To Discuss The Relationship Between NLR And Postoperative Efficacy Of HIFU In The Treatment Of Adenomyosis

Objective: 1.To explore the clinical effect of HIFU in the treatment of adenomyosis;2.To observe the relationship between NLR,PLR,PLT,CA125 and the severity of the disease;3.To explore the relationship between NLR,PLR,PLT,CA125 and the efficacy of HIFU in the treatment of adenomyosis.Method: From November 2016 to December 2017,101 patients were recruited who were diagnosed as adenomyosis by clinical and imaging examinations and treated with HIFU at the Affiliated Hospital of North Sichuan Medical College.All patients underwent plain and enhanced MRI scans before and 48 hours after HIFU treatment.The volume of lesions(V=0.5233*D1*D2*D3)was calculated.The volume of lesions before operation was V1 and the volume of non-perfusion area after operation was V2.Blood routine and CA125 were detected before operation.Symptoms of dysmenorrhea were scored by visual analogue scale(VAS).Other symptoms were evaluated by "uterine myoma phase"(UFS).Dysmenorrhea and other related symptoms were followed up for 1 month,3 months,6 months and 12 months after treatment and scored again.The ablation rate was calculated according to preoperative lesion volume(V1)and postoperative non-perfusion area volume(V2);NLR(neutrophil/lymphocyte)and PLR(platelet/lymphocyte)were calculated according to the values of neutrophil,platelet and lymphocyte.The correlation of NLR,PLR,PLT,CA125 with VAS and UFS was analyzed by pearson correlation method;the correlation of NLR,PLR,PLT,CA125 withthe improvement of VAS and UFS after operation was analyzed by pearson correlation method;according to the difference of VAS score,patients were divided into three groups: G1(mild),G2(moderate)and G3(severe).Rank sum test was used to compare the difference of NLR,PLR,PLT and CA125 among different groups.According to the VAS scores of 12 months and 6months after operation,the patients were divided into two groups: the group with recurrence risk and the group with stable curative effect.According to the NLR value,to draw the ROC curve and find the critical value of NLR.P< 0.05 was statistically significant.Result: A total of 101 patients were enrolled in this study.One of them refused to follow up,five of them(2 pregnant women and 3 surgical patients)withdrew from follow-up,seven of them lost follow-up,88 patients actually completed the whole follow-up.1.By analyzing the VAS and UFS scores of 88 patients,we found that the VAS and UFS scores after operation were lower than those before operation,and the difference was statistically significant(P < 0.05).2.VAS score and UFS score decreased gradually in 1 month,3 months and 6 months after operation.VAS score and UFS score increased slightly in12 months after operation compared with 6 months after operation.3.The correlation of NLR,PLR,PLT,CA125 with VAS and UFS was analyzed by pearson correlation method.The results showed that PLT was correlated with preoperative VAS(r=0.337,P=0.001),CA125 was correlated with preoperative VAS(r=0.259,P=0.015);NLR and PLR were not correlated with preoperative VAS;NLR was correlated with preoperative UFS(r=0.284,P=0.007);PLT,PLR and CA125 were not significantly correlated with preoperative UFS.4.The correlation between NLR,PLR,PLT,CA125 and the improvement of VAS and UFS was analyzed by pearson correlation method.The results showed that NLR was correlated with the improvement of VAS(r=-0.24,P=0.025);PLT was correlated with the improvement of VAS(r=0.294,P=0.005);CA125 and PLR were not correlated with the improvement of VAS after operation.PLT was correlated with the improvement of UFS(r=0.222,P=0.038).PLR,NLR and CA125 were not correlated with the improvement of UFS after operation.5.Rank sum test was used to compare the difference of NLR,PLR,PLT and CA125 among patients with different degrees of dysmenorrhea.The difference of PLT among the three groups was statistically significant(P=0.009),the difference of CA125 among the three groups was statistically significant(P=0.003),and the difference of PLR among the three groups was statistically significant(P=0.041).There was no significant difference in NLR among the three groups.6.According to the changes of VAS score and preoperative NLR value,ROC curve was drawn.The area under curve(AUC)was 0.988(P < 0.001),and the critical value of NLR was 2.465,which increased the risk of recurrence in 12 months after operation.ROC curve was drawn with preoperative PLT value,the area under the curve was 0.578(P=0.209),and its AUC value was less than 0.7,which meaned it was little clinical significance.Conclusion:1.The symptoms of patients with adenomyosis improved significantly after HIFU treatment,indicating that HIFU is effective as a new treatment for adenomyosis.2.NLR were positively correlated with UFS,PLT and CA125 were positively correlated with VAS,indicating that NLR,PLT and CA125 were correlated with the severity of adenomyosis.3.NLR was negatively correlated with the improvement of VAS.When NLR > 2.465 before operation,the risk of recurrence increased in 12 months after operation.PLT was positively correlated with the improvement of VAS and UFS,but the area under ROC curve is small which was little clinical significance.It is suggested that NLR may be used as clinical indicators to predict the efficacy of HIFU in the treatment of adenomyosis.