外周血炎症标记物联合纤维蛋白原及D-二聚体预测绝经后子宫内膜病变的价值研究

Value of peripheral blood inflammatory markers combined with fibrinogen and D-dimer in predicting postmenopausal endometrial lesions

摘要

目的 探讨外周血炎症标记物联合纤维蛋白原(FIB)、D-二聚体(D-D)对绝经后子宫内膜不典型增生(AEH)及子宫内膜癌(EC)的临床预测价值。方法 回顾性分析2021年1月至2023年9月于安徽医科大学附属巢湖医院妇科行宫腔镜检查及诊刮,或子宫内膜病损切除的182例绝经后患者的临床资料.根据病理结果将其分为AEH/EC组(n=25)与良性组(n=157).采用受试者工作特征(ROC)曲线计算曲线下面积(AUC),评估外周血炎症标记物、FIB、D-D单独及联合预测绝经后AEH及EC的效能,并寻找最佳阈值.采用多因素Logistic回归分析绝经后患者发生AEH及EC的影响因素。结果 AEH/EC组的子宫内膜厚度(ET)、中性粒细胞(N)、血小板计数(PLT)、中性粒细胞与淋巴细胞比值(NLR)、血小板计数与淋巴细胞比值(PLR)、中性粒细胞与单核细胞比值(NMR)、FIB及D-D水平均显著高于良性组(t值分别为3.605、4.205、4.535、3.866、4.288、2.984、5.166和3.392,P<0.05).ROC曲线分析显示,ET、NLR、FIB、D-D,以及FIB+D-D联合、ET+NLR+FIB+D-D联合预测绝经后发生AEH及EC的AUC均>0.5,其中FIB+D-D联合预测的AUC为0.757、ET+NLR+FIB+D-D联合预测的AUC为0.851.多因素Logistic回归分析显示,ET、NLR、FIB、D-D均是影响绝经后患者发生AEH及EC的独立危险因素,OR(95%CI)分别为1.150(1.053~1.256)、3.527(1.296~9.071)、4.710(2.331~9.516)、3.143(2.892~9.738),P<0.05,联合预测效能优于单项或部分联合指标。结论 监测绝经后患者的ET、NLR、FIB及D-D指标,对预测绝经后发生AEH及EC有一定的临床价值.

Abstract

Objective To investigate the clinical predictive value of peripheral blood inflammatory markers combined with fibrinogen (FIB) and D-dimer (D-D) in postmenopausal endometrial dysplasia (AEH) and endometrial cancer (EC). Methods The clinical data of 182 postmenopausal patients who underwent hysteroscopy and curettage or endometrial lesion resection in the Department of Gynecology, Chaohu Hospital of Anhui Medical University from January 2021 to September 2023 were retrospectively analyzed. According to the pathological results, the patients were divided into AEH/EC group (n=25) and benign group (n=157). The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC), and the performance of peripheral blood inflammatory markers, FIB, and D-D alone and in combination in predicting postmenopausal AEH and EC was evaluated, and the optimal threshold was found. Multivariate logistic regression analysis was used to analyze the influencing factors of AEH and EC in postmenopausal patients. Results The levels of endometrial thickness (ET), neutrophil (N), platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet count-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), FIB and D-D levels in the AEH/EC group were significantly higher than those in the benign group (t=3.605, 4.205, 4.535, 3.866, 4.288, 2.984, 5.166 and 3.392, respectively, P<0.05). The analysis of ROC curves showed that the AUC of ET, NLR, FIB, D-D, and FIB+D-D and ET+NLR+FIB+D-D in predicting the occurrence of AEH and EC after menopause was greater than 0.5, among which the AUC of FIB+D-D was 0.757 and that of ET+NLR+FIB+D-D was 0.851. Multivariate Logistic regression analysis showed that ET, NLR, FIB, and D-D were independent risk factors for AEH and EC in postmenopausal patients, and the OR (95% CI) were 1.150 (1.053-1.256), 3.527 (1.296-9.071), 4.710 (2.331-9.516), and 3.143 (2.892-9.738), respectively, all P<0.05, the joint prediction performance was better than that of single or partial joint indicators. Conclusion Monitoring ET, NLR, FIB and D-D indexes in postmenopausal patients has certain clinical value in predicting the occurrence of AEH and EC after menopause.

关键词

子宫内膜癌 / 不典型增生 / 绝经后 / 炎症标记物 / 纤维蛋白原 / D-二聚体

Key words

endometrial carcinoma / hyperplasia / postmenopausal / inflammatory markers / fibrinogen / D-dimer

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