中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、β人绒毛膜促性腺激素和宫腔团块最大直径对葡萄胎预后的预测价值

Predictive value of neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,human chronic gonadotropin and maximum diameter of intrauterine mass for prognosis of hydatidiform moles

目的探讨中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、β人绒毛膜促性腺激素(β-HCG)和宫腔团块最大直径团对葡萄胎预后的预测价值。方法回顾性分析81例葡萄胎患者的临床资料,所有患者至少随访1年。根据随访过程中葡萄胎是否发生恶变分为恶变组12例和非恶变组69例。比较两组患者清宫术前NLR、PLR、lgβ-HCG及宫腔团块最大直径。根据受试者工作特征曲线确定NLR、PLR、lgβ-HCG及宫腔团块最大直径的截断点,评价NLR、PLR、lgβ-HCG及宫腔团块最大直径对葡萄胎预后的预测价值。结果恶变组的NLR、PLR、lgβ-HCG、宫腔团块最大直径均大于非恶变组(均P<0.05)。当NLR=3.16时,约登指数最大为0.561,曲线下面积(AUC)为0.784(P<0.001,95%CI:0.758~0.809),其预测葡萄胎恶变的敏感度为87.0%,特异度为69.1%;当PLR=179.96时,约登指数最大为0.562,AUC为0.784(P<0.001,95%CI:0.763~0.804),其预测葡萄胎恶变的敏感度为79.7%,特异度为76.5%;当lgβ-HCG=5.62 mIU/mL时,约登指数最大为0.609,AUC为0.861(P<0.001,95%CI:0.840~0.882),其预测葡萄胎恶变的敏感度为76.2%,特异度为84.7%;当宫腔团块最大直径=8.05 cm时,约登指数最大为0.562,AUC为0.777(P<0.001,95%CI:0.743~0.811),其预测葡萄胎恶变的敏感度为70.5%,特异度为85.7%。结论葡萄胎清宫术前NLR、PLR、β-HCG和宫腔团块最大直径可预测葡萄胎患者的预后。

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),βhuman chronic gonadotropin(β-HCG) and the maximum diameter of intrauterine mass for the prognosis of hydatidiform moles.Methods The clinical data of 81 patients with hydatidiform moles were retrospectively analyzed,and were followed up for one year at least.The patients were assigned into canceration group(12 cases) and non-canceration group(69 cases) in accordance with the occurrence or non-occurrence of canceration.The NLR,PLR,lgβ-HCG and maximum diameter of intrauterine mass before uterine curettage were compared between the patients of both groups.The cut-off values of NLR,PLR,lgβ-HCG and maximum diameter of intrauterine mass were determined by using receiver operating characteristic curve,and the predictive value of NLR,PLR,lgβ-HCG and maximum diameter of intrauterine mass for prognosis of hydatidiform moles was evaluated.Results The NLR,PLR,lgβ-HCG and maximum diameter of intrauterine mass were higher or larger in the canceration group than those in the non-canceration group(all P<0.05).With a value of 3.16, NLR processed the maximum Youden index of 0.561,area under the curve(AUC) of 0.784(P<0.001,95% CI:0.758-0.809), sensitivity of 87.0% and specificity of 69.1% for predicting canceration of hydatidiform moles;with a value of 179.96,PLR obtained the maximum Youden index of 0.562,AUC of 0.784(P<0.001,95% CI:0.763-0.804),sensitivity of 79.7% and specificity of 76.5% for predicting canceration of hydatidiform moles;with a value of 5.62 mIU/mL,lgβ-HCG achieved the maximum Youden index of 0.609,AUC of 0.861(P<0.001,95% CI:0.840-0.882),sensitivity of 76.2% and specificity of 84.7% for predicting canceration of hydatidiform moles;with a value of 8.05 cm,the maximum diameter of intrauterine mass had the maximum Youden index of 0.562,AUC of 0.777(P<0.001,95% CI:0.743-0.811),sensitivity of 70.5% and specificity of 85.7% for predicting canceration of hydatidiform moles.Conclusion The NLR,PLR,β-HCG and maximum diameter of intrauterine mass before uterine curettage can predict the prognosis of the patients with hydatidiform moles.