河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (11): 1322-1327.doi: 10.3969/j.issn.1007-3205.2023.11.015

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基于超声检查与血脂相关指标构建子宫肌瘤发病的预测模型及其价值验证

  

  1. 南京医科大学附属淮安第一医院超声科，江苏 淮安 210000

  • 出版日期:2023-11-25 发布日期:2023-12-05
  • 作者简介:刘晨冰（1991-），女，江苏淮安人，南京医科大学附属淮安第一医院住院医师，医学学士，从事医学超声诊断研究。
  • 基金资助:
    南京医科大学附属淮安第一医院高层次人才科研项目（YGRS202001）

Construction of a predictive model for the development of uterine fibroids based on ultrasonography and lipid-related indicators and validation of its value

  1. Department of Ultrasound, the First Hospital of Huai′an City Affiliated to Nanjing Medical University, Jiangsu Province, Huai′an 210000, China

  • Online:2023-11-25 Published:2023-12-05

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摘要： 目的 基于超声检查与血脂相关指标构建子宫肌瘤发病的预测模型，并对其预测价值进行验证。
方法 选取女性体检者6 333例，统计子宫肌瘤发病情况，根据是否发生子宫肌瘤分为观察组与对照组，比较2组临床资料、超声检查指标［超声特征、子宫动脉收缩期峰值血流速度（peak systolic velocit，PSV）、血流阻力指数（resistance index，RI）、搏动指数（pulsation index，PI）］、血脂相关指标［三酰甘油（triglyceride，TG）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein cholestero，LDL-C）、总胆固醇（total cholesterol，TC）、血浆致动脉硬化指数（atherogenic index of plasma，AIP）、三酰甘油-葡萄糖指数（triglyceride glucose index，TyG）］，构建列线图预测模型，并进行验证。
结果 经选取标准筛选后，共纳入女性体检者4 812例作为入组对象，超声诊断发生子宫肌瘤1 065例，子宫肌瘤发病率为22.13%，其中肌壁间肌瘤854例，占80.19%，浆膜下肌瘤156例，占14.65%，黏膜下肌瘤55例，占5.16%；平均子宫肌瘤数目（4.18±1.02）个，平均最大肌瘤直径（6.64±1.89）cm。观察组子宫动脉PSV、PI高于对照组，RI低于对照组（P＜0.05）；2组HDL-C水平差异无统计学意义（P＞0.05），TG、LDL-C、TC、AIP、TyG水平高于对照组（P＜0.05）；Logistic回归分析，子宫动脉PSV、RI、PI、TG、LDL-C、TC、AIP、TyG是子宫肌瘤发病的独立影响因素（P＜0.05）；根据上述超声与血脂相关指标构建子宫肌瘤发病的列线图预测模型，校准曲线显示，该预测模型一致性指数为0.827，具有较好的一致性；Hosmer-Lemeshow拟合优度检验显示，P=0.710＞0.05，该预测模型拟合度较好；受试者工作特征曲线（receiver operating characteristic，ROC）分析，该预测模型预测子宫肌瘤发病的曲线下面积（area under curve，AUC）为0.912（95%CI：0.837~0.994），敏感度为92.02%，特异度为90.74%。
结论 基于超声检查参数子宫动脉PSV、RI、PI与血脂指标TG、LDL-C、TC、AIP、TyG构建子宫肌瘤发病预测模型具有可行性，且预测价值较为可靠。


关键词: 平滑肌瘤 , 子宫, 超声检查, 血脂相关指标

Abstract: Objective To construct a predictive model for the development of uterine fibroids based on ultrasonography and lipid-related indicators, and to validate its predictive value. 
Methods A total of 6 333 female patients undergoing physical examination were selected to calculate the incidence of uterine fibroids, and they were divided into observation group and control group according to occurrence of uterine fibroids. The clinical data, ultrasound examination indicators ［ultrasound characteristics, peak systolic velocity (PSV), resistance index (RI), pulsation index (PI)］, and lipid-related indicators ［triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), atherogenic index of plasma (AIP) and triglyceride glucose index (TyG)］ were compared between two groups. A nomogram predictive model was constructed and validated. 
Results  After screening by selection criteria, a total of 4 812 female physical examinees were included as research subjects, among whom 1 065 patients with uterine fibroids were diagnosed by ultrasound, and the incidence of uterine fibroids was 22.13%, including 854 patients with intermyometrial fibroids (80.19%), 156 patietns with subplasmaline fibroids (14.65%), and 55 patients with submucosal fibroids (5.16%). The average number of fibroids was (4.18±1.02), and  the mean maximum fibroid diameter was (6.64±1.89) cm. The observation group had higher PSV and PI than the control group, but lower RI than the control group (P＜0.05). The difference in HDL-C levels between two groups was not statistically significant (P＞0.05), and the levels of TG, LDL-C, TC, AIP and TyG were higher than those in the control group (P＜0.05). Logistic regression analysis showed that uterine artery PSV, RI, PI, TG, LDL-C, TC, AIP, and TyG were independent influencing factors for the development of uterine fibroids (P＜0.05). The nomogram predictive model for the development of uterine fibroids was constructed based on the above ultrasound and lipid-related indicators, and the calibration curve showed that the consistency index of the predictive model was 0.827, which had good consistency. The Hosmer-Lemeshow goodness-of-fit test showed P=0.710>0.05, and the predictive model had a good fit. The area under receiver operating characteristic (ROC) curve (AUC) of this predictive model for predicting the onset of uterine fibroids was 0.912 (95%CI: 0.837-0.994), with a sensitivity of 92.02% and a specificity of 90.74%. 
Conclusion It is feasible to construct a predictive model for development of uterine fibroids based on ultrasonographic parameters, including uterine artery PSV, RI, PI, and lipid-related indicators TG, LDL-C, TC, AIP, and TyG, and the predictive value is more reliable. 

Key words: leiomyoma, uterus, ultrasonography, lipid-related indicators

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