Clinical effect of high- intensity focused ultrasound ablation on adenomyosis and its influence on serum CA125 of patients
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摘要:
目的 探讨高强度聚焦超声（HIFU）消融子宫腺肌病的疗效及对患者血清糖类抗原125（CA125）的影响。 方法 选取2020年12月~2021年12月本院收治的73例子宫腺肌病患者，均行HIFU治疗。根据患者术后情况对HIFU治疗进行有效性评价。比较患者术前及术后1、3、6月的痛经评分、经量评分，测量子宫及腺肌病灶的体积及患者血清CA125水平变化。术后随访6月，记录不良反应和复发情况。 结果 73例子宫腺肌病患者中，治疗显效患者22例（30.14%），治疗有效47例（64.38%），总有效率为94.52%。患者术后1、3、6月的痛经评分、经量评分、病灶体积和子宫体积均低于术前（P < 0.05）。术后1、3、6月随访中，患者痛经评分、经量评分和病灶体积的差异均有统计学意义（P < 0.05），但患者的子宫体积变化无统计学意义（P > 0.05）。术后1、3、6月随访中，患者血清CA125水平逐渐降低，趋于正常（P < 0.05）。患者术后IgA、IgM、补体C3、C4和Th17/Treg比值均低于术前，IgG水平高于术前（P < 0.05）。术后随访6月，患者不良反应总发生率为10.96%，2例（2.74%）患者复发。 结论 HIFU消融治疗可有效缓解子宫腺肌病患者痛经等临床症状、缩小病灶体积，同时不良反应率和复发率较低，是一种安全有效的治疗方法。在使用HIFU治疗时可检测患者CA125水平变化，为判定子宫腺肌病患者疗效评价提供参考。 Abstract:Objective To investigate the efficacy of high-intensity focused ultrasound (HIFU) in ablation of adenomyosis, and its influence on serum CA125. Methods From December 2020 to December 2021, 73 patients with adenomyosis were treated with HIFU. The effectiveness of HIFU treatment according to the postoperative condition of patients was evaluated. The dysmenorrhea score and menstrual flow score were compared before operation and 1, 3, 6 months after operation. The volume of uterine and glandular muscle lesions was measured, and the change of serum CA125 level was observed. All patients were followed up for 6 months, and the occurrence and recurrence of adverse reactions were recorded. Results Among the 73 patients of adenomyosis, 22 patients (30.14%) were markedly effective and 47 patients (64.38%) were effective, with a total effective rate of 94.52%. After 1, 3 and 6 months, the dysmenorrhea score, menstrual flow score, lesion volume and uterus volume were lower than those before operation (P < 0.05). After 1, 3 and 6 months follow-up, there were statistical differences in dysmenorrhea score, menstrual flow score and lesion volume (P < 0.05), but there was no statistical difference in uterine volume (P > 0.05), and the level of serum CA125 gradually decreased and became normal (P < 0.05). After operation, IgA, IgM, complement C3, C4 and Th17/Treg ratio were lower than those before operation, but IgG level was higher than that before operation (P < 0.05). After 6 months of follow- up, the total incidence of adverse reactions was 10.96%, and 2 patients (2.74%) recurred. Conclusion HIFU ablation can effectively relieve the clinical symptoms such as dysmenorrhea in patients with adenomyosis, reduce the volume of the lesion, and reduce the adverse reaction rate and recurrence rate. It is a safe and effective method to treat adenomyosis. When HIFU is used, the change of CA125 level can be detected, which can provide reference for evaluating the curative effect of patients with adenomyosis. -
Key words:
- adenomyosis of uterus /
- high-intensity focused ultrasound /
- CA125 /
- efficacy evaluation
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图 1 患者HIFU治疗前后对比图
Figure 1. Comparison of patients before and after HIFU treatment. A: MRI examination before HIFU showed that the patient's lesion was located in the anterior wall of uterus, showing low signal intensity on T2WI; B: MRI examination after HIFU showed a slightly high signal on T2WI of the patient's focus, and no obvious enhancement was found in the enhanced scan.
表 1 患者一般资料
Table 1. General data of patients (n=73)
Index Value Age (years, Mean±SD) 37.15±5.28 Focus volume (cm3, Mean±SD) 37.92±6.87 Number of lesions [n(%)] Single shot 67（91.78） Multiple shots 6（8.22） Uterine position [n(%)] Front 58（79.45） Middle 4（5.48） Back 11（15.07） Location of focus [n(%)] Antetheca 9（12.33） Paries posterior 51（69.86） Palace bottom 13（18.81） Uterine volume (cm3, Mean±SD) 183.29±30.27 Dysmenorrhea score (point, Mean±SD) 8.14±1.96 Menstrual volume score(point, Mean±SD) 4.31±0.95 Total energy of HIFU treatment (kJ, Mean±SD) 297.82±26.79 HIFU: High-intensity focused ultrasound. 
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表 2 患者手术前后痛经、经量评分比较
Table 2. Comparison of dysmenorrhea and menstrual volume scores before and after operation (score, n=73, Mean±SD)
Time Dysmenorrhea score Menstrual volume score Preoperative 8.14±1.96 4.31±0.95 1 month after operation 6.43±1.49a 3.54±0.71a 3 months after operation 4.81±1.14ab 3.02±0.53ab 6months after operation 2.27±0.57abc 2.21±0.39abc aP < 0.05 vs preoperative; bP < 0.05 vs 1 month after operation; cP < 0.05 vs 3 months after operation.
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表 3 患者手术前后病灶体积和子宫体积变化
Table 3. Changes of focus volume and uterine volume before and after operation (cm3, n=73, Mean±SD)
Time Focus volume Uterine volume Preoperative 37.92±6.87 183.29±30.27 1 month after operation 28.51±4.92a 171.82±25.36a 3 months after operation 22.34±3.07ab 165.27±23.38a 6 months after operation 18.93±2.24abc 161.73±22.19a aP < 0.05 vs preoperative; bP < 0.05 vs 1 month after operation; cP < 0.05 vs 3 months after operation.
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表 4 患者手术前后免疫功能比较
Table 4. Comparison of immune function of patients before and after operation (n=73, Mean±SD)
Time IgA（g/L） IgG（g/L） IgM（g/L） C3（mg/dL） C4（mg/dL） Th17/treg Preoperative 3.71±0.59 11.83±1.27 1.52±0.37 105.84±5.91 25.08±3.89 0.42±0.04 Postoperative 3.04±0.41 14.69±1.41 1.05±0.21 91.57±4.46 19.94±3.50 0.36±0.07 t 7.968 12.877 9.439 16.467 8.392 6.359 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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