| 唐 卉,张 蕾,支小改,岳嫒媛,丁兰芳.血清TSGF、MCP-1、Ang-2与腹腔镜下子宫肌瘤剔除术后复发的关系及列线图预测模型构建[J].现代生物医学进展英文版,2024,(18):3509-3515. |
| 血清TSGF、MCP-1、Ang-2与腹腔镜下子宫肌瘤剔除术后复发的关系及列线图预测模型构建 |
| Study on the Relationship between Serum TSGF, MCP-1, Ang-2 and Recurrence after Laparoscopic Myomectomy and the Construction of a Nomograph Prediction Model |
| Received:February 05, 2024 Revised:February 28, 2024 |
| DOI：10.13241/j.cnki.pmb.2024.18.021 |
| 中文关键词: 子宫肌瘤 腹腔镜下子宫肌瘤剔除术 TSGF MCP-1 Ang-2 复发 列线图 预测模型 |
| 英文关键词: Uterine fibroids Laparoscopic myomectomy TSGF MCP-1 Ang-2 Recurrence Nomograph Prediction model |
| 基金项目:江苏省"六大人才高峰"高层次人才选拔培养资助项目（WSW-086） |
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| 中文摘要: |
| 摘要 目的：探究血清肿瘤特异性生长因子（TSGF）、单核细胞趋化蛋白-1（MCP-1）、血管生成素2（Ang-2）与腹腔镜下子宫肌瘤剔除术（LM）术后复发的关系及列线图预测模型构建。方法：纳入2018年6月至2020年6月我院收治的213例行LM的子宫肌瘤患者作为研究对象。检测所有患者的血清TSGF、MCP-1、Ang-2水平。随访3年，根据术后3年是否复发分为复发组与未复发组，比较两组血清TSGF、MCP-1、Ang-2水平。采用单因素及多因素Logistic回归分析子宫肌瘤患者LM术后复发的危险因素，根据危险因素构建术后复发风险列线图预测模型。采用受试者工作特征（ROC）曲线分析血清MCP-1、TSGF、Ang-2对子宫肌瘤患者LM术后复发的预测效能。结果：213例子宫肌瘤LM患者随访3年，失访者8例，205例子宫肌瘤患者LM术后3年复发37例，复发率为18.05%（37/205）。未复发组血清Ang-2、TSGF、MCP-1水平均低于复发组，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，术后肌瘤残留、血清TSGF升高、年龄≥35岁、MCP-1升高、多发肌瘤、Ang-2升高为子宫肌瘤患者LM术后复发的独立危险因素（P<0.05）。ROC分析显示，血清TSGF、MCP-1、Ang-2、列线图预测模型的曲线下面积（AUC）为0.873（95%CI：0.801~0.944）、0.721（95%CI：0.624~0.817）、0.803（95%CI：0.722~0.885）、0.986（95%CI：0.973~0.998）。内部验证（B=1000）显示，C-index为0.972，提示该列线图预测模型预测能力较好。决策分析显示，该模型的阈值概率0.01~0.95，净收益率>0，高于两条无效线。结论：血清TSGF、MCP-1、Ang-2水平升高可导致子宫肌瘤患者LM术后复发。年龄≥35岁、多发肌瘤、术后肌瘤残留、血清TSGF升高、MCP-1升高、Ang-2升高为子宫肌瘤患者LM术后复发的独立危险因素。依据独立危险因素构建的列线图预测模型对子宫肌瘤患者LM术后复发具有良好预测价值。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the relationship between serum tumor specific growth factor (TSGF), monocyte chemoattractant protein-1 (MCP-1), angiopoietin-2 (Ang-2) and recurrence after laparoscopic myomectomy (LM) and the construction of a nomograph prediction model. Methods: 213 uterine fibroids patients who were undergoing LM surgery admitted to our hospital from June 2018 to June 2020 were selected as study subjects. The serum levels of TSGF, MCP-1 and Ang-2 were detected in all patients. After 3 years of follow-up, patients were divided into recurrence group and non-recurrence group according to whether patients had recurred 3 years after operation, the serum levels of TSGF, MCP-1 and Ang-2 were compared between two groups. The risk factors of recurrence after LM in uterine fibroids patients were analyzed by univariate and multivariate Logistic regression analysis, and a nomograph prediction model for postoperative recurrence risk was constructed according to the risk factors. The predictive efficacy of serum MCP-1, TSGF and Ang-2 on the recurrence of LM in uterine fibroids patients were analyzed by receiver operating characteristic (ROC) curve. Results: 213 uterine fibroids patients were followed up for 3 years, and 8 patients were lost to follow-up, there were 37 cases of recurrence in 205 uterine fibroids patients 3 years after LM, and the recurrence rate was 18.05% (37/205). The serum levels of Ang-2, MCP-1 and TSGF in non-recurrence group were lower than those in recurrence group, and the differences were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that, postoperative residual myoma, elevated serum TSGF, age≥35 years, elevated MCP-1, multiple fibroids and elevated Ang-2 were independent risk factors for recurrence after LM in uterine fibroids patients(P<0.05). ROC analysis showed that, the area under the curve (AUC) of serum TSGF, MCP-1, Ang-2 and nomograph prediction model was 0.873 (95%CI: 0.801~0.944), 0.721 (95%CI: 0.624~0.817), 0.803 (95%CI: 0.722~0.885), 0.986 (95%CI: 0.973~0.998). Internal validation (B=1000) showed that, the C-index was 0.972, suggesting that the nomograph prediction model had a good predictive ability. The decision analysis shows that, the threshold probability of the model was 0.01~0.95, and the net return rate was>0, which was higher than the two invalid lines. Conclusion: The increase of serum TSGF, MCP-1 and Ang-2 levels can lead to the recurrence of LM in uterine fibroids patients. Age≥35 years old, multiple fibroids, postoperative residual myoma, elevated serum TSGF, elevated MCP-1 and elevated Ang-2 are independent risk factors for recurrence after LM in uterine fibroids patients.The nomograph prediction model base on independent risk factors has a good predictive value for the recurrence of LM in uterine fibroids patients. |
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