多发性子宫肌瘤剔除术前后彩色多普勒超声参数、lncRNA XIST变化对术后复发评估价值

The value of color doppler flow imaging parameters and lncRNA XIST changes before and after multiple uterine fibroids in evaluating postoperative recurrence

摘要

目的 分析多发性子宫肌瘤剔除术前后彩色多普勒超声(CDFI)参数、长链非编码RNA X染色体失活特异转录本(lncRNA XIST)变化对术后复发的评估价值。方法 选取2022年1月至2024年2月泸州市人民医院收治的196例拟行多发性子宫肌瘤剔除术患者作为研究对象,根据术后6个月是否复发分为复发组和未复发组,采用倾向性评分匹配(PSM)来降低组间选择偏倚。采用Voluson E10型彩色多普勒超声诊断仪测定术前、术后1个月舒张期血流速度(EDV)、收缩期血流速度(PSV)、子宫阻力指数(UtA-RI)、子宫搏动指数(UtA-PI),采用实时荧光定量聚合酶链式反应(qRT-PCR)测定术前、术后1个月lncRNA XIST,采用Logistic回归方程分析CDFI参数、lncRNA XIST与多发性子宫肌瘤剔除术后复发的关系,采用受试者工作特征(ROC)曲线分析模型预测价值。结果 术后6个月,研究对象中共有5例失访,55例(28.79%)复发;匹配后复发组术前lncRNA XIST、EDV、PSV、UtA-PI高于未复发组,UtA-RI低于未复发组,差异有统计学意义(t值介于11.733~16.918之间,P<0.05);ROC曲线显示,术前lncRNA XIST、EDV、PSV、UtA-PI、UtA-RI预测多发性子宫肌瘤剔除术后复发的曲线下面积(AUC)分别为0.754、0.766、0.792、0.776、0.742,联合预测的AUC为0.918,灵敏度为81.82%,特异度为92.73%,联合预测AUC高于单独预测(Z值介于2.215~3.340之间,P<0.001);按截断值分组,lncRNA XIST、EDV、PSV、UtA-RI、UtA-PI高值患者复发风险是低值患者的1.647、1.875、1.406、0.700、1.664倍。结论 lncRNA XIST、EDV、PSV、UtA-PI、UtA-RI异常均会增加多发性子宫肌瘤剔除术后复发风险,五者联合有助于提高预测价值,指导临床诊治。

Abstract

Objective To analyze the evaluation value of color doppler flow imaging (CDFI) parameters and the change of long-chain non-coding RNA X-chromosome inactivation specific transcript (lncRNA XIST) before and after the removal of multiple uterine fibroids for postoperative recurrence. Methods A total of 196 patients who underwent the removal of multiple uterine fibroids at Luzhou People's Hospital from January 2022 to February 2024 were selected as the research subjects. They were divided into the recurrence group and the non-recurrence group based on whether they had recurrence 6 months after the operation. Propensity score matching (PSM) was used to reduce the selection bias between the groups. The end-diastolic velocity (EDV), peak systolic blood flow velocity (PSV), uterine artery resistance index (UtA-RI), and uterine artery pulsatility index (UtA-PI) were measured before and 1 month after the operation using the Voluson E10 color Doppler ultrasound diagnostic instrument. lncRNA XIST was measured before and 1 month after the operation using real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). Logistic regression equation was used to analyze the relationship between CDFI parameters, lncRNA XIST, and postoperative recurrence after the removal of multiple uterine fibroids. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model. Results 5 subjects were lost to follow-up 6 months after the operation, and 55 cases (28.79%) recurred. After matching, the lncRNA XIST, EDV, PSV, UtA-PI of the recurrence group before the operation were higher than those of the non-recurrence group, and the UtA-RI was lower than that of the non-recurrence group. The differences were statistically significant (t ranged from 11.733 to 16.918, P<0.05). The ROC curve showed that the area under the curve (AUC) of lncRNA XIST, EDV, PSV, UtA-PI, and UtA-RI for predicting postoperative recurrence after the removal of multiple uterine fibroids before the operation was 0.754, 0.766, 0.792, 0.776, and 0.742, respectively. The combined prediction AUC was 0.918, with a sensitivity of 81.82% and a specificity of 92.73%. The combined prediction AUC was higher than the individual prediction (Z ranged from 2.215 to 3.340, P<0.001). According to the cutoff value, the recurrence risk of patients with high values of lncRNA XIST, EDV, PSV, UtA-RI, and UtA-PI was 1.647, 1.875, 1.406, 0.700, and 1.664 times that of patients with low values, respectively. Conclusion Abnormal lncRNA XIST, EDV, PSV, UtA-PI, and UtA-RI all increase the risk of postoperative recurrence after the removal of multiple uterine fibroids. The combination of these five parameters is helpful to improve the predictive value and guide clinical diagnosis and treatment.

关键词

子宫肌瘤 / 多发性 / 腹腔镜子宫肌瘤剔除术 / 复发 / 彩色多普勒超声 / 长链非编码RNA X染色体失活特异转录本

Key words

uterine fibroid / multiple / laparoscopic myomectomy / recurrence / color doppler flow imaging / long-chain non-coding RNA X-chromosome inactivation specific transcript

参考文献

[1] Lin Y, Wu R C, Huang Y L, et al. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis[J]. Abdom Radiol(NY), 2022, 47(6): 2197-2208.

