摘要
目的探讨术前系统免疫炎症指数(SII)水平对卵巢子宫内膜异位囊肿(OMA)合并不孕病人术后自然妊娠结局的影响。方法选取2015年1月至2020年12月在邯郸市中医院妇科接受腹腔镜手术并且经病理确诊为OMA的病人208例,分为未妊娠组102例与妊娠组106例。收集病人的临床资料及血液指标,SII定义为(血小板计数×中性粒细胞绝对值)/淋巴细胞绝对值。应用Cox回归分析确定术前SII对病人术后妊娠结局的独立预测价值。应用受试者操作特征(ROC)曲线与Hosmer-Lemeshow检验评估术前SII的预测准确性与一致性,并与内异症生育指数(EFI)进行比较。评估术前SII与病人术后抗苗勒氏管激素(AMH)变化的相关性。结果与未妊娠组病人相比,妊娠组病人的年龄显著较小[(30.3±3.9)岁比(31.8±4.1)岁]、不孕年限显著较短[2(1,3)年比2(2,4)年],而术前AMH[4.0(2.0,4.5)μg/L比2.3(2.0,4.0)μg/L]与SII[426(323,620)比314(248,413)]显著较高(P<0.05)。多因素分析结果显示,术前AMH>2μg/L[OR=2.24,95%CI:(1.15,4.34)]与术前SII>380[OR=5.93,95%CI:(3.15,11.18)]是术后自然妊娠的独立预测因素(P<0.05)。术前SII结合AMH预测术后妊娠结局的准确性(AUC=0.76)与一致性(P>0.05)良好,其临床效能优于EFI。另外,高SII病人的术后中位AMH(3.7μg/L比3.2μg/L)与低SII病人相比显著较高(P<0.05)。结论术前SII与OMA合并不孕病人术后的自然妊娠结局密切相关,可以作为临床决策的重要依据。
Objective To investigate the impact of preoperative systemic immune-inflammation index(SII)on the natural pregnancy outcome of infertile patients with ovarian endometrioma(OMA).Methods Two-hundred and eight OMA patients confirmed by histopathology who underwent laparoscopic surgery at the TCM Hospital of Handan were enrolled between January 2015 and December 2020.Clinical features and blood parameters were collected.Cox regression analysis was used to identify the independent predictive value of SII for postoperative pregnancy outcome.The accuracy and good fit of SII were evaluated by using receiver operating characteristic curve and Hosmer-Lemeshow test,and were compared with the endometriosis fertility index(EFI).Moreover,the association between preoperative SII and change of anti-Müllerian hormone(AMH)were investigated.Results Compared with the non-pregnancy group,the age[(30.3±3.9)vs.(31.8±4.1)]and duration of infertility[2(1,3)vs.2(2,4)years]was significantly lower while the preoperative SII[426(323,620)vs.314(248,413)]and AMH[4.0(2.0,4.5)μg/L vs.2.3(2.0,4.0)μg/L]was significantly higher in the pregnancy group(P<0.05).Multivariate analysis revealed that the SII of>380[OR=5.93,95%CI:(3.15,11.18)]and AMH of≥2μg/L[OR=2.24,95%CI:(1.15,4.34)]were independent factors for postoperative pregnancy outcome(P<0.05).A combination of preoperative SII and AMH had a high predictive ability(AUC=0.76)and a good fit(P>0.05),and had a better clinical utility than the EFI.Moreover,compared with those with lower SII,patients with higher SII had a significantly higher level of postoperative SII(median:3.7μg/L vs.3.2μg/L)(P<0.05).Conclusion Preoperative SII is closely associated with the natural pregnancy outcome in infertile patients with OMA,which can assist in the decision-making processes.
作者
刘俊容
LIU Junrong(Department of Gynecology,TCM Hospital of Handan,Handan,Hebei 056001,China)
出处
《安徽医药》
CAS
2023年第11期2224-2228,共5页
Anhui Medical and Pharmaceutical Journal
