子宫内膜异位症患者NLR、HE4水平变化及动态监测临床意义

Changes of NLR and HE4 levels in patients with endometriosis and clinical significance of dynamic monitoring

目的:研究子宫内膜异位症(EMS)患者中性粒细胞与淋巴细胞比值(NLR)、人附睾蛋白4(HE4)水平及动态监测临床意义。方法:选取我院2018年7月至2019年11月收治的135例EMS患者为研究对象,采用全自动血细胞分析仪检测计算NLR,酶联免疫吸附法检测HE4水平。比较术前不同美国生育协会(rAFS)分期、术后7 d复发与未复发EMS患者NLR、HE4水平,分析术前NLR、HE4水平与rAFS分期的关联性,NLR、HE4对复发的影响及术后7 d联合检测对复发的预测价值。结果:随着rAFS分期提高,NLR、HE4水平呈逐渐升高趋势(P<0.05);经Spearman相关性分析,EMS患者NLR、HE4水平与rAFS分期呈正相关(P<0.05);EMS患者术后7 d NLR、HE4水平低于术前(P<0.05);复发患者术后7 d NLR、HE4水平高于未复发患者(P<0.05);经Cox回归分析将年龄、性别、病程、术后辅助药物治疗等其他因素调整后,NLR、HE4仍为复发的重要影响因素(P<0.01);经ROC曲线分析,联合检测AUC值0.831、敏感度82.49%、特异度86.25%高于NLR值单一检测0.762、78.56%、75.29%,HE4单一检测0.748、74.59%、78.67%(P<0.05)。结论:EMS患者NLR、HE4水平明显异常升高,与临床分期具有密切关联性,且动态监测可预测复发情况的发生,具有重要临床意义。

Objective:To investigate the neutrophils-to-lymphocytes ratio(NLR)and human epididymis protein 4(HE4)level in patients with endometriosis(EMS)and the clinical significance of dynamic monitoring.Methods:A total of 135 patients with EMS treated in our hospital from Jul 2018 to Nov 2019 were selected as the research objects.NLR was detected and calculated by automatic blood cell analyzer,and HE4 level was detected by enzyme-linked immunosorbent assay(ELISA).The revised American Fertility Society(rAFS)stage were evaluated before operation.The levels of NLR and HE4 in patients with recurrent and non-recurrent EMS were detected before and at 7 d after operation.The correlation of preoperative NLR and HE4 levels with rAFS stage,the effect of NLR and HE4 on recurrence and the predictive value of the combined detection at 7 d after operation were analyzed.Results:With the increase of rAFS stage,the levels of NLR and HE4 increased gradually(P<0.05).Spearman correlation analysis showed that the levels of NLR and HE4 in EMS patients were positively correlated with rAFS stage(P<0.05).The levels of NLR and HE4 at 7 days after operation were lower than those before operation(P<0.05).The levels of NLR and HE4 in recurrent patients were higher than those in non-recurrent patients at 7 days after operation(P<0.05).After adjusting for age,sex,course of disease and postoperative adjuvant drug therapy,Cox regression analysis showed that NLR and HE4 were still important influencing factors for recurrence of EMS(P<0.01).After ROC curve analysis,AUC value of combined detection was 0.831,sensitivity was 82.49%,specificity was 86.25%,which were higher than those of the single detection(NLR:0.762,78.56%,75.29%respectively;HE4:0.748,74.59%,78.67%respectively)(P<0.05).Conclusion:The levels of NLR and HE4 in patients with EMS are significantly increased,which is closely related to clinical stage,and dynamic monitoring can predict the recurrence,which is of great clinical significance.