete (50.0％) necrosis whereas 33/40 (82.50％) patients with menorrhagia reported improvement with complete (96.15％) and incomplete (57.14％) necrosis.Predisposing factors determined from the logistic regression analysis were serum CA125 levels and accompanying endometriosis.The areas under the ROC curves (AUCs) of CA125,endometriosis,and both were 0.785,0.708,and 0.845,respectively.Conclusion Symptom relief of dysmenorrhea and menorrhagia for patients with complete necrosis was significantly better than that for patients with incomplete necrosis.Serum CA125 levels and accompanying endometriosis can effectively distinguish complete necrosis from incomplete necrosis.%目的 探讨子宫腺肌症患者在子宫动脉栓塞术(UAE)后,影响腺肌症病灶治疗应答的相关因素.方法 纳入本研究的68例症状性子宫腺肌症患者均在我院行UAE.根据术前及术后核磁共振表现(MRI)对病灶的治疗应答进行分组(完全坏死组和未完全坏死组).术后随访12个月,记录患者的症状是否缓解.Logistic分析用于确定可以对病灶治疗应答进行预测的变量.最后受试者工作曲线(ROC)用以确定各模型的预测价值.结果 46例患者的病灶达到完全坏死;另有22例的病灶未完全坏死.59例完成最后12个月的随访,9例失访.其中56例术前有痛经症状,45例术后症状缓解,总体缓解率为80.36％;40例术前有月经量过多症状,33例术后症状缓解,总体缓解率为82.50％.痛经及月经量过多症状缓解率在完全坏死组和未完全坏死组中分别为:94.74％、50.0％和96.15％ 、57.14％.Logistic分析显示,血清癌抗原125(CA125)与是否伴发子宫内膜异位症在两组间差异有统计学意义.ROC曲线结果显示单独血清CA125、单独伴发子宫内膜异位症和两种因素联合预测的曲线下面积分别为0.785、0.708和0.845.结论 完全坏死组患者的症状缓解率要明显高于未完全坏死组.并且血清CA125和是否伴发子宫内膜异位症能较为有效的鉴别子宫腺肌症在UAE术后的病灶治疗应答情况.