经阴道二维超声联合三维能量多普勒对绝经后女性子宫内膜病变的鉴别价值

陈仙秋; 金纬纬

doi:10.16766/j.cnki.issn.1674-4152.003125

经阴道二维超声联合三维能量多普勒对绝经后女性子宫内膜病变的鉴别价值

doi: 10.16766/j.cnki.issn.1674-4152.003125

陈仙秋¹,
金纬纬^2, ,

1.
温州市中西医结合医院超声科，浙江温州 325000
2.
温州市中西医结合医院妇科

基金项目:

浙江省医药卫生科技计划项目 2020KY923

详细信息

通讯作者:
金纬纬, E-mail: christina192819@163.com

中图分类号: R445.1 R711.32
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-26
- 网络出版日期: 2023-09-13

The value of transvaginal two-dimensional ultrasound combined with three-dimensional energy Doppler in differentiating endometrial lesions in postmenopausal women

CHEN Xianqiu¹,
JIN Weiwei^{2
, ,}

1.
Department of Ultrasound, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的分析二维超声联合三维能量多普勒对绝经后女性子宫内膜病变的鉴别价值。方法选择2019年5月—2022年5月温州市中西医结合医院妇科就诊的214例绝经后子宫内膜病变患者作为研究对象。按照病理检查结果分为良性病变组(109例)、不典型增生组(68例)、子宫内膜癌组(37例)。所有研究对象均行阴道超声检查，获取子宫内膜厚度、二维血流分级、三维能力多普勒血流参数。结果良性病变组、不典型增生组、子宫内膜癌组子宫内膜逐渐增厚(F=15.392，P＜0.001)，血管指数(VI)、血流指数(FI)、血管血流指数(VFI)逐渐升高(均P＜0.001)，血流2、3级构成比逐渐升高(Z=5.994, P＜0.001)。患者BMI、子宫内膜厚度、血流3级、VFI是子宫内膜病变升级的危险因素(OR=2.555、1.941、1.858、2.450，均P＜0.05)。子宫内膜厚度、血流3级对子宫内膜良性病变与不典型增生具有鉴别价值(AUC=0.770、0.811, P＜0.05)。VFI对子宫内膜良性病变与不典型增生、不典型增生与子宫内膜癌具有鉴别价值(AUC=0.793、0.859，P＜0.001)。在子宫内膜厚度＞7.6 cm、血流3级及VFI＞11中，满足1项、2项、3项与病理诊断符合率为61.5%、70.7%、90.8%。结论子宫内膜厚度、血流分级联合VFI对绝经后女性子宫内膜病变类型具有较好的鉴别价值。
- 超声 /
- 血流 /
- 三维能量多普勒 /
- 子宫内膜
Abstract: Objective To analyze the value of transvaginal two-dimensional ultrasound combined with three-dimensional energy Doppler in the differentiation of endometrial lesions in postmenopausal women. Methods A total of 214 postmenopausal patients with endometrial disease in the Department of Gynecology of Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected as the research objects. The patients were divided into benign lesion group (109 cases), atypical hyperplasia group (68 cases) and endometrial cancer group (37 cases) according to the pathological examination results. All subjects underwent transvaginal ultrasound to obtain endometrial thickness, two-dimensional blood flow classification, three-dimensional power Doppler blood flow. Results The endometrial thickness of the benign lesion group, the atypical hyperplasia group and the endometrial cancer group was gradually thickened (F=15.392, P < 0.001), the vascular index (VI), flow index (FI) and vascular flow index (VFI) were gradually increased (all P < 0.001), and the flow grade 2 and 3 was gradually increased (Z=5.994, P < 0.001). BMI, endometrial thickness, blood flow grade 3, and VFI were risk factors for the progression of endometrial lesions (OR=2.555, 1.941, 1.858, 2.450, all P < 0.05). Endometrial thickness and blood flow grade 3 had differential value between benign endometrial lesions and atypical hyperplasia (AUC=0.770, 0.811, P < 0.05). Endometrial VFI had differential value between benign endometrial lesions and atypical hyperplasia, atypical hyperplasia and endometrial cancer (AUC=0.793, 0.859, P < 0.001). In the cases of endometrial thickness > 7.6 cm, blood flow grade 3 and VFI > 11, the coincidence rates of 1, 2 and 3 with pathological diagnosis were 61.5%, 70.7% and 90.8%, respectively. Conclusion Endometrial thickness, blood flow grading combined with VFI has a good value in differentiating the types of endometrial lesions in postmenopausal women.
- Ultrasound /
- Blood flow /
- Three-dimensional energy Doppler /
- Endometrium

