基于倾向性评分匹配的子宫内膜异位症患者T淋巴细胞亚群与临床分期的相关性评价

Evaluation on correlation between T lymphocyte subsets and clinicalstaging in patients with endometriosis based on propensity score matching

目的:基于倾向性评分匹配探讨分析T淋巴细胞亚群与子宫内膜异位症(EMs)患者临床分期的关系。方法:回顾性分析2018年6月至2021年6月170例EMs患者病历资料,将全部患者依据修正EMs分期法(r-AFS)评分分为晚期组(Ⅲ~Ⅳ期,90例)和早期组(Ⅰ~Ⅱ期,80例)。使用倾向性评分匹配分析患者年龄、月经周期、孕次等基线资料,采用近邻法进行1∶1匹配,将晚期组与早期组配对,经倾向性评分匹配后最终纳入晚期组、早期组。检测两组入院当天的T淋巴细胞亚群,分析T淋巴细胞亚群与EMs患者临床分期的关系。结果:倾向性评分匹配前晚期组与早期组年龄、月经周期、孕次、月经初潮时间、痛经程度、子宫内膜异位病灶部位比较,差异有统计学意义(P<0.05)。经倾向性评分匹配后,最终纳入晚期组早期组病例各50例。倾向性评分匹配后晚期组与早期组年龄、月经周期、孕次、月经初潮时间、痛经程度、子宫内膜异位病灶部位比较,差异无统计学意义(P>0.05)。匹配后的两组数据中,晚期组的CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)值低于早期组,CD8^(+)水平高于早期组,差异有统计学意义(P<0.05)。两组的HE4、CA125水平对比,差异无统计学意义(P>0.05)。经多元Logistic回归分析结果显示,EMs患者入院当天的CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)值高是EMs患者临床分期高的保护因素(OR<1,P<0.05);CD8^(+)水平高是EMs患者临床分期高的危险因素(OR>1,P<0.05)。绘制受试者工作特征曲线,结果显示,EMs患者入院当天的CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)值评估患者临床分期高风险的AUC均>0.70,评估价值较理想。结论:T淋巴细胞亚群与EMs患者临床分期存在相关性。

Objective:To explore the relationship between T lymphocyte subsets and clinical staging of patients with endometriosis(EMs)based on propensity score matching.Methods:The medical records of 170 patients with EMs who were admitted into hospital from June 2018 to June 2021 were analyzed retrospectively.All patients were divided into late group(90 cases with stageⅢ-Ⅳ)and early group(80 cases with stageⅠ-Ⅱ)according to the Revised AFS Classification of Endometriosis(r-AFS).The baseline data such as age,menstrual cycle and graviditas were analyzed by propensity score matching,and the nearest neighbor method was used for 1∶1 matching,and the late group was matched with the early group.After propensity score matching,the cases were finally included in the late group and the early group.The T lymphocyte subsets in the two groups were detected on the day after admission,and the relationship between T lymphocyte subsets and clinical staging of EMs patients was analyzed.Results:There were significant differences in age,menstrual cycle,graviditas,menarche time,the degree of dysmenorrhea and the EMs lesion location between the late group and the early group before propensity score matching(P<0.05).After propensity score matching,they were finally included in the late group and the early group,with 50 cases in each group.There were no significant differences between the late group and the early group in age,menstrual cycle,graviditas,menarche time,the degree of dysmenorrhea and EMs lesion location(P>0.05).After matching,the levels of CD3^(+),CD4^(+) and the ratio of CD4^(+)/CD8^(+) in the late group were lower than those in the early group,while the level of CD8^(+) was higher than that in the early group,with statistically significant differences(P<0.05).There were no significant differences in HE4 and CA125 levels between the two groups(P>0.05).Multivariate Logistic regression analysis showed that the high levels of CD3^(+),CD4^(+) and the ratio of CD4^(+)/CD8^(+) were the protective factors for the high clinical stage of EMs patients(OR<1,P<0.05);the high level of CD8^(+) was a risk factor for the high clinical stage of EMs(OR>1,P<0.05).Receiver operating characteristic curve was drawn.The results showed that the AUC of CD3^(+),CD4^(+),CD8^(+) and CD4^(+)/CD8^(+) ratio of EMs patients with high clinical stage risk were all>0.70 on the day after admission,with the ideal evaluation value.Conclusion:There is a correlation between T lymphocyte subsets and clinical staging of EMs patients.