| Objective:Investigate the correlations between carbohydrate antigen 125 and human epididymis protein 4 and neutrophil-to-lymphocyte ratio in patients with endometriosis and their clinical values for early diagnosis of endometriosis.Methods:From October 2016 to May 2018,127 patients who were pathologically diagnosed as EM after laparoscopic or laparotomy in binzhou medical college affiliated hospital were selected as the EM group,aged 26-45 years old,and who met the following exclusion criteria:(2)exclude other indicators of CA125 combined with gynecological malignant tumor patients;(3)exclude patients with inflammatory diseases that affect the neutrophil/lymphocyte ratio.Other selected medical center over the same physical examination of 83 cases of healthy women as control group,20-47 years old,no statistical difference in age composition and EM group(P>0.05),the residual inclusion criteria are as follows:no clinical discomfort and check-up before 6 months no hormonal drugs,endocrine and immune system disease,without history,malignant tumor is not a state of pregnancy.Excluding the differences caused by general demographic characteristics,CA125,HE4 and blood routine examination results of patients in the control group and the EM group were collected,and the NLR was further calculated based on the blood routine results.The EM group was confirmed by postoperative pathology,and the staging of EM was further determined according to the ASRM modified endometriosis staging method(1997),referring to the details of the position,number,size and degree of adhesion of the ectopic endometrium in the surgical records.SPSS21.0 software was used for statistical analysis.The data of measurement data were expressed as mean standard deviation(s),and t test was used for comparison between groups.The Person rank correlation method was used for the correlation of each index.The predictive efficacy of 3 indicators was analyzed by using the subject's working characteristic curve,ROC curve was drawn by GraphPad Prism 5,and EM was predicted by the 3 indicators combined with the logistic stepwise regression model.Results P<0.05 was considered statistically significant.Results:1.The values of CA125,HE4 and NLR were significantly higher in EM group than those in no-EM group.2.Serum CA125 was positively correlated with HE4,and the correlation index r=0.405,the difference was statistically significant.(P=0.000).Serum CA125 was positively correlated with NLR,and the correlation index r=0.191,the difference was statistically significant(P=0.005).There was no significant correlation between HE4 and NLR(r=0.003),and the difference was not statistically significant(P=0.961).3.In the Logistic stepwise regression analysis of CA125,HE4 and NLR by EM,the probability criteria for selecting in and removing variables were both 0.1,indicating that CA125,HE4 and NLR were significantly correlated with endometriosis,and the difference was statistically significant(P<0.05).Furthermore,the ROC curve was made using CA125 in serum as a variable with the normal control group as the reference level,and CA125 as a marker to distinguish the EM group from the normal group was 0.981(P<0.05).Furthermore,with the normal control group as the reference level and HE4 as the variable to do the ROC curve,it can be obtained that HE4 as a marker to distinguish the EM group and the normal group of AUC is 0.801(P<0.05).Then,the NLR was used as a marker to distinguish the AUC of EM group from that of the normal group using the normal control group as the reference level and NLR as the variable as the ROC curve is 0.745(P<0.05).4.The three predictive variables included in the model have significant explanatory power to predict the occurrence of EM.Three indicators joint area under the ROC curve in the regression model of AUC is 0.983(P<0.05),were greater than the area of the single diagnosis of each index(0.981,0.801,0.745),compared with serum CA125,HE4 NLR joint diagnosis of EM and normal sensitivity,specific and some index,of which the sensitivity of the serum CA125 in the diagnosis of EM is 88.1%,specific degree was 97.8%,about an index was 0.859;The sensitivity and specificity of serum HE4 diagnostic EM were 51.6%,91.1%and 0.427,respectively.The sensitivity,specificity and Jordan index of NLR were 79.4%,63.3%and 0.427 respectively.The EM sensitivity,specificity and Jordan index of CA125,HE4 and NLR were 88.1%,98.9%and 0.870 respectively.5.EM staging was gradually progressive,and CA125,HE4 and NLR levels were increased as a whole(P<0.05).The EM group had a total of 70 patients in stage ?+?,39 patients in stage ?,and 18 patients in stage ?.The level of CA125 in stage ?patients was(191.28 49.67)u/mL,the level of HE4 was(60.09 11.74)pmol/L,and the level of NLR was(2.70 0.82),which was higher than that in stage ? patients(64.4528.90)u/mL,the level of HE4(49.31 12.10)pmol/L,and the level of NLR2.26 1.04.The difference was statistically significant(P<0.05).CA125 level(51.89 19.53)u/mL,HE4 level(48.58 10.15)pmol/L,and NLR2.24 0.50 in stage ?+? patients were also significantly higher(P<0.05).Further according to patients' CA125,HE4 and NLR of multinomial Logistic regression with EM in installment,also confirmed that the model was statistically significant(P<0.05),but Pearson chi-square significant value is 0.524,the pseudo R square value up to 0.394,the overall prediction accuracy was 63.0%,the model suggests that the overall variation explanation ability is insufficient,overall prediction ability.Conclusions:1.The values of CA125,HE4 and NLR were significantly higher in EM group than those in no-EM group.2.CA125 was positively correlated with HE4 and NLR(r=0.405,P=0.000;r=0.191,P=0.005).HE4 had no obvious correlated with NLR(r=0.003,P=0.961).3.The AUC value of combined detection for EM was 0.983,significantly higher than that of any signal factor(0.981?0.801?0.745).The combination of the three indexes can obtain the highest diagnostic efficiency.4.CA125,HE4 and NLR were significantly increased as the progress of EM staging. |
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