T₃、FER与HDL对子宫肌瘤生长的影响及预测价值

Effects and predictive value of T₃, FER and HDL on the growth of uterine fibroids

摘要

目的 探讨三碘甲状腺原氨酸(T₃)、高密度脂蛋白胆固醇(HDL-C)及铁蛋白(FER)与子宫肌瘤最大直径的关联及其对肌瘤生长风险的预测价值。方法 回顾性收集2023年1月1日至2023年12月31日在新疆维吾尔自治区维吾尔医院住院的114例子宫肌瘤患者的34项临床指标,以肌瘤最大直径2.5 cm分为小直径组(<2.5 cm,n=68)和大直径组(≥2.5 cm,n=46)。采用Spearman等级相关分析筛选与肌瘤直径相关的临床指标,通过独立样本t检验或Mann-Whitney U检验进行组间比较,将差异有统计学意义的变量纳入二元Logistic回归模型分析独立影响因素,并绘制受试者工作特征(ROC)曲线评估其预测效能。结果 Spearman相关分析显示,子宫肌瘤最大直径与年龄(r=0.241,P=0.010)、T₃(r=0.190,P=0.043)呈正相关,与FER(r=-0.304,P=0.001)、HDL-C(r=-0.322,P=0.001)呈负相关。组间比较显示,大直径组年龄(Z=-2.737,P=0.006)、T₃(t=-2.169,P=0.032)、FT₃(t=-2.116,P=0.037)均高于小直径组,而FER(Z=-2.022,P=0.043)、HDL-C(Z=-3.163,P=0.002)均低于小直径组。二元Logistic回归分析显示,年龄(OR=1.084,95%CI:1.002~1.173)、FER(OR=0.974,95%CI:0.950~0.999)、HDL-C(OR=0.167,95%CI:0.033~0.845)均为肌瘤直径≥2.5 cm的独立影响因素(P均<0.05)。ROC曲线分析显示,HDL-C预测效能最优(AUC=0.820,95%CI:0.737~0.903),年龄次之(AUC=0.781,95%CI:0.698~0.864),FER(AUC=0.703,95%CI:0.603~0.803),三者P值均=0.001。结论 年龄、铁蛋白、高密度脂蛋白胆固醇对子宫肌瘤生长风险具有中等预测效能,可为肌瘤的风险评估提供临床参考。

Abstract

Objective To investigate the associations of triiodothyronine (T₃), ferritin (FER), and high-density lipoprotein cholesterol (HDL-C) with the maximum diameter of uterine fibroids (UF) and to evaluate their predictive value for the risk of fibroid growth. Methods A total of 114 patients with UF who were hospitalized at the Uygur Medicine Hospital of Xinjiang Uygur Autonomous Region between January 1 and December 31, 2023, were retrospectively enrolled. Thirty-four clinical variables were collected. According to the maximum fibroid diameter, patients were divided into a small-diameter group (<2.5 cm, n=68) and a large-diameter group (≥2.5 cm, n=46). Spearman's rank correlation analysis was performed to identify clinical indicators associated with fibroid diameter. Differences between groups were compared using the independent-samples t test or the Mann-Whitney U test, as appropriate. Variables with statistically significant differences were subsequently included in a binary Logistic regression model to identify independent influencing factors. Receiver operating characteristic (ROC) curves were constructed to evaluate their predictive performance. Results Spearman's rank correlation analysis showed that the maximum diameter of UF was positively correlated with age (r=0.241, P=0.010) and T₃ (r=0.190, P=0.043), but negatively correlated with FER (r=-0.304, P=0.001) and HDL-C (r=-0.322, P=0.001). Compared with the small-diameter group, the large-diameter group had significantly higher age (Z=-2.737, P=0.006), T₃ (t=-2.169, P=0.032), and free triiodothyronine (FT₃) (t=-2.116, P=0.037), whereas FER (Z=-2.022, P=0.043) and HDL-C (Z=-3.163, P=0.002) were significantly lower. Binary Logistic regression analysis identified age (OR=1.084, 95%CI: 1.002-1.173), FER (OR=0.974, 95%CI: 0.950-0.999), and HDL-C (OR=0.167, 95%CI: 0.033-0.845) as independent influencing factors for a maximum fibroid diameter ≥2.5 cm (all P<0.05). ROC curve analysis demonstrated that HDL-C had the best predictive performance (AUC=0.820, 95%CI: 0.737-0.903), followed by age (AUC=0.781, 95%CI: 0.698-0.864) and FER (AUC=0.703, 95%CI: 0.603-0.803), with all P=0.001. Conclusion Age, ferritin, and high-density lipoprotein cholesterol showed moderate predictive performance for the risk of uterine fibroid growth and may provide useful clinical references for the risk assessment of UF.

关键词

子宫肌瘤 / 甲状腺激素 / 铁蛋白 / 高密度脂蛋白胆固醇 / 预测价值

Key words

uterine fibroid / thyroid hormone / ferritin / high-density lipoprotein cholesterol / predictive value

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基金资助

“中医药现代化”国家重点研发课题(2024YFC3505603)

“天山英才”医药卫生高层次人才培养计划(TSYC202301A071)