三维能量多普勒超声用于围绝经期AUB-O鉴别诊断及疗效评价的研究

边焕杰; 钱绿丽; 章林燕

doi:10.16766/j.cnki.issn.1674-4152.004422

三维能量多普勒超声用于围绝经期AUB-O鉴别诊断及疗效评价的研究

doi: 10.16766/j.cnki.issn.1674-4152.004422

1.
诸暨市妇幼保健院超声科，浙江绍兴 311800
2.
诸暨市妇幼保健院中医科
3.
诸暨市妇幼保健院妇科

基金项目:

浙江省中医药科技计划项目 2023XY200

详细信息

通讯作者:
边焕杰，E-mail: bhjxy2020@163.com

中图分类号: R445.1 R711.52
计量
- 文章访问数: 11
- HTML全文浏览量: 5
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-06
- 网络出版日期: 2026-06-02

Exploratory study on 3D-CPA for differential diagnosis and efficacy evaluation of AUB-O in perimenopause

1.
Department of Ultrasound, Zhuji Maternal and Child Health Hospital, Shaoxing, Zhejiang 311800, China

摘要

摘要: 目的探讨三维能量多普勒超声(3D-CPA)用于围绝经期排卵障碍性异常子宫出血(AUB-O)病情诊断、评估及疗效监测的临床价值。方法选取2020年9月—2024年3月诸暨市妇幼保健院收治的160例AUB患者及同期160名健康受试者为研究对象，全部研究对象均进行子宫3D-CPA检查，分析围绝经期AUB-O患者与其他类型AUB患者、健康女性在3D-CPA参数方面的差异。结果围绝经期AUB-O患者子宫内膜容积(EV)、子宫内膜血管指数(VI)、血流指数(FI)和血管血流指数(VFI)等3D-CPA指标均高于其他类型AUB患者及健康受试者(P < 0.001)，虽然AUB-O患者和其他类型AUB患者子宫内膜厚度均高于健康受试者(P < 0.001)，但AUB-O患者和其他类型AUB患者之间差异无统计学意义(P>0.05)。围绝经期AUB-O患者经米非司酮治疗2周后血清促卵泡激素(FSH)、促黄体生成素(LH)和雌二醇(E2)水平均较治疗前显著下降[(13.96±2.07)IU/L vs. (22.96±3.14)IU/L；(12.06±1.58)IU/L vs. (19.78±2.49)IU/L；(52.63±6.12)ng/L vs. (96.54±10.49)ng/L, 均P < 0.001]。经米非司酮治疗有效AUB-O患者EV、VI、FI和VFI数值均显著低于治疗无效患者(P < 0.001)。围绝经期AUB-O患者经米非司酮治疗前后EV、VI、FI和VFI变化值均与性激素水平变化值呈正相关关系(P < 0.05)。结论 3D-CPA检查可有效识别AUB-O患者与健康受试者，以及不同疗效水平AUB-O患者间的子宫血流供给及子宫内膜增殖活跃度的差异，在AUB-O诊断、疗效评价、病情监测和预后评估等方面具有潜在的应用价值。
- 围绝经期 /
- 排卵障碍性异常子宫出血 /
- 三维能量多普勒超声 /
- 米非司酮 /
- 病情监测 /
- 疗效评
Abstract: Objective To explore the clinical value of three dimensional energy Doppler ultrasound (3D-CPA) in the diagnosis, evaluation, and efficacy monitoring of perimenopausal ovulation disorders associated with abnormal uterine bleeding (AUB-O). Methods A total of 160 patients with perimenopausal AUB and 160 healthy subjects admitted to Zhuji Maternal and Child Health Hospital were selected as the study subjects from September 2020 to March 2024. All study subjects underwent a uterine 3D-CPA examination to explore the differences in 3D-CPA parameters between perimenopausal AUB-O patients and other types of AUB patients, as well as healthy women. Results The 3D-CPA indicators of endometrial volume (EV), vascularity index (VI), flow index (FI), and vascular flow index (VFI) in perimenopausal AUB-O patients were higher than those in other types of AUB patients and healthy subjects (P < 0.001). Although the endometrial thickness of AUB-O patients and other types of AUB patients was higher than that of healthy subjects (P < 0.001), the difference between AUB-O patients and other types of AUB patients was not statistically significant (P>0.05). After 2 weeks of mifepristone treatment, the serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels in perimenopausal AUB-O patients significantly decreased compared to before treatment [(13.96±2.07) IU/L vs. (22.96±3.14) IU/L; (12.06±1.58) IU/L vs. (19.78±2.49) IU/L; (52.63±6.12) ng/L vs. (96.54±10.49) ng/L, P < 0.001]. The EV, VI, FI, and VFI values of AUB-O patients who were effectively treated with mifepristone were significantly lower than those of patients who were ineffective in treatment (P < 0.001). The changes in EV, VI, FI, and VFI before and after mifepristone treatment in perimenopausal AUB-O patients were positively correlated with changes in sex hormone levels (P < 0.05). Conclusion 3D-CPA examination can effectively identify the differences in uterine blood flow supply and endometrial proliferation activity between AUB-O patients and healthy subjects, as well as between AUB-O patients with different therapeutic levels. Therefore, it has potential application value in AUB-O diagnosis, therapeutic evaluation, disease monitoring, and prognosis evaluation.
- Perimenopausal period /
- Ovulation disorders with abnormal uterine bleeding /
- Three dimensional energy Doppler ultrasound /
- Mifepristone /
- Disease monitoring /
- Efficacy evaluation

