赵红,田芬,侯晓英.超声介入联合高强度聚焦超声治疗瘢痕妊娠[J].中国医学影像技术,2021,37(7):1044~1048
超声介入联合高强度聚焦超声治疗瘢痕妊娠
Ultrasound interventional with high-intensity focused ultrasound in treatment of scar pregnancy
投稿时间:2020-08-30  修订日期:2021-05-26
DOI:10.13929/j.issn.1003-3289.2021.07.019
中文关键词:  妊娠  氨甲蝶呤  高强度聚焦超声消融
英文关键词:pregnancy  methotrexate  high-intensity focused ultrasound ablation
基金项目:河北省医学科学研究课题计划(20200450)。
作者单位E-mail
赵红 邯郸市中心医院超声科, 河北 邯郸 056001  
田芬 邯郸市中心医院妇一科, 河北 邯郸 056001 tianye_0406@163.com 
侯晓英 邯郸市中心医院超声科, 河北 邯郸 056001  
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中文摘要:
      目的 观察超声介入联合高强度聚焦超声(HIFU)治疗瘢痕妊娠的效果。方法 纳入130例瘢痕妊娠患者,随机分为HIFU组、联合组,每组65例,HIFU组予HIFU治疗,联合组予超声介入MTX联合HIFU治疗。对比治疗前后组间包块大小、视觉模拟评分法(VAS)评分、实验室检查结果、超声参数及妊娠结局等差异。绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)评价治疗后β-人绒毛膜促性腺激素(β-HCG)、妊娠组织直径及瘢痕部位肌壁厚度预测妊娠结局的效能。结果 治疗前,2组间各指标差异均无统计学意义(P均>0.05)。治疗后,联合组包块大小、血清β-HCG、超敏C反应蛋白(hs-CRP)、白细胞介素-8(IL-8)、白细胞介素-17(IL-17)、氧化型低密度脂蛋白(OX-LDL)及血流指数(FI)、搏动指数(PI)、血管化指数(VI)均低于HIFU组(P均<0.05),血清谷胱甘肽过氧化物酶(GSH-Px)及过氧化氢酶(CAT)均高于HIFU组(P均<0.05);联合组β-HCG恢复正常时间、月经恢复时间均明显短于HIFU组(P均<0.05);联合组VAS评分低于HIFU组(P<0.05);联合组自然分娩率高于HIFU组(P<0.05),提前终止妊娠率低于HIFU组(P<0.05)。2组内各指标治疗后与治疗前比较差异均有统计学意义(P均<0.05)。MTX治疗后血清β-HCG水平、妊娠组织直径、瘢痕部位肌壁厚度预测瘢痕妊娠结局的AUC分别为0.72、0.65及0.75。结论 超声介入MTX联合HIFU治疗可明显改善瘢痕妊娠患者β-HCG、疼痛程度、减轻炎症反应及氧化应激反应、改善病灶血供,使患者恢复情况、妊娠结局更加理想。
英文摘要:
      Objective To observe the effect of interventional ultrasound with methotrexate (MTX) combined with high-intensity focused ultrasound (HIFU) on scar pregnancy. Methods A total of 130 patients with scar pregnancy were randomly divided into the HIFU group and combination group, 65 cases in each group. HIFU group was treated with HIFU, and combination group was treated with ultrasound interventional MTX combined with HIFU. The size of the mass, visual analogue scale (VAS) score, laboratory findings, ultrasound parameters and pregnancy outcomes were compared between the groups before and after treatment. Receiver operating characteristic (ROC) curves were drawn, and the area under the curves (AUC) were calculated to evaluate post-treatment β-Human chorionic gonadotropin (β-HCG), diameter of gestational tissue and thickness of the muscle wall at the uterine scar site to predict pregnancy outcome. Results Before treatment, there were no significant differences in all indexes between the 2 groups (all P>0.05). After treatment, the size of the mass, serum β-HCG, hypersensitive C-reactive protein (hs-CRP), interleukin-8 (IL-8), interleukin-17 (IL-17), oxidized low density lipoprotein (OX-LDL), blood flow index (FI), pulsatility index (PI), and vascularization index (VI) in combination group were lower in HIFU group (all P<0.05), while serum glutathione peroxidas (GSH-Px) and catalase (CAT) were higher in HIFU group (all P<0.05). The recovery time of β-HCG and menstruation in combination group were significantly shorter than those in HIFU group (all P<0.05). VAS score of the combined group was lower than that of HIFU group (P<0.05). The rate of spontaneous delivery in combination group was higher than that in HIFU group (P<0.05), and the rate of premature termination of pregnancy was lower than that in HIFU group (P<0.05). After MTX treatment, the AUC of serum β-HCG, diameter of pregnancy tissue and thickness of muscle wall in predicting scar pregnancy outcome was 0.72, 0.65 and 0.75, respectively. Conclusion Ultrasound intervention of MTX combined with HIFU treatment can significantly improve scar pregnancy patients β-HCG, pain levels, reduced inflammatory and oxidative stress responses, improved blood supply to the lesion, patient recovery and pregnancy outcome were more desirable.
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