子宫内膜息肉宫腔镜切除术后复发的影响因素及模型预测

Risk Factors and Model Prediction of Recurrence AfterHysteroscopy Resection of Endometrial Polyps

目的探讨子宫内膜息肉(EP)宫腔镜切除术后复发的影响因素及模型预测。方法选取2018年9月至2021年9月在郑州大学第三附属医院接受宫腔镜切除术治疗的150例EP患者,并以术后1 a作为观察终点,将出现复发的30例患者作为复发组,余120例患者纳入未复发组。收集两组一般临床资料,采用单因素、logistic多因素分析EP宫腔镜切除术后复发的独立影响因素,构建复发风险的列线图预测模型,并绘制受试者工作特征(ROC)曲线、校准曲线及临床获益(DCA)曲线,评价该模型区分度、一致性及临床获益。结果复发组患者的体重指数(BMI)、流产次数、息肉数目、子宫内膜炎占比、多囊卵巢综合征(PCOS)占比、宫腔镜电切术占比及子宫内膜组织基质金属蛋白酶-9/金属蛋白酶抑制因子-1(MMP-9/TIMP-1)、缺氧诱导因子-1α(HIF-1α)、血小板衍生生长因子(PDGF)mRNA表达均高于未复发组,差异有统计学意义(P<0.05);BMI、流产次数、息肉数目、子宫内膜炎、PCOS、宫腔镜电切术及子宫内膜组织MMP-9/TIMP-1、HIF-1α、PDGF均为EP患者宫腔镜切除术后复发的独立危险因素,差异有统计学意义(P<0.05);列线图模型预测EP患者宫腔镜切除术后复发的曲线下面积(AUC)为0.918(95%CI:0.846~0.990),Hosmer-Lemeshow拟合优度检验=7.682,P=0.315,预测术后复发的校准曲线斜率接近1,且DCA曲线显示该模型具有明显的正向净收益。结论BMI、流产次数、息肉数目、子宫内膜炎、PCOS、宫腔镜电切术、MMP-9/TIMP-1、HIF-1α、PDGF均为EP患者宫腔镜切除术后复发的独立危险因素,基于上述因素构建列线预测模型,其预测EP宫腔镜切除术后复发风险的效果较好,具有良好的临床效用。

Objective To investigate the factors influencing recurrence after hysteroscopic resection of endometrial polyps(EP)and model prediction.Methods A total of 150 EP patients who received hysteroscopic resection in the Third Affiliated Hospital of Zhengzhou University from September 2018 to September 2021 were selected,and one year after surgery was taken as the observation end point,and 30 patients with recurrence were included in the recurrence group,and the remaining 120 patients were included in the non-recurrence group.General clinical data and expressions of MMP-9/TIMP-1,HIF-1αand PDGF in endometrial tissues of the two groups were collected.The independent influencing factors of relapse after EP hysteroscope resection were analyzed by univariate and logistic multivariate analysis,and a nomogram prediction model for recurrence risk was constructed.Receiver operating characteristic(ROC)curve,calibration curve and clinical benefit(DCA)curve were plotted to evaluate the differentiation,consistency and clinical benefit of the model.Results Body mass index(BMI)of patients in the relapse group,number of abortion,number of polyps,proportion of endometritis,proportion of polycystic ovary syndrome(PCOS),proportion of hysteroscope resection and endometrial tissue matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1(MMP-9/TIMP-1),Hypoxia inducible factor-1α(HIF-1α),platelet derived growth factor(PDGF)mRNA expression were higher than in not relapse group,and the difference was statistically significant(P<0.05).BMI,number of abortions,number of polyps,endometritis,PCOS,hysteroscopic resection and endometrial tissue MMP-9/TIMP-1,HIF-1α,PDGF were independent risk factors for recurrence after hysteroscopic resection in EP patients,and the difference was statistically significant(P<0.05).The area under the curve(AUC)of EP patients predicted after hysteroscopic resection was 0.918(95%CI=0.846-0.990),the Hosmer-Lemeshow excellence of fit test was 7.682,P=0.315,and the slope of the calibration curve for predicting postoperative recurrence was close to 1.The DCA curve shows that the model has obvious positive net benefit.Conclusion BMI,number of miscarriages,number of polyps,endometritis,PCOS,hysteroscopic electrodesiccation,MMP-9/TIMP-1,HIF-1αand PDGF are independent risk factors for recurrence after hysteroscopic resection in EP patients,and a column-line prediction model was constructed based on the above factors,which was effective in predicting the risk of recurrence after hysteroscopic resection of EP,and has good clinical utility.