子宫肌瘤并子宫腺肌症的相关影响因素临床分析  

Clinical Analysis of Related Influencing Factors of Leiomyomas Coexisting with Adenomyosis

作　　者：王文娟 王智霆 庄亚琼 段畅 封全灵[1] WANG Wen-juan;WANG Zhi-ting;ZHUANG Ya-qiong;DUAN Chang;FENG Quan-ling(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第三附属医院妇产科,郑州450000

出　　处：《临床误诊误治》2020年第5期80-85,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河南省医学科技攻关项目(201403114)。

摘　　要：目的探讨子宫肌瘤并子宫腺肌症患者的影响因素。方法选取行子宫全(次)切除术治疗并经术后病理检查诊断为子宫肌瘤并子宫腺肌症的150例作为观察组,行子宫全(次)切除术治疗并经术后病理检查诊断为单纯子宫肌瘤的259例作为对照组,调查比较两组临床资料进行单因素分析,采用多因素Logistic回归分析筛选子宫肌瘤并子宫腺肌症的相关影响因素,并绘制受试者工作特征(ROC)曲线对血中性粒细胞与淋巴细胞比值(NLR)预测子宫肌瘤并子宫腺肌症的临床价值进行分析。结果单因素分析结果显示,两组流产次数、哺乳时间、血中性粒细胞、血红蛋白、血NLR、血小板与淋巴细胞比值、空腹胰岛素、稳态模型胰岛素抵抗指数(HOMA-IR)、癌抗原125(CA125)及是否合并乳腺结节比较差异有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析结果显示,流产≥3次、血红蛋白<60 g/L、血NLR、HOMA-IR≥2.69及CA125≥35 U/ml为子宫肌瘤并子宫腺肌症的高危影响因素(P<0.05或P<0.01),哺乳时间≥6个月为子宫肌瘤并子宫腺肌症的保护因素(P<0.01)。ROC曲线分析结果显示,血NLR预测子宫肌瘤并子宫腺肌症ROC曲线下面积为0.734[95%可信区间(0.682,0.786),P=0.019]。血NLR预测子宫肌瘤并子宫腺肌症的最佳临界值为1.926,敏感度为85.3%,特异度为74.1%。150例子宫肌瘤并子宫腺肌症中血NLR≥1.926 128例,血NLR<1.926 22例。结论血NLR对子宫肌瘤并子宫腺肌症有较好预测价值。频繁流产、严重贫血、高水平CA125及HOMA-IR常提示子宫肌瘤和子宫腺肌症并存,哺乳时间≥6个月可作为预防子宫肌瘤和子宫腺肌症并存的保护因素加以提倡。Objective To study the influencing factors for patients with leiomyomas coexisting with adenomyosis. Methods A total of 150 patients with leiomyomas coexisting with adenomyosis who underwent subtotal or total hysterectomy and were diagnosed by pathological examination after operation were selected as observation group, while 259 patients diagnosed with simple leiomyoma after operation and pathological examination were selected as observation group. Clinical data were compared between the two groups using univariate analysis. Multivariate logistic regression analysis was used to screen the relevant influencing factors of leiomyomas coexisting with adenomyosis, and the receiver operating characteristic(ROC) curve was delineated to analyze the clinical value of blood neutrophil to lymphocyte ratio(NLR) in predicting leiomyomas coexisting with adenomyosis. Results Univariate analysis showed that there was a statistically significant difference between the two groups in the number of abortions, duration of breastfeeding, blood neutrophils, hemoglobin, NLR, platelet-to-lymphocyte ratio, fasting insulin, homeostatic model assessment insulin resistance index(HOMA-IR), cancer antigen 125(CA125), and presence and absence of combined breast nodules(P<0.05 or P<0.01). Multivariate logistic regression analysis showed that the number of abortions≥3, hemoglobin level <60 g/L, blood NLR value, HOMA-IR≥2.69, and CA125≥35 U/ml were high risk factors for leiomyomas coexisting with adenomyosis(P<0.05 or P<0.01), and duration of breastfeeding≥6 months was considered as a protective factor(P<0.01). ROC curve analysis showed than ROC of NLR for predicting adenomyosis coexisting with leiomyomas was 0.734[95%CI(0.682, 0.786),P=0.019], the optimal critical value for NLR to predict adenomyosis coexisting with leiomyomas was 1.926, the sensitivity was 85.3%, and the specificity was 74.1%. Among 150 patients with adenomyosis coexisting with leiomyomas, 128 patients had NLR≥1.926 and 22 patients had blood NLR <1.926. Conclusion NLR

关 键 词：平滑肌瘤 子宫疾病 子宫腺肌症 血红蛋白 中性粒细胞与淋巴细胞比值 稳态模型胰岛素抵抗指数 癌抗原125 哺乳时间 

分 类 号：R711.71[医药卫生—妇产科学] R737.33[医药卫生—临床医学]