RU2350259C1 - Method of predicting fast growth of hysteromyoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely to gynecology, and can be used for predicting fast growth of hysteromyoma. Determine quantity of medical abortions in the anamnesis, presence of an arterial hypertensia during previous pregnancy, threats of premature delivery, duration of maternity, presence of anomalies of patrimonial activity in previous maternity, inflammatory postnatal diseases, and also chronic diseases of a gastroenteric tract. The prediction indicator of hysterioma growth rate is calculated under the formula DF=0.131×A+0.171×NPT+0.513×AHP+0.773×MD+0.432×PAA+1.255×PD+0.777×GET, where: A - quantity of abortions in the anamnesis; NPT - threat of habitual noncarrying of pregnancy (0 - is not present; 1 - in I trimester, 2 - in II trimester, 3 - in III trimester, 4 - during all pregnancy); AHP - an arterial hypertensia during pregnancy (0 - not present, 1 - present); MD - maternity duration (0 - normal, 1 - fast, 2-fixing); PAA - anomalies of patrimonial activity (0 - not present, 1 - present); PD - inflammatory postnatal diseases (0 - not present, 1 - present); GET-disease of a gastroenteric tract (0 - not present, 1 - present). At DF value > 1.70 prognosticate fast growth of the tumour.

EFFECT: method allows to prognosticate fast growth of a hysteromyoma, and also an accompanying extragenital pathology.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to gynecology, and can be used to predict the rapid growth of uterine fibroids.

Data from epidemiological studies indicate a disproportion between the frequency of existence of fibroids in women in the population and the frequency of development of clinically significant forms of fibroids, forcing the patient to consult a doctor. In this regard, it is of interest not only to study the causes of uterine fibroids, but also to identify risk factors for the development of symptomatic forms of the disease, which will make it possible to make a prognosis of the course of the tumor process in each patient. Predicting the likelihood of developing a slow or rapid growth of uterine fibroids is undoubtedly one of the most important tasks, the solution of which will allow optimizing the results of treatment of patients of this category, timely correcting violations revealed in this case, and deciding on the strategy and tactics in each case.

There are known sources of information that identify individual risk factors for the rapid growth of uterine fibroids, in particular, a high incidence of respiratory viral diseases in history, chronic often recurring nasolabial herpes (Malyshkina A.I. Immune mechanisms of the rapid growth of uterine fibroids. Abstract. Diss. Ph.D. - Moscow, 2006. - 48 p.), overweight (Marshall LM, Spiegelman D., Manson JE et al. Risk of uterine leiomyomata among premenopausal women in relation to body size and cigarette smoking.//Epidemiology. - 1998. - Vol.9. - No. 5. - P.511-517.), gynecological morbidity (inflammatory diseases pelvic organs, chlamydial infection, internal endometriosis) (Faerstein E., Szklo M., Rosenshein NB Risk factors for uterine leiomyoma: a practice-based case-control study.//Am. J. Epidemiol. - 2001. - Vol .153. - No. 1. - P.11-19), a large number of intrauterine interventions (Tikhomirov A.L., Serov V.N., Zharov E.V., Lubnin D.M. Etiology and pathogenesis of uterine leiomyoma - facts , hypotheses, reflections. // Ag-info. - 2006. - No. 3. - C.3-8.), As well as extragenital pathology (hypertension, diabetes mellitus) (Brekhman G.I. Uterine fibroids and extragenital diseases. // Akush. And gynecol. - 1978. - No. 6. - P.19. -23.). The disadvantages of the described methods include their low prognostic value due to the lack of a comprehensive assessment of all significant risk factors for the rapid growth of uterine fibroids.

A known method for predicting the rapid growth of uterine fibroids on the basis of laboratory data, in particular, according to the results of the study of certain subpopulations of lymphocytes (CD38 ⁺ ) in peripheral blood: when the relative content of peripheral blood CD38-positive lymphocytes is 23% or more, rapid growth of uterine fibroids is predicted with an accuracy of 75.8% (Malyshkina A.I. Immune mechanisms of the rapid growth of uterine fibroids. Abstract of diss. for the degree of candidate of medical sciences - M., 2006. - 48 p.).

