外周血系统性炎症标志物预测完全性葡萄胎恶变的价值研究

目的:探讨外周血系统性炎症标志物在预测完全性葡萄胎恶变中的临床价值。方法:对2005年1月至2016年1月在西安交通大学第一附属医院清宫并随访的完全性葡萄胎患者进行回顾性分析。本研究共纳入206例完全性葡萄胎患者,根据术后2年随访的血β-h CG监测结果,将患者分为恶变组和治愈组。根据患者清宫术前血常规检查结果计算外周血系统性炎症标志物[血小板计数(PLT)、淋巴细胞绝对值(L)、中性粒细胞与淋巴细胞比值(NLR)、血小板计数与淋巴细胞绝对值比值(PLR)及衍生的中性粒细胞与淋巴细胞比值(dNLR)]等,通过受试者工作曲线(ROC)计算曲线下面积(AUC)。结果:①在符合条件的206例患者中,29例(14. 08%)完全性葡萄胎患者进展为妊娠滋养细胞肿瘤。恶变组患者L[(1. 23±0. 35)×10⁹/L vs(1. 69±0. 50)×10⁹/L]及PLT[(165. 0±37. 0)×10⁹/L vs(213. 7±52. 3)×10⁹/L]和PLR(120. 1±51. 1 vs 156. ...

Predictive Value of Peripheral Systemic Inflammatory Markers in the Malignancy Transformation of Complete Hydatidiform Mole

Objective:To explore the clinical value of peripheral systematic inflammatory markers in the prediction of complete hydatidiform mole malignancy transformation.Methods:Complete hydatidiform mole patients with curettage and followed up were retrospectively analyzed in the First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to January 2016.A total of 206 complete hydatidiform mole patients were enrolled in this study.Patients were divided into malignant group and cured group according to theβ-h CG results during two years follow up after curettage.Peripheral systematic inflammatory markers including platelet count(PLT),lymphocyte(L),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and derived neutrophil to lymphocyte ration(d NLR)before curettage were calculated.The clinical value of those markers in the prediction of postmolar malignancy transformation were tested by multivariable logistic regression analysis via ROC by calculating the area under the curve(AUC).Results:①Of 206 eligible patients,29(14.08%)complete hydatidiform mole patients were progressed into gestational trophoblastic neoplasm.Lymphocyte[(1.23±0.35)×10^9/L vs.(1.69±0.50)×10^9/L],platelet[(165.0±37.0)×10^9/L vs.(213.7±52.3)×10^9/L]and PLR(120.1±51.1 vs.156.4±52.6)in the malignant group was significantly lower than that in the cured group(P<0.001),while the NLR(3.71±0.99 vs.2.97±1.46)and the d NLR(4.14±2.24 vs.3.13±2.86)in the malignant group was significantly higher than that in the cured group(P<0.05).②There was statistically significant difference in the AUC of the ROC in gestational age(GA),lymphocyte count,platelet count,NLR,PLR,d NLR andβ-h CG in two groups(P<0.001).The AUC value of the combined inflammatory markers of complete hydatidiform mole in prediction of malignant transformation was 0.871,the sensitivity and specificity were 93.1%and 65.5%respectively.The AUC value of the clinical combined predictive index was 0.807,the sensitivity and specificity were 86.2%and 68.9%;the AUC value of combined inflammatory factors with clinical index was 0.911,the sensitivity and specificity were 93.1%and 82.5%,respectively.The AUC value of combined detection was higher than the single parameter.③Multivariate logistic regression analysis revealed that gestation age>8.4 week,PLT≤180×10^9/L、NLR>3.24、PLR≤113.6 andβ-h CG>94654 U/L were independent risk factors of the malignancy transformation of complete hydatidiform mole after evacuation(P<0.001),OR values were 12.561(95%CI3.776-41.788),7.934(95%CI 2.459-25.600),8.261(95%CI 2.343-29.127),5.182(95%CI1.146-23.426),10.743(95%CI,3.030-38.095)respectively.There was significantly statistical difference.Conclusions:Preoperative peripheral inflammatory markers including PLT、L、NLR、PLR andβ-hCG in complete hydatidiform patients have some clinical value in the prediction of malignancy transformation.