摘要目的 探讨子宫内膜异位症患者糖链抗原125(CA-125)、CA-19-9和中性粒细胞淋巴细胞比值(NLR)与腹腔镜手术治疗后自然妊娠率之间的关系.方法 对62例2013年1月至2015年12月期间来本院就诊的初诊的、合并不孕且接受过腹腔镜手术的子宫内膜异位症患者进行了1年的随访,经过治疗后,37例患者受孕(受孕组),25例患者未受孕(未孕组),比较两组患者CA-125、CA-19-9和NLR的水平和分期、异位灶位置分布情况.采用受试者工作特征曲线法、多元Logistic回归分析患者初次就诊的CA-125、CA-19-9和NLR、分期与术后自然妊娠率的关系.结果 经过一年随访后37例患者自然受孕,受孕患者的CA-125、CA-19-9和NLR、分期显著低于未孕患者(均P<0.05),两组异位灶位置分布情况并无明显差异.CA-125、CA-19-9和NLR预测患者受孕的曲线下面积分别为0.74(95% CI:0.62~0.87)、0.83(95% CI :0.71~0.95)和0.85(95% CI :0.75~0.95),三者曲线下面积的差异无统计学意义(均P>0.05).在多元Logistic回归中,分期、CA-19-9和NLR均为治疗后自然受孕的独立相关因素,其优势比分别为0.054(95% CI :0.008~0.385)、0.138(95% CI :0.033~0.583)和0.718(95% CI :0.580~0.888).结论 CA-19-9和NLR可以用于预测子宫内膜异位症患者经过腹腔镜手术治疗后自然妊娠的几率.

abstractsObjective To investigate the relationship between carbohydrate antigen CA-125,CA-19-9,neutrophil-to-lymphocyte ratio(NLR)and spontaneous pregnancy in endometriosis patients after laparoscopic surgery. Methods Sixty-two first-visit patients with endometriosis and infertility,who had underwent laparoscopic surgery and admitted to our hospital between January 2013 and December 2015, were followed up for 1 year. After the treatment,37 patients were pregnant(pregnant group),whereas 25 patients were not pregnant(non-pregnant group). The levels of CA-125,CA-19-9 and NLR,staging and the location distribution of the ectopic foci were compared between the two groups. The receiver operating characteristic(ROC)curve analysis and multivariate logistic regression were used to analyze the relationship between the levels of CA-125,CA-19-9 and NLR,staging and postoperative spontaneous pregnancy rate at the first visit. Results At one year after the follow up,there were 37 cases of spontaneous pregnancy. The levels of CA-125,CA19-9 and NLR and staging in the pregnant patients were significantly lower than those in the non-pregnant patients(both P<0.05). There was no significant difference in the location distribution of the ectopic foci between the two groups. The area under ROC curve(AUC)predicting pregnancy by CA-125, CA-19-9 and NLR were 0.74(95% CI :0.62-0.87),0.83(95% CI :0.71-0.95)and 0.85(95% CI :0.75- 0.95),respectively,with no statistically significant difference(all P>0.05). In the multivariable logistic regression,staging,CA-19-9 and NLR were independent factors related to spontaneous pregnancy after the treatment. The odds ratios were 0.054(95% CI:0.008-0.385)and 0.138(95% CI:0.033-0.583),and 0.718(95% CI:0.580-0.888),respectively. Conclusion CA19-9 and NLR may be used to predict the probability of spontaneous pregnancy in endometriosis patients after laparoscopic surgery.