目的 探讨经阴道彩色多普勒超声（transvaginal color Doppler ultrasound,TVCDS）联合外周血血红蛋白（hemoglobin,Hb）、中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio,NLR）、血清金属蛋白酶组织抑制因子-1（tissue inhibitory factor of metalloproteinase 1,TIMP-1）、可溶性fms样酪氨酸激酶-1（soluble fms-like tyrosine kinase-1,sFlt-1）在鉴别诊断子宫肌瘤（uterine fibroids,UF）、子宫腺肌症（adenomyosis,Am）中的价值。方法 选取自贡市第一人民医院2023年6月至2024年5月收治的经病理确诊的UF和Am患者143例,将其分为UF组（81例）和Am组（62例）。比较两组临床资料及外周血Hb、NLR、血清TIMP-1、sFlt-1水平,分析Am发生的危险因素,外周血Hb、NLR、血清TIMP-1、sFlt-1水平鉴别诊断UF、Am的价值,以及TVCDS联合上述四项指标鉴别诊断UF、Am的价值。结果 Am组痛经、经期延长比例及外周血NLR、血清TIMP-1、sFlt-1水平高于UF组,外周血Hb水平低于UF组。多因素Logistic回归分析结果显示,痛经、经期延长、外周血Hb、NLR及血清TIMP-1、sFlt-1水平均是Am发生的影响因素。受试者工作特征曲线（receiver operating characteristic,ROC）显示,外周血Hb、NLR、血清TIMP-1、sFlt-1水平鉴别诊断UF、Am的曲线下面积（area under the curve,AUC）分别为0.743、0.842、0.746、0.850。TVCDS、外周血Hb、NLR、血清TIMP-1、sFlt-1联合检测鉴别诊断UF、Am的敏感度、准确度高于各指标单独检测;TVCDS单独检测的敏感度高于血清TIMP-1、sFlt-1（P<0.05）,准确度高于外周血Hb、NLR、血清TIMP-1;sFlt-1单独检测的特异度高于外周血Hb、NLR、血清TIMP-1（P<0.05）,准确度高于血清TIMP-1。结论 TVCDS联合外周血Hb、NLR、血清TIMP-1、sFlt-1鉴别诊断UF、Am更具优势。

Objective To investigate the value of transvaginal color Doppler ultrasound (TVCDS) combined with peripheral blood hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR), serum tissue inhibitory factor of metalloproteinase 1 (TIMP-1), and soluble fms-like tyrosine kinase-1 (sFlt-1) in differential diagnosis of uterine fibroids (UF) and adenomyosis (Am). Methods 143 cases of patients with pathologically confirmed UF and Am admitted to the First People's Hospital of Zigong from June 2023 to May 2024 were selected. They were divided into the UF group (81 cases) and Am group (62 cases). The clinical data, including peripheral blood Hb, NLR, serum TIMP-1 and sFlt-1 were compared between the two groups. The risk factors of Am, the value of levels of peripheral blood Hb, NLR, serum TIMP-1 and sFlt-1 for the differential diagnosis of UF and Am, and the diagnostic value of TVCDS combined with these four indicators in distinguishing UF from AMS were analyzed. Results The proportion of dysmenorrhea, prolonged menstruation, levels of peripheral blood NLR, serum TIMP-1 and sFlt-1 were higher than the UF group, level of peripheral blood Hb was lower than the UF group. Multivariate Logistic regression analysis showed that dysmenorrhea, prolonged menstrual period, peripheral blood Hb, NLR, serum TIMP-1 and sFlt-1 were independent risk factors for Am. ROC analysis showed that the area under the curve (AUC) values for differential diagnosis of UF and Am at levels of peripheral blood Hb, NLR, serum TIMP-1, and sFlt-1 were 0.743, 0.842, 0.746, and 0.850. The sensitivity and accuracy of combined detection of TVCDS, peripheral blood Hb, NLR, serum TIMP-1 and sFlt-1 in the differential diagnosis of UF and Am were higher than those of single detection of each index; the sensitivity of TVCDS alone was higher than that of serum TIMP-1 and sFlt-1, and the accuracy was higher than that of peripheral blood Hb, NLR and serum TIMP-1; the specificity of sFlt-1 alone was higher than that of peripheral blood Hb, NLR and serum TIMP-1, and the accuracy was higher than that of serum TIMP-1. Conclusion TVCDS combined with peripheral blood Hb, NLR, serum TIMP-1, sFlt-1 was more advantageous for the differential diagnosis of UF and Am.