清宫前血细胞相关指标对葡萄胎恶变的预测价值

Predictive role of peripheral blood cell parameters in the cancer development of hydatidiform moles

目的探讨首次清宫前红细胞分布宽度(RDW)、中性粒细胞/淋巴细胞比值(NLR)、血小板计数(PLT)以及中性粒细胞绝对值(N)在预测葡萄胎恶变中的临床价值。方法选取2011年1月—2021年5月于安徽理工大学第一附属医院清宫和随访的葡萄胎患者88例。根据术后血β-HCG的变化,将患者分为恶变组(76例)和未恶变组(12例)。分析2组患者首次清宫术前PLT、N、NLR和RDW,通过受试者工作曲线(ROC)计算曲线下面积(AUC)。结果(1)恶变组患者的年龄、孕周、Logβ-HCG、RDW、血小板分布宽度(PDW)、N和NLR高于未恶变组,而淋巴细胞绝对值(L)和PLT低于未恶变组(P<0.05)。(2)多因素logistic回归分析显示:RDW、NLR和N的升高以及PLT的降低是葡萄胎恶变的独立危险因素。(3)ROC曲线分析:当清宫前RDW=14.95,AUC为0.925;当清宫前NLR=3.84,AUC为0.946;当清宫前N=7.12×10^(9)/L,AUC为0.893;当清宫前PLT=182.00×10^(9)/L,AUC为0.713。(4)根据RDW、NLR、PLT和N的临界点分组,高RDW、高NLR和高N组患者的恶变率分别高于低RDW、低NLR和低N组患者,但低PLT组患者的恶变率高于高PLT组患者(P<0.05)。结论葡萄胎患者首次清宫前RDW、NLR、PLT和N在预测葡萄胎恶变中具有一定的临床指导意义。

Objective To investigate the clinical value of red blood cell distribution width(RDW),neutrophil/lymphocyte ratio(NLR),platelet count(PLT)and absolute neutrophil count(N)in predicting malignant transformation of hydatidiform mole prior to the initial curettage.Methods A total of 88 hydatidiform moles patients with curettage and follow-up in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Anhui University of Science and Technology from January 2011 to May 2021 were selected.Patients were divided into malignant group(76 cases)and non-malignant group(12 cases)according to the serumβ-HCG results after curettage.The platelet count(PLT),neutrophil(N),neutrophil to lymphocyte ratio(NLR)and red blood cell distribution width(RDW)before the first curettage in the 2 groups were analyzed.The critical value of those markers was calculated by the area under the curve(AUC)statistic derived from the ROC curves.Results(1)Age,gestational weeks,Logβ-HCG,RDW,PDW,N and NLR in patients with malignant group were higher than that in non-malignant group,while absolute lymphocyte values(L)and PLT in the malignant group was significantly lower than that in non-malignant group(P<0.05).(2)Multivariate logistic regression analysis revealed that RDW,NLR and N increase as well as PLT decreased were independent risk factors for hydatidiform mole canceration.(3)ROC curve analysis that among the clinical markers measured before first curettage,for RDW=14.95,NLR=3.84,N=7.12×109/L and PLT=182.00×109/L,the AUC was estimated as 0.925,0.946,0.893 and 0.713,respectively.(4)According to the threshold grouping of RDW,NLR,N and PLT,the malignant transformation rate of high RDW,NLR and N group were higher than patients in the low RDW,NLR and N group,while the malignant transformation rate of low PLT was higher than patients in the high PLT group(P<0.05).Conclusion RDW,NLR,PLT and N with hydatidiform mole patients before the first curettage have certain clinical guiding significance in predicting the malignant transformation of hydatidiform moles.