The disadvantage of this method should be considered the need to perform an expensive immunological examination in order to determine the subpopulation composition of lymphocytes by flow cytometry. The technique is limited in the use of antenatal clinics by its doctors due to the lack of technical capabilities for its implementation in some cases.

The technical result achieved by the invention is to provide a high accuracy forecast for the rapid growth of uterine fibroids due to the quantitative assessment of a set of factors affecting the rapid growth of uterine fibroids without the use of expensive equipment.

The essence of the invention is to achieve the technical result in a method for predicting the rapid growth of uterine fibroids, according to which the number of medical abortions in the anamnesis, the presence of arterial hypertension during previous pregnancies, the threat of miscarriage, the duration of childbirth, the presence of abnormalities in labor in the previous childbirth, inflammatory postpartum are determined diseases, as well as chronic diseases of the gastrointestinal tract, the prognosis indicator is calculated oza uterine fibroid growth rate according to the formula DF = 0.131 × A + 0.171 × UNB + 0.513 × AGB + 0.773 × PR + 0.432 × ARD + 1.255 × PZ + 0.777 × GIT,

where A is the number of medical abortions in history;

UNB - the threat of miscarriage: 0 - no; 1 - in the I trimester, 2 - in the II trimester, 3 - in the III trimester, 4 - throughout the pregnancy;

AGB - arterial hypertension during pregnancy: 0 - no, 1 - eat;

PR - duration of labor: 0 - normal, 1 - fast, 2 - prolonged;

ARD - anomalies of labor: 0 - no, 1 - there is;

PZ - inflammatory postpartum diseases: 0 - no, 1 - there is;

Gastrointestinal tract - diseases of the gastrointestinal tract: 0 - no, 1 - yes, and with a DF value> 1.70 rapid tumor growth is predicted.

The invention is based on the results of a clinical study of 404 patients with uterine myoma, of which 167 patients lacked clinical symptoms of the tumor process (group I), 24 women had symptoms of fibroids, but no surgical treatment was required (group II), and 213 patients had clinical manifestations of the disease required surgical treatment (group III). The age of patients of group I ranged from 31 to 71 years, the average age was 46.5 ± 0.5 years; in group II, the age of the patients was from 36 to 61 years, the average age was 44.9 ± 1.3 years. The age of group III patients ranged from 20 to 49 years, the average age was 45.0 ± 1.6 years. The examination complex, along with the clinical and anamnestic methods of research, included: 1) ultrasound examination, Dopplerometry, color Doppler mapping (CDC) of the pelvic organs; 2) hysteroscopy with separate diagnostic curettage of the uterus; 3) laparoscopy; 4) colposcopic and oncocytological examination of the cervix; 4) morphological study of removed drugs; 5) x-ray mammography and ultrasound of the mammary glands.

In all examined patients with uterine myoma (n = 404), the tumor growth rate was studied. The growth rate was judged on the basis of an increase in the volume of the uterus with a tumor that occurred during one year of observation. The calculation was made on the basis of the dimensions of a pathologically altered organ (longitudinal, transverse, anteroposterior) measured by ultrasound according to the formula G.B. Healy (1989).

An increase in volume by an amount equal to or greater than 50.0 cm ³ for 1 year of observation was considered as a fast tumor growth rate, an increase in uterine volume due to tumor growth by an amount less than 50.0 cm ³ for 1 year - as slow growth, absence changes in the volume of the uterus during the year - as a tumor that is stable in size (or the absence of growth of uterine fibroids).

The signs characterizing two extreme conditions assessing the growth rate of the tumor were compared: stable sizes of uterine fibroids (no increase in tumor size) and rapid growth. The consideration of these two “polar” states of growth rates was carried out in order to most clearly identify the differences that would allow us to assess the risk of rapid growth of uterine fibroids.

