摘要
目的分析外周血细胞炎症标志物与多囊卵巢综合征(PCOS)患者性激素水平、胰岛素抵抗的关系。方法将2021年8月-2022年8月就诊于桂林市妇幼保健院的200例PCOS患者纳入PCOS组,另选同期年龄匹配的健康体检女性纳入对照组。比较两组外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、衍生中性粒细胞与淋巴细胞比值(dNLR)、系统免疫炎症指数(SII)、黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)。采用Pearson法分析外周血细胞炎症标志物与性激素水平、胰岛素抵抗的相关性;绘制受试者工作特征(ROC)曲线评价外周血细胞炎症标志物对PCOS发生的预测效能;采用多因素Logistic逐步回归模型分析影响PCOS发生的危险因素。结果PCOS组白细胞计数、淋巴细胞计数、中性粒细胞计数、单核细胞计数与血小板计数均高于对照组(P<0.05);PCOS组NLR、dNLR、PLR、LMR与SII均高于对照组(P<0.05);PCOS组LH、T、HOMA-IR均高于对照组,FSH、ISI均低于对照组(P<0.05);Pearson相关性显示,外周血NLR、dNLR、PLR、LMR、SII与LH(r=0.385、0.425、0.483、0.231和0.494)、T(r=0.435、0.479、0.539、0.349和0.501)、HOMA-IR(r=0.452、0.561、0.580、0.361和0.632)呈正相关(P<0.05),与FSH(r=-0.340、-0.463、-0.621、-0.378和-0.533)、ISI(r=-0.512、-0.546、-0.732、-0.462和-0.638)呈负相关(P<0.05);ROC曲线分析结果显示,NLR、dNLR、PLR、LMR、SII及联合预测PCOS发生的敏感性分别为68.9%(95%CI:0.593,0.782)、72.6%(95%CI:0.652,0.796)、75.1%(95%CI:0.683,0.818)、64.2%(95%CI:0.528,0.721)、76.2%(95%CI:0.699,0.842)、82.1%(95%CI:0.782,0.896),特异性分别为76.2%(95%CI:0.693,0.832)、84.3%(95%CI:0.793,0.902)、87.9%(95%CI:0.816,0.921)、75.3%(95%CI:0.673,0.828)、90.2%(95%CI:0.834,0.953)、96.7%(95%CI:0.893,0.986);多因素逐步Logistic回归分析结果显示,■均为PCOS发生的危险因素(P<0.05)。结论PCOS患者外周血NLR、dNLR、PLR、LMR、SII呈高表达,与性激素水平、胰岛素抵抗密切相关,联合检测可有效预测PCOS的发生。
Objective To analyze the correlation of inflammatory markers of peripheral blood cells with sex hormone levels and insulin resistance in patients with polycystic ovary syndrome (PCOS).Methods A total of 200PCOS patients who visited Guilin Women’s and Children’s Health Hospital from August 2021 to August 2022 were included in the PCOS group,and other age-matched healthy women who underwent physical examination during the same period were included in the control group.The peripheral blood neutrophil lymphocyte ratio (NLR),platelet lymphocyte ratio (PLR),monocyte lymphocyte ratio (MLR),derived neutrophil lymphocyte ratio (dNLR),systemic immune inflammation index (SII),luteinizing hormone (LH),follicle-stimulating hormone (FSH),testosterone (T),homeostatic model insulin resistance index (HOMA-IR),and insulin sensitivity index (ISI) were compared between the two groups.After Pearson correlation analysis of the relationship of inflammatory markers of peripheral blood cells with sex hormones and insulin resistance,the working curve of the subject (ROC) was drawn to evaluate the value of inflammatory markers of peripheral blood cells in the prediction of PCOS,and a binary logistic regression model was established to analyze the correlation between inflammatory markers of peripheral blood cells and PCOS.Results The levels of white blood cell count,lymphocyte count,neutrophil count,monocyte count,and platelet count were higher in the PCOS group than in the control group (P<0.05);the levels of NLR,dNLR,PLR,LMR,and SII were higher in the PCOS group than in the control group (P<0.05);the levels of LH,T,and HOMA-IR were higher in the PCOS group than in the control group,and the levels of FSH and ISI levels were all lower than those in the control group (P<0.05);Pearson correlations showed that peripheral blood NLR,dNLR,PLR,LMR,and SII were all positively correlated with LH (r=0.385,0.425,0.483,0.231 and 0.494),T (r=0.435,0.479,0.539,0.349and 0.501),HOMA-IR (r=0.452,0.561,0.580,0.361 and 0.632)(P<0.05),and negatively correlated with FSH(r=-0.340,-0.463,-0.621,-0.378 and-0.533),ISI (r=-0.512,-0.546,-0.732,-0.462 and-0.638)(all P<0.05);ROC curves showed that the sensitivities of NLR,dNLR,PLR,LMR,SII,and combined to predict the occurrence of PCOS were 0.689 (95%CI:0.593,0.782),0.726 (95%CI:0.652,0.796),0.751 (95%CI:0.683,0.818),0.642 (95%CI:0.528,0.721),0.762 (95%CI:0.699,0.842),and 0.821 (95%CI:0.782,0.896),respectively;the specificities were 0.762 (95%CI:0.693,0.832),0.843 (95%CI:0.793,0.902),0.879 (95%CI:0.816,0.921),0.753 (95%CI:0.673,0.828),0.902 (95%CI:0.834,0.953),and 0.967 (95%CI:0.893,0.986),respectively;multi-factor logisticregression analysis showed that ■were all risk factors for the development of PCOS (P<0.05).Conclusion The high levels of NLR,dNLR,PLR,LMR,and SII in peripheral blood of PCOS patients are closely related to sex hormone levels and insulin resistance,and the combination can effectively predict the occurrence of PCOS.
作者
杨羞花
张慧青
Yang Xiu-hua;Zhang Hui-qing(Department of Gynaecology,Guilin Maternal and Child Health Hospital,Guilin,Guangxi 541001,China)
出处
《中国现代医学杂志》
CAS
北大核心
2023年第3期69-75,共7页
China Journal of Modern Medicine
基金
广西壮族自治区卫健委自筹经费科研课题(No:Z20210753)。
关键词
多囊卵巢综合征
外周血细胞炎症标志物
性激素水平
胰岛素抵抗
polycystic ovary syndrome
inflammatory markers of peripheral blood cells
sex hormone levels
insulin resistance
