Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Ultrasound Med. 2023 Aug;42(8):1647-1660. doi: 10.1002/jum.16168. Epub 2022 Dec 30.
The aim of this study was to determine the correlation between uterine diameters and menstrual abdominal pain intensity in patients with and without endometriosis (EM), and the independent influence of EM on the pain intensity.
Uterine diameters and the diagnosis of adenomyosis were ascertained by transvaginal ultrasonography (TVS). Menstrual abdominal pain intensity was estimated by visual analog scale (VAS). Linear regression was used to figure out the impact of uterine diameters and EM on the VAS scores. Logistic regression was used to calculate the correlation between uterine diameters and the diagnosis of adenomyosis. The cutoff values of uterine anteroposterior diameter (AD) to predict dysmenorrhea (VAS ≥ 4) and the diagnosis of adenomyosis were determined by receiver operating characteristic curves.
There were 220 patients with and 233 patients without EM included. Uterine AD independently correlated with the VAS scores in patients with (B = .230, P = .000) and without (B = .203, P = .000) EM. A uterine AD of 39.5 mm predicted dysmenorrhea in both groups. The presence of EM increased the VAS scores by 1.151 points when controlling for uterine diameters. Uterine AD also independently correlated with the diagnosis of adenomyosis under TVS in patients with (OR = 1.212, 95% CI = 1.130-1.301; P = .000) and without (OR = 1.192, 95% CI = 1.123-1.263; P = .000) EM. A uterine AD of 38.5 and 39.5 mm predicted the diagnosis of adenomyosis under TVS in patients with and without EM, respectively.
Increased uterine AD, which is probably ascribed to adenomyosis, plays an important role in augmented menstrual abdominal pain intensity. Meanwhile, the presence of EM reinforces the pain.
本研究旨在确定子宫内膜异位症（EM）患者与非 EM 患者的子宫直径与月经腹痛强度之间的相关性，以及 EM 对疼痛强度的独立影响。
通过经阴道超声（TVS）确定子宫直径和子宫腺肌病的诊断。通过视觉模拟量表（VAS）评估月经腹痛强度。线性回归用于确定子宫直径和 EM 对 VAS 评分的影响。Logistic 回归用于计算子宫直径与子宫腺肌病诊断之间的相关性。通过受试者工作特征曲线确定预测痛经（VAS≥4）和子宫腺肌病诊断的子宫前后径（AD）截断值。
共有 220 例 EM 患者和 233 例非 EM 患者纳入研究。子宫 AD 与 EM 患者（B=0.230，P=0.000）和非 EM 患者（B=0.203，P=0.000）的 VAS 评分独立相关。子宫 AD 为 39.5mm 可预测两组患者的痛经。控制子宫直径后，EM 的存在使 VAS 评分增加 1.151 分。子宫 AD 还与 TVS 下的子宫腺肌病诊断独立相关，在 EM 患者（OR=1.212，95%CI=1.130-1.301；P=0.000）和非 EM 患者（OR=1.192，95%CI=1.123-1.263；P=0.000）中。子宫 AD 分别为 38.5mm 和 39.5mm 预测 EM 患者和非 EM 患者的 TVS 下子宫腺肌病诊断。
可能归因于子宫腺肌病的增大的子宫 AD 在增加月经腹痛强度方面起着重要作用。同时，EM 的存在加剧了疼痛。