A comparison of the data of obstetric and gynecological history in patients with uterine fibroids with different variants of the clinical course - the absence of an increase in the size of the uterus and the rapid growth of tumor nodes, made it possible to identify a number of signs, the totality of which allows us to predict the course of the disease in relation to the speed of progression of tumor size. The table presents in order of decreasing prognostic significance the most informative risk factors for the rapid growth of uterine fibroids.

Table

Sign F p Duration of labor 11.80 <0.001 Inflammatory postpartum diseases 10.98 <0.002 Anomalies of labor 10.19 <0.003 Gastrointestinal diseases 8.07 <0.006 Arterial Hypertension During Pregnancy 5.69 <0.02 The threat of miscarriage 5.60 <0.02 The frequency of medical abortions 4.69 <0.03 λ Wilk = 0.82; p <0.001.

Using the method of linear discriminant analysis, the equation of the discriminant function DF was obtained.

After calculating the DF values according to the obtained formula for each patient, the following decisive diagnostic rule was formulated: if DF does not exceed 1.70, then stable uterine fibroids are predicted, and if DF is more than 1.70, then fast growth of the uterine tumor is predicted.

Evaluation of the accuracy of the forecast according to the anamnesis in relation to the tumor growth rate established using the discriminant function had the following characteristics: sensitivity - 62.1%; specificity - 79.2%; prognostic value of a positive result - 62.1%; prognostic value of a negative result - 79.2%; forecast accuracy - 73.1%.

The method is carried out, for example, as follows.

Based on the obstetric and gynecological history, the presence of arterial hypertension during previous pregnancies, the threat of miscarriage, the duration of childbirth, the presence of anomalies of labor in the previous birth, inflammatory postpartum diseases, and the presence of chronic diseases of the gastrointestinal tract are determined, and the rate of myoma growth rate is calculated uterus according to the formula

DF = 0.131 × A + 0.171 × UNB + 0.513 × AGB + 0.773 × PR + 0.432 × ARD + 1.255 × PZ + 0.777 × GIT,

where A is the number of abortions in history;

UNB - the threat of miscarriage (0 - no; 1 - in the I trimester, 2 - in the II trimester, 3 - in the III trimester, 4 - throughout the pregnancy);

AGB - arterial hypertension during pregnancy (0 - no, 1 - yes);

PR - the duration of labor (0 - normal, 1 - fast, 2 - prolonged);

ARD - anomalies of labor activity (0 - no, 1 - yes);

PZ - inflammatory postpartum diseases (0 - no, 1 - yes);

Gastrointestinal tract - diseases of the gastrointestinal tract (0 - no, 1 - yes), and with a DF value> 1.70 rapid tumor growth is predicted.

The method is illustrated by the following clinical examples.

Example 1. Patient G., 44 years old, turned to a antenatal clinic for a routine examination. No complaints. When examining for the first time revealed uterine fibroids, which corresponded to a period of 5-6 weeks of pregnancy. The diagnosis was confirmed by ultrasound, the size of the uterus was 7.0 × 6.6 × 5.8 cm (the volume of the uterus was 139.3 cm ³ ) with a myomatous node of subserous localization with a diameter of 3.5 cm. The patient had a history of 1 birth and 1 medical abortion for a period of 7-8 weeks of pregnancy (A = 1). Pregnancy proceeded with the threat of miscarriage in the first trimester (UNB = 1), in connection with which the patient was hospitalized and underwent hormone therapy with progesterone. Blood pressure during pregnancy is within the normal range - 110 / 70-100 / 60 mm Hg (AHB = 0). The duration of labor through the natural birth canal was 12 hours (PR = 0). Anomalies of labor activity were not ARD = 0, no birth-stimulating therapy was carried out. Inflammatory diseases in the postpartum period are not marked P3 = 0. Extragenital pathology: gastric ulcer gastrointestinal tract = 1.

