中性粒细胞与淋巴细胞比值联合血红蛋白水平预测子宫肌瘤并子宫腺肌症价值分析

The value analysis of neutrophil to lymphocyte ratio combined with hemoglobin level in predicting uterine fibroids combined with adenomyosis

目的探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合血红蛋白(hemoglobin,Hb)水平预测子宫肌瘤并子宫腺肌症发生的价值。方法回顾性分析行子宫切除术治疗的子宫良性病变患者167例的临床资料,根据组织病理学诊断结果分为单纯子宫肌瘤(对照组)95例和子宫肌瘤并子宫腺肌症(观察组)72例。检测患者外周血中性粒细胞计数(neutrophil count,NEUT)、淋巴细胞计数(lymphocyte count,LY)、Hb水平等血常规指标,并计算NLR。比较2组临床资料和生化指标。采用多因素Logistics回归分析子宫肌瘤并子宫腺肌症发生的影响因素,绘制受试者工作特征曲线评估外周血NLR、Hb水平对子宫肌瘤并子宫腺肌症发生的预测价值。结果观察组糖尿病史患者比例、流产史患者比例、血清人附睾蛋白4(human epididymis protein 4,HE4)、糖类抗原125(carbohydrate antigen 125,CA125)含量、外周血NLR高于对照组,外周血LY、Hb水平均低于对照组(P<0.05)。多因素Logistic分析结果显示,血清HE4含量、血清CA125含量、外周血NLR、外周血Hb水平是影响子宫肌瘤并子宫腺肌症发生的危险因素(OR=1.579、5.726、3.669、1.833);NLR、Hb水平、NLR联合Hb水平预测子宫肌瘤并子宫腺肌症发生的曲线下面积(area under the curve,AUC)分别为0.759(95%CI:0.681~0.836)、0.776(95%CI:0.700~0.852)、0.849(95%CI:0.786~0.913);NLR联合Hb水平预测子宫肌瘤并子宫腺肌症发生的AUC大于单独NLR、Hb水平(P<0.05)。结论外周血NLR、Hb水平是子宫肌瘤并子宫腺肌症发生的危险因素,可以作为子宫肌瘤并子宫腺肌症早期筛查和诊断的参考指标。

Objective To explore the value of neutrophil to lymphocyte ratio(NLR)combined with hemoglobin(Hb)level in predicting the occurrence of uterine fibroids combined with adenomyosis.Methods The clinical data of 167 patients with benign uterine lesions who underwent hysterectomy were retrospectively analyzed.According to the results of histopathological diagnosis,they were divided into simple uterine fibroids group(control group,n=95)and uterine fibroids combined with adenomyosis group(observation group,n=72).Blood routine indexes such as neutrophils count(NEUT),lymphocyte count(LY)and hemoglobin(Hb)level in peripheral blood were detected,and NLR was calculated.The clinical data and biochemical indicators of the two groups were compared.Multivariate Logistics regression was used to analyze the influencing factors of uterine fibroids and adenomyosis.Receiver operating characteristic curve(ROC)was used to assess the predictive value of peripheral blood NLR and Hb levels in occurrence of uterine fibroids and adenomyosis symptom.Results The proportion of patients with history of diabetes and abortion,serum human epididymal protein 4(HE4),carbohydrate antigen 125(CA125)content,and peripheral blood NLR in the observation group were higher than those in the control group,and peripheral blood LY and Hb level were lower than those in the control group(P<0.05).Multivariate Logistic analysis showed that serum HE4 content,serum CA125 content,peripheral blood NLR,and peripheral blood Hb level were risk factors affecting the occurrence of uterine fibroids and adenomyosis(OR=1.579,5.726,3.669,1.833).The area under the ROC curve(AUC)of NLR,Hb level,NLR combined with Hb level in predicting uterine fibroids and adenomyosis were 0.759(95%CI:0.681-0.836),0.776(95%CI:0.700-0.852),and 0.849(95%CI:0.786-0.913),respectively.The AUC of NLR combined with Hb level in predicting the occurrence of uterine fibroids and adenomyosis was greater than that of NLR alone and Hb level alone(P<0.05).Conclusion Peripheral blood NLR and Hb levels are risk factors for the occurrence of uterine fibroids and adenomyosis,which,therefore,can be used as reference indexes for early screening and diagnosis of uterine fibroids and adenomyosis.