邱衎 梁宗文 王丹菡 徐肖文

[摘要] 目的 回顾性分析子宫内膜异位症患者血清中糖链抗原125（CA-125）、人附睾蛋白4（HE-4）、中性粒细胞与淋巴细胞比值（NLR）及血小板与淋巴细胞比值（PLR）的表达及其诊断价值。 方法 收集2019 年1月～2020年1月在温州医科大学附属第二医院妇科行腹腔镜手术后病理结果确诊为子宫内膜异位症的患者118例（EMS组），选取同时段健康体检女性50例为对照组，回顾性分析各组血清中CA-125、HE-4 及中性粒细胞及血小板分别与淋巴细胞的比值，分析上述四个标记物的表达及其之间相关性。运用受试者工作特征曲线（ROC）分析比较四个指标单独及联合检测对子宫内膜异位症的价值。 结果 子宫内膜异位症患者血清中CA-125、HE-4 和NLR、PLR的表达水平高于对照组，CA-125和NLR水平随着子宫内膜异位症分期的加重而升高（P<0.05）。四指标单独回归模型中ROC曲线下面积（AUC）是CA-125（0.927）最高，NLR单独诊断的面积最小（0.628），CA-125、HE-4及PLR的联合回归模型中ROC曲线下面积（AUC）为0.937，大于各指标单独诊断时的面积。 结论 CA-125、HE-4 和NLR、PLR对子宫内膜异位症均有潜在应用价值，CA-125和NLR对子宫内膜异位症的病情发展有较高应用价值，同时联合CA-125、HE-4 和PLR对子宫内膜异位症诊断有一定的应用价值。

[关键词] 糖链抗原-125;人附睾蛋白-4;中性粒细胞与淋巴细胞比值;血小板与淋巴细胞比值;子宫内膜异位症

[中图分类号] R271.9          [文獻标识码] A          [文章编号] 1673-9701（2020）33-0017-04

[Abstract] Objective To retrospectively analyze the expression and diagnostic value of serum glucose chain antigen 125（CA-125）， human epididymal protein 4（HE-4）， neutrophil to lymphocyte ratio （NLR）， and platelet to lymphocyte ratio （PLR） in endometriosis patients. Methods A total of 118 patients with endometriosis confirmed by pathological results after laparoscopic surgery in the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to January 2020 were collected（EMS group）. Fifty health check-up women at the same time period were selected as the control group. The serum CA-125， HE-4， NLR， and PLR in each group were retrospectively analyzed. The expression of the above four markers and their correlations were analyzed. The receiver operating characteristic curve（ROC） analysis was used to compare the value of the four indicators alone and in combination for endometriosis. Results The serum levels of CA-125， HE-4， NLR， and PLR in patients with endometriosis were higher than those in the control group， and the levels of CA-125 and NLR increased with the progression of endometriosis（P<0.05）. The area under ROC curve（AUC） of the four independent regression models was the highest in CA-125（0.927）， the lowest in NLR（0.628）. The area under the ROC curve（AUC） of the combined regression models of CA-125， HE-4， and PLR was 0.937， larger than the area when each indicator was separately diagnosed. Conclusion CA-125， HE-4， NLR， and PLR have potential application value in endometriosis. CA-125 and NLR have high application value in the development of endometriosis. The combination of CA-125， HE-4， and PLR has specific application value in the diagnosis of endometriosis.

[Key words] Sugar chain antigen-125; Human epididymal protein-4; Neutrophil to lymphocyte ratio; Ratio of Platelet to lymphocyte; Endometriosis

子宫内膜异位症（Endometriosis，EMS）是在子宫体以外的部位出现子宫内膜组织（腺体和间质），引起女性盆腔痛、痛经、性交痛和不孕等临床症状，严重影响女性健康和生活质量，而且该病的发病机制不明，现有的研究显示，其可能与遗传免疫、炎症、细胞增殖与凋亡、血管的新生等有关[1-3]。有数据显示，子宫内膜异位症患者的不孕率高达50%，在原因不明的不孕患者中，最终被确诊为子宫内膜异位症占30%～40%[4]。有研究者认为子宫内膜异位症早期给予积极的手术干预治疗，可以使妊娠率提高到69.3%[5]。……