The calculation of the value of DF according to the proposed formula:

DF = 0.131 × 1 + 0.171 × 1 + 0.777 × 1 = 1.079

The value of the discriminant function was 1.08 (i.e., less than 1.70), which allowed us to conclude that there is a low risk of rapid tumor growth.

Over the next 5 years of observation, uterine fibroids were stably small.

Example 2. Patient A., 31 years old, went to the doctor in connection with menstrual irregularities of the type of menorrhagia. On examination, uterine fibroids were found that corresponded to a gestational age of 7-8 weeks. Ultrasound visualized three myomatous nodes of subserous and intramural-submucous localization. The size of the uterus is 8.6 × 7.7 × 6.4 (the volume of the uterus is 220.4 cm ³ ), the diameter of the largest node is 4.1 cm. According to a morphological study, the endometrium corresponded to the phase of the menstrual cycle. The patient has a history of 2 births, 3 medical abortions up to 12 weeks of pregnancy (A = 3). Pregnancies that ended in childbirth proceeded with the threat of termination of pregnancy in the first and second trimester (UNB = 2). Hormone therapy, tocolytic therapy was carried out. Arterial hypertension was not observed during pregnancy (AGB = 0). Childbirth flowed through the natural birth canal, rodostimulating therapy was carried out in connection with the developed primary weakness of labor (ARD = 1). The duration of the first birth was 14 hours, the second - 9 hours (PR = 0). The postpartum period was complicated by the development of metroendometritis (PZ = 1). Extragenital pathology: chronic gastroduodenitis (GIT = 1).

The DF value was calculated according to our formula, which allows us to predict the fast growth rate of uterine fibroids and stable tumor sizes:

DF = 0.131 × 3 + 0.171 × 2 + 0.432 × 1 + 1.255 × 1 + 0.777 × 1 = 3.199

The value of the discriminant function was 3.20 (that is, more than 1.70), which allowed us to conclude that there is a high risk of rapid tumor growth. Over the next year of observation, the volume of uterine fibroids according to ultrasound data increased in size by more than 50.0 cm ³ . Given the fast growth rate of the nodes and the reproductive age of the patient, a surgical operation was performed in the amount of conservative myomectomy.

Using the proposed method allows to predict the rapid growth of uterine fibroids based on a comprehensive assessment of obstetric and gynecological history, as well as concomitant extragenital pathology with a high prediction accuracy of 73.1% (λ Wilk = 0.82; p <0.001). The method has simplicity, accessibility and economic feasibility, since it does not require the use of expensive laboratory equipment.

Claims (1)

A method for predicting the rapid growth of uterine fibroids, which consists in determining the number of medical abortions in the anamnesis, the presence of arterial hypertension during previous pregnancies, the threat of miscarriage, the duration of childbirth, the presence of abnormalities in labor in the previous birth, inflammatory postpartum diseases, and also chronic diseases gastrointestinal tract, calculate the forecast rate of growth of uterine fibroids according to the formula
DF = 0.131 · A + 0.171 · UNB + 0.513 · AGB + 0.773 · PR + 0.432 · ARD + 1.255 · PZ + 0.777 · GIT
where A is the number of medical abortions in history;
UNB - the threat of miscarriage: “0” - no, “1” in the I trimester, “2” in the II trimester, “3” in the III trimester, “4” - throughout the pregnancy;
AGB - arterial hypertension during pregnancy: "0" - no, "1" - there is;
PR - the duration of labor: "0" - normal, "1" - fast, "2" - protracted;
ARD - anomalies of labor: "0" - no, "1" - there is;
PZ - inflammatory postpartum diseases: "0" - no, "1" - there is;
Gastrointestinal tract - diseases of the gastrointestinal tract: "0" - no, "1" - yes, and with a DF value> 1.70 rapid tumor growth is predicted.