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表 1 3组子宫内膜病变患者一般资料比较

Table 1. Comparison of the general data of patients with endometrial lesions in 3 groups

组别	例数	年龄 (x±s，岁)	BMI (x±s)	产次[例(%)]
组别	例数	年龄 (x±s，岁)	BMI (x±s)	＜2次	≥2次
良性病变组	109	55.4±8.2	22.17±9.19	35(32.11)	74(67.89)
不典型增生组	68	54.7±9.3	23.08±10.16	21(30.88)	47(69.12)
子宫内膜癌组	37	56.9±8.5	25.76±9.38	10(27.03)	27(72.97)
统计量		0.783^a	1.956^a	0.335^b
P值		0.458	0.144	0.846
注：^a为F值，^b为χ²值。

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表 2 3组子宫内膜病变患者子宫内膜超声参数单因素比较

Table 2. Univariate comparison of endometrial ultrasound parameters in patients with endometrial lesions in 3 groups

组别	例数	子宫内膜 (x±s，cm)	二维血流分级[例(%)]				三维能量多普勒(x±s)
组别	例数	子宫内膜 (x±s，cm)	0级	1级	2级	3级	VI	FI	VFI
良性病变组	109	6.15±2.13	47(43.12)	47(43.12)	14(12.84)	1(0.92)	15.91±6.89	25.27±9.46	4.29±3.55
不典型增生组	68	7.95±2.38	18(26.47)	21(30.88)	13(19.12)	16(23.53)	24.27±7.50	30.56±11.17	6.94±2.64
子宫内膜癌组	37	9.68±3.97	5(13.51)	8(21.62)	11(29.73)	13(35.14)	29.38±10.54	36.30±11.73	9.34±2.28
统计量		15.392^a	5.994^b				50.292^a	16.756^a	22.610^a
P值		＜0.001	＜0.001				＜0.001	＜0.001	＜0.001
注：^a为F值，^b为Z值。

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表 3 子宫内膜病变的有序多分类logistic回归分析

Table 3. Ordered multiple logistic regression analysis of endometrial lesions

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.701	0.359	2.429	0.119	1.630	0.882~3.012
BMI	0.804	0.337	9.215	0.002	2.555	1.394~4.681
子宫内膜厚度	0.734	0.384	4.426	0.035	1.941	1.046~3.602
二维血流分级
1级	0.430	0.402	0.076	0.782	1.091	0.588~2.024
2级	0.550	0.394	0.377	0.539	1.016	0.967~1.067
3级	0.725	0.302	3.843	0.041	1.858	1.223~3.452
三维能量多普勒
VI	0.592	0.353	0.398	0.522	1.106	0.951~1.354
FI	0.626	0.316	0.892	0.345	1.335	0.733~2.432
VFI	0.768	0.329	8.030	0.005	2.450	1.318~4.553
注：二维血流分级以0级为参考。

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表 4 单一超声参数对子宫内膜病变的鉴别价值

Table 4. Value of single ultrasound parameters in the identification of endometrial lesions

类型	AUC	灵敏度 (%)	特异度 (%)	截断值	P值
内膜厚度
良性病变vs. 不典型增生	0.770	52.1	43.5	7.59	＜0.001
不典型增生vs. 子宫内膜癌	0.568				0.259
二维血流3级
良性病变vs. 不典型增生	0.811	60.3	45.6		0.002
不典型增生vs. 子宫内膜癌	0.601				0.188
三维能量多普勒VFI
良性病变vs. 不典型增生	0.793	53.6	50.5	7.21	＜0.001
不典型增生vs. 子宫内膜癌	0.859	65.9	59.7	10.85	＜0.001

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表 5 联合超声参数对子宫内膜癌诊断的一致性

Table 5. Consistency of diagnosis of endometrial cancer combined with ultrasound parameters

条件	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)	Kappa值
满足1项	38.5	68.7	61.5	0.06
满足2项	76.6	86.8	70.7	0.64
满足3项	89.6	92.3	90.8	0.81

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