宫腔镜下子宫内膜息肉切除术后复发与临床特征及雌孕激素受体的相关性分析

Correlation between recurrence,clinical features and profiles of estrogen and progesterone receptors in patients with endometrial polyps after hysteroscopic polypectomy

目的:分析宫腔镜下子宫内膜息肉(EP)切除术后复发与患者临床特征及雌孕激素受体的相关性。方法:选择2018年1月至2020年1月广东省廉江市人民医院收治的180例EP患者作为研究对象。根据半年内是否复发分为复发组(29例)和未复发组(151例)。收集年龄、病程、是否绝经、体质量指数(BMI)、产次、息肉大小、息肉数量、高血压、糖尿病、子宫内膜炎、术后药物治疗方式等临床资料;比较治疗前和治疗后1个月肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)表达水平,统计孕激素受体(PR)和雌激素受体(ER)阳性率;分析术后复发危险因素。结果:与未复发组相比,复发组中BMI≥24 kg/m^(2)、有子宫内膜炎、术后使用屈螺酮炔雌醇片、PR阳性率1%~51%和ER阳性率51%~100%的患者较多(P<0.05);复发组△TNF-α、△IL-6水平均高于未复发组(P<0.05);△TNF-α、△IL-6预测术后复发的ROC曲线下面积分别为0.862、0.822,差异均有统计学意义(P<0.05);Logistic回归性分析证实,肥胖、子宫内膜炎、子宫内膜息肉组织中ER高表达和PR低表达、△TNF-α≥23.096 ng/L和△IL-6≥97.329 ng/L是术后复发的危险因素,术后使用左炔诺孕酮宫内节育系统能降低EP复发率(P<0.05)。结论:宫腔镜下子宫内膜息肉切除术后复发的危险因素较多,应完善临床特征观察及实验室指标检测,有效预测及预防术后复发。

Objective:To investigate the correlation between recurrence,clinical features and profiles of estrogen and progesterone receptors in patients with endometrial polyps(EP)after hysteroscopic polypectomy.Methods:A total of 180 EP patients admitted to Lianjiang People s Hospital in Guangdong Province between January 2018 and January 2020 were enrolled,and according to the 6-month recurrence,were divided into the recurrence group(n=29)and non-recurrence group(n=151).The subjects were recorded for clinical data such as age,duration of disease,menopause,body mass index(BMI),parity,polyp size,number of polyps,hypertension,diabetes,endometritis,and postoperative medications.The expression levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were compared between baseline and at one month after surgery.The positive rates of progesterone receptor(PR)and estrogen receptor(ER)were calculated.The risk factors for postoperative recurrence were analyzed.Results:Compared with the non-recurrence group,there were more patients in the recurrence group with BMI≥24 kg/m^(2),endometritis,postoperative use of oral drospirenone/ethinylestradiol,a positive rate of PR ranging from 1%to 51%and a positive rate of ER ranging from 51%to 100%(P<0.05).The levels of△TNF-αand△IL-6 in the recurrence group were higher than those in the non-recurrence group(P<0.05).The area under the ROC curves for△TNF-αand△IL-6 were 0.862 and 0.822,respectively,in predicting postoperative recurrence,with statistically significant difference(P<0.05).Logistic regression analysis confirmed that obesity,endometritis,high expression of ER and low expression of PR in endometrial polyps,△TNF-α≥23.096 ng/L and△IL-6≥97.329 ng/L were risk factors of postoperative recurrence,and that postoperative use of levonorgestrel intrauterine system was associated with lower rate of EP recurrence(P<0.05).Conclusion:Multiple risk factors are noted for EP recurrence after hysteroscopic polypectomy.Attentions to clinical features and laboratory findings should be enhance to effectively predict and prevent the postoperative recurrence.