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表 1 围绝经期AUB-O患者、其他类型AUB患者和健康受试者超声指标比较(x±s)

Table 1. Comparison of ultrasound indicators among perimenopausal AUB-O patients, other types of AUB patients, and healthy subjects (x±s)

组别	例数	EV(m³)	VI(%)	FI	VFI	子宫内膜厚度
健康受试组	160	3.41±0.48	27.62±2.77	18.94±2.23	3.74±0.49	3.02±0.48
其他类型AUB组	48	5.16±0.69^a	30.58±2.94^a	21.06±2.31^a	4.59±0.55^a	6.94±1.18^a
AUB-O组	112	5.93±0.73^ab	34.81±3.58^ab	23.52±2.57^ab	5.26±0.61^ab	7.35±1.26^a
F值		589.031	177.072	123.452	260.841	809.652
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：与健康受试组比较，^aP < 0.05；与其他类型AUB组比较，^bP < 0.05。

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表 2 围绝经期AUB-O患者治疗前后性激素水平比较(x±s)

Table 2. Comparison of sex hormone levels before and after treatment in AUB-O patients during perimenopause (x±s)

时间	例数	FSH(IU/L)	LH(IU/L)	E2(ng/L)
治疗前	112	22.96±3.14	19.78±2.49	96.54±10.49
治疗后	112	13.96±2.07	12.06±1.58	52.63±6.12
t值		-25.332	-27.712	-38.263
P值		< 0.001	< 0.001	< 0.001

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表 3 不同疗效水平围绝经期AUB-O患者治疗后3D-CPA参数比较(x±s)

Table 3. Comparison of 3D-CPA parameter differences in perimenopausal AUB-O patients with different therapeutic efficacy levels after treatment (x±s)

组别	例数	EV(m³)	VI(%)	FI	VFI
有效组	90	3.82±0.53	28.41±3.61	19.42±2.71	4.01±0.62
无效组	22	4.61±0.76	32.05±3.82	22.31±2.86	4.74±0.73
t值		5.302	4.663	4.941	4.972
P值		< 0.001	< 0.001	< 0.001	< 0.001

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表 4 围绝经期AUB-O患者3D-CPA参数变化与性激素含量水平的相关性

Table 4. Correlation between changes in 3D-CPA parameters and changes in sex hormone levels before and after treatment in AUB-O patients during perimenopause

项目	ΔEV(m³)		ΔVI(%)		ΔFI		ΔVFI
项目	r值	P值	r值	P值	r值	P值	r值	P值
ΔFSH(IU/L)	0.759	0.012	0.716	0.027	0.743	0.015	0.735	0.019
ΔLH(IU/L)	0.721	0.025	0.774	0.009	0.761	0.011	0.748	0.014
ΔE2(ng/L)	0.772	0.009	0.788	0.004	0.775	0.008	0.769	0.010

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