血清NLR、Hb、CA125及CA199的检测对子宫肌瘤合并子宫腺肌症的鉴别诊断及预后评估的价值

The expression of serum NLR,Hb,CA125,and CA199 on differential diagnosis and prognostic evaluation of uterine fibroid with adenomyosis

目的探讨血清中性粒细胞与淋巴细胞比值(NLR)、血红蛋白(Hb)、糖类抗原125(CA125)及糖类抗原(CA199)检测对子宫肌瘤合并子宫腺肌症的鉴别诊断及预后评估价值。方法143例子宫良性病变患者根据病变类型分为对照组(子宫肌瘤,91例)和观察组(子宫肌瘤合并子宫腺肌症,52例);收集2组患者基本资料,采用血细胞分析仪检测并比较2组患者入院时的中性粒细胞计数、淋巴细胞计数、NLR、Hb等血常规指标;采用酶联免疫吸附试验检测并比较2组患者入院时的血清CA125及CA199水平;采用logistic回归方程获取联合诊断因子P,采用受试者工作特性(ROC)曲线下面积(AUC)评价NLR、Hb、CA125、CA199联合诊断因子P对子宫肌瘤合并子宫腺肌症的诊断价值;分析NLR、Hb、CA125、CA199与子宫肌瘤合并子宫腺肌症患者临床疗效的相关性;采用戈舍瑞林缓释植入剂对观察组患者进行治疗,并进行疗效评估,比较不同疗效患者血清NLR、Hb、CA125、CA199水平,并进行相关性分析。结果观察组患者淋巴细胞计数、Hb水平低于对照组,NLR、CA125、CA199水平高于对照组,差异有统计学意义(P<0.05);ROC曲线分析显示,NLR、Hb、CA125、CA199、联合诊断因子P对子宫肌瘤合并子宫腺肌症具有显著的鉴别诊断价值(AUC>0.7,P<0.05),且联合诊断因子P诊断子宫肌瘤合并子宫腺肌症的AUC大于NLR、Hb、CA125单一指标(P<0.05);显效患者的NLR、CA125、CA199水平低于有效和无效患者,而Hb水平高于有效和无效患者(P<0.05);血清NLR(r=-0.649)、CA125(r=-0.911)、CA199(r=-0.612)水平与临床疗效呈负相关(P<0.05),Hb(r=0.483)与临床疗效呈正相关(P<0.05)。结论检测NLR、Hb、CA125、CA199对子宫肌瘤合并子宫腺肌症具有一定的鉴别诊断价值,各指标联合检测可提高子宫肌瘤合并子宫腺肌症的诊断准确度,可作为患者预后的评估指标。

Objective To explore the differential diagnosis and prognostic evaluation value of serum neutrophil to lymphocyte ratio(NLR),hemoglobin(Hb),carbohydrate antigen 125(CA125),and carbohydrate antigen(CA199)detection for uterine fibroids with adenomyosis.Methods A total of 143 patients with benign uterine lesions were divided into a control group(91 cases of uterine fibroids)and an observation group(52 cases of uterine fibroids combined with adenomyosis)based on the type of lesion.Basic data of two groups were collected and blood cell analyzer was used to detect and compare neutrophil count,lymphocyte count,NLR,Hb and other blood routine indicators of patients at admission.Serum CA125 and CA199 levels were detected and compared by enzyme-linked immunosorbent assay(ELISA).The logistic regression equation was used to obtain the joint diagnostic factor P and the area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the diagnostic value of NLR,Hb,CA125,CA199 combined diagnostic factor P for uterine fibroids with adenomyosis;the correlation between NLR,Hb,CA125,CA199 and clinical efficacy of patients with uterine fibroids complicated with uterine adenomyosis was analyzed.The patients of observation group were treated with Goserelin sustained-release implants and the therapeutic effects were evaluated.The serum levels of NLR,Hb,CA125,and CA199 were compared among patients with different therapeutic effects and correlation analysis was conducted.Results The lymphocyte count and Hb level in the observation group were lower than those in the control group while the levels of NLR,CA125,and CA199 were higher than those in the control group with statistical significance(P<0.05).ROC curve analysis showed that NLR,Hb,CA125,CA199 and the combined diagnostic factor P had significant differential diagnostic value for uterine fibroids with adenomyosis(AUC>0.7,P<0.05),and the combined diagnostic factor P had a higher AUC for diagnosing uterine fibroids with adenomyosis than the single indicator NLR,Hb,and CA125(P<0.05).The levels of NLR,CA125,and CA199 were lower than those of effective and ineffective patients while Hb levels were higher than those in effective and ineffective patients(P<0.05).The serum levels of NLR(r=-0.649),CA125(r=-0.911),and CA199(r=-0.612)were negatively correlated with clinical efficacy(P<0.05)while Hb(r=0.483)was positively correlated with clinical efficacy(P<0.05).Conclusion NLR,Hb,CA125,and CA199 have certain differential diagnostic value for uterine fibroids combined with adenomyosis.Combined detection of various indicators can improve the diagnostic accuracy of uterine fibroids combined with adenomyosis and can be used as a prognostic indicator for patients.