Li Wanqing, Hang Yuting, Xu Yunyu, Zhang Wen, He Ye, Ye Wei, Hu Xinyue, Wei Zhaolian
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
BMC Womens Health. 2025 May 30;25(1):268. doi: 10.1186/s12905-025-03759-3.
Despite proposed mechanisms hypotheses, the etiology of adenomyosis remains unclear. The limited efficacy of current therapeutic approaches may stem from insufficient understanding of its pathobiological underpinnings and the pronounced heterogeneity in clinical presentation and treatment responsiveness among subtypes. This study seeks to compare clinical and sonographic profiles of adenomyosis subtypes to elucidate distinct disease mechanisms and inform subtype-specific management strategies.
In this retrospective cohort of 1,350 surgically treated and pathologically confirmed adenomyosis cases (2017-2022), patients were categorized into diffuse versus focal and anterior versus posterior lesion groups according to sonographic features. Comparative analyses of demographics, symptomatology, concurrent gynecological conditions, and laboratory profiles were conducted to delineate subtype-specific patterns.
1074 (79.56%) had a definitive adenomyotic sonographic signs, with 329 (30.63%) focal adenomyosis and 745 (69.37%) diffuse adenomyosis. Multivariate logistic regression analysis revealed that, compared with focal adenomyosis, diffuse adenomyosis were older (OR, 1.09; 95%CI: 1.06-1.12), had more pregnancies (OR, 1.22; 95%CI: 1.11-1.33), higher BMI (OR, 1.05; 95%CI: 1.00-1.09), long course of disease (OR, 1.06; 95%CI: 1.02-1.11) and higher risk of moderate to severe dysmenorrhea (OR, 1.88; 95%CI: 1.36-2.60). Divided to the location of adenomyosis lesion indicated by sonographic, patients in the posterior wall group (n = 418) have higher risk of moderate to severe dysmenorrhea (OR, 1.88; 95% CI: 1.36-2.60), more endometriosis combination (OR, 3.24; 95%CI: 1.85-5.68) and intraoperative blood loss (OR, 1.001; 95%CI: 1.001-1.003).
By stratifying adenomyosis into diffuse/focal and anterior/posterior subtypes, we identified distinct clinical-pathological profiles: (1) Diffuse adenomyosis was independently associated with older age, higher gravidity, and severe dysmenorrhea, suggesting a progressive phenotype driven by tissue injury mechanisms; (2) Posterior lesions exhibited a 3.24-fold risk of concurrent endometriosis and increased surgical complexity, implicating shared pathways with deep infiltrating endometriosis. These findings redefine adenomyosis as a heterogeneous disorder with subtype-specific pathophysiology, advocating for tailored therapeutic strategies.
尽管提出了一些机制假说，但子宫腺肌病的病因仍不明确。目前治疗方法的疗效有限，可能是由于对其病理生物学基础了解不足，以及各亚型在临床表现和治疗反应方面存在显著异质性。本研究旨在比较子宫腺肌病各亚型的临床和超声特征，以阐明不同的疾病机制，并为亚型特异性管理策略提供依据。
在这项回顾性队列研究中，纳入了1350例经手术治疗并经病理证实的子宫腺肌病病例（2017 - 2022年），根据超声特征将患者分为弥漫型与局灶型以及前壁病变组与后壁病变组。对人口统计学、症状学、并发妇科疾病和实验室检查结果进行比较分析，以描绘亚型特异性模式。
1074例（79.56%）有明确的子宫腺肌病超声征象，其中局灶型子宫腺肌病329例（30.63%），弥漫型子宫腺肌病745例（69.37%）。多因素logistic回归分析显示，与局灶型子宫腺肌病相比，弥漫型子宫腺肌病患者年龄更大（OR，1.09；95%CI：1.06 - 1.12）、妊娠次数更多（OR，1.22；95%CI：1.11 - 1.33）、BMI更高（OR，1.05；95%CI：1.00 - 1.09）、病程更长（OR，1.06；95%CI：1.02 - 1.11）以及中度至重度痛经风险更高（OR，1.88；95%CI：1.36 - 2.60）。根据超声所示子宫腺肌病病变位置分组，后壁组患者（n = 418）中度至重度痛经风险更高（OR，1.88；95%CI：1.36 - 2.60）、子宫内膜异位症合并症更多（OR，3.24；95%CI：1.85 - 5.68）且术中失血量更多（OR，1.001；95%CI：1.001 - 1.003）。
通过将子宫腺肌病分为弥漫型/局灶型和前壁/后壁亚型，我们确定了不同的临床病理特征：（1）弥漫型子宫腺肌病与年龄较大、妊娠次数较多和严重痛经独立相关，提示其为一种由组织损伤机制驱动的进展性表型；（2）后壁病变并发子宫内膜异位症的风险高3.24倍，且手术复杂性增加，这表明其与深部浸润性子宫内膜异位症存在共同途径。这些发现将子宫腺肌病重新定义为一种具有亚型特异性病理生理学的异质性疾病，提倡采用针对性的治疗策略。