[2] Keizer A L, Semmler A, Kok H S, et al. Modifiable prognostic factors in uterine fibroid development: a systematic review of literature[J]. J Obstet Gynaecol, 2024, 44(1): 2288225.

[3] 洪开, 张春莲, 李秋月, 等. 仿生物电刺激对腹腔镜子宫肌瘤剔除术后胃肠功能恢复的影响[J]. 中国妇幼健康研究, 2024, 35(6): 96-102.

[4] Balulescu L, Brasoveanu S, Pirtea M, et al. The impact of laparoscopic myomectomy on pregnancy outcomes: a systematic review[J]. J Pers Med, 2024, 14(4): 340.

[5] Frijlingh M, Juffermans L, de Leeuw R, et al. How to use power Doppler ultrasound in transvaginal assessment of uterine fibroids[J]. Ultrasound Obstet Gynecol, 2022, 60(2): 277-283.

[6] Chuang T D, Ton N, Rysling S, et al. The in vivo effects of knockdown of long non-coding RNA XIST on fibroid growth and gene expression[J]. FASEB J, 202, 38(21): 53-58.

[7] 任小霞, 徐海波, 吴金婷, 等. 子宫内膜癌组织中lncRNA XIST, miR-132-3p的表达及与病理参数和预后的关系[J]. 中国医药导报, 2023, 20(32): 33-37.

[8] 子宫肌瘤的诊治中国专家共识专家组, 妇产科相关专家组(统称). 子宫肌瘤的诊治中国专家共识[J]. 中华妇产科杂志, 2017, 52(12): 793-800.

[9] 杨丽娜, 白金录, 刘照龙, 等. 子宫肌瘤患者血清CTGF, miR-26a手术前后变化及对术后复发的评估价值[J]. 广东医学, 2023, 44(6): 741-747.

[10] Aktoz F, Arslan T, Güzel Y. Intraoperative laparoscopic ultrasound during laparoscopic myomectomy: a narrative review[J]. J Turk Ger Gynecol Assoc, 2024, 25(3): 179-183.

[11] Paul P G, Mehta S, Annal A, et al. Reproductive outcomes after laparoscopic myomectomy: conventional versus barbed suture[J]. J Minim Invasive Gynecol, 2022, 29(1): 77-84.

[12] Tsakos E, Xydias E M, Ziogas A C, et al. Multi-port robotic-assisted laparoscopic myomectomy: a systematic review and meta-analysis of comparative clinical and fertility outcomes[J]. J Clin Med, 2023, 12(12): 4134.

[13] Daniels J, Middleton L J, Cheed V, et al. Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT[J]. Health Technol Assess, 2022, 26(22): 1-74.

[14] Frijlingh M, Stoelinga B, de Leeuw R A, et al. Microvascular flow imaging of fibroids: a prospective pilot study[J]. Acta Obstet Gynecol Scand, 2024, 103(11): 2193-2202.

[15] 李晓果, 管秀娟, 李林林. 阴道彩色多普勒超声血流显像对子宫肌瘤检查的图像特征及诊断效能分析[J]. 四川解剖学杂志, 2024, 32(1): 28-30.

[16] 李锐. 血清NF-κBp65、经阴道超声血流参数与子宫肌瘤患者保守治疗效果的相关性研究[J]. 四川生理科学杂志, 2025, 47(6): 1328-1330, 1333.

[17] 许昌翠, 徐燕红, 殷广莉, 等. 经阴道与经腹部彩色多普勒超声对子宫肌瘤及子宫腺肌病的鉴别诊断[J]. 中国实验诊断学, 2022, 26(1): 50-54.

[18] 张锋, 王倩, 张燕, 等. 超微血管成像与子宫肌瘤微血管密度的关系及在高强度聚焦超声疗效评估中的应用[J]. 西部医学, 2024, 36(4): 570-574.

[19] Chuang T D, Ton N, Rysling S, et al. The effect of race/ethnicity and MED12 mutation on the expression of long non-coding RNAs in uterine leiomyoma and myometrium[J]. Int J Mol Sci, 2024, 25(2): 1307.

[20] Falahati Z, Mohseni-Dargah M, Mirfakhraie R. Emerging roles of long non-coding RNAs in uterine leiomyoma pathogenesis: a review[J]. Reprod Sci, 2022, 29(4): 1086-1101.

[21] 刘宗凤, 冯猛, 梁世峰, 等. LncRNA XIST在甲状腺癌中的表达及其对甲状腺癌细胞增殖,侵袭和迁移能力的影响[J]. 解剖科学进展, 2023, 29(5): 462-466.

[22] 朱慧婧, 张敏, 张小霞, 等. 宫颈癌患者血清lncRNA XIST的表达及其意义[J]. 国际检验医学杂志, 2023, 44(17): 2086-2091.

[23] 李玉萍, 马会, 禹航. 子宫肌瘤患者血清lncRNA MIAT和lncRNA XIST的表达及临床意义[J]. 安徽医学, 2024, 45(2): 174-179.

[24] 尤克莎, 杨金光, 陈艳, 等. 血浆lncRNA XIST在子宫平滑肌瘤患者中的相对表达量及其临床意义[J]. 检验医学与临床, 2024, 21(17): 2480-2485.

[25] 范渊, 吴海龙, 竹梦, 等. lncRNA XIST通过靶向miR-3666调控胃癌细胞增殖、侵袭转移机制[J]. 中国免疫学杂志, 2022, 38(8): 964-968.

基金资助

2024年泸州市医学会科研项目(2024-YXXM-055)