预后营养指数（PNI）与MLR、NLR、HE4、CEA、CA125单独及联合检测在子宫内膜癌诊断中的临床价值

王甜甜; 张蓓; 王晴; 况蕾; 李妍雨; 周佳韫

doi:10.3969/j.issn.2096-3882.2022.10.005

预后营养指数（PNI）与MLR、NLR、HE4、CEA、CA125单独及联合检测在子宫内膜癌诊断中的临床价值

Sole and Combined Effect of the Prognostic Nutritional Index (PNI), MLR, NLR, HE4, CEA, CA125 on the diagnosis of Endometrial Cancer

摘要

摘要: 目的：探讨预后营养指数（PNI）与中性粒细胞-淋巴细胞比值（NLR）、单核细胞-淋巴细胞比值（MLR）、人附睾蛋白4（HE4）、癌胚抗原（CEA）、血清糖类抗原125（CA125）单独及联合检测在子宫内膜癌诊断中的临床价值。方法：回顾性分析2016年1月至2021年9月于徐州医科大学附属医院诊治，经病理学检查确诊为EC患者136例作为EC组，同期选择正常子宫内膜患者147例作为非EC组，收集记录患者相关数据。采用t检验、非参数检验、Spearman相关分析、ROC曲线、混淆矩阵计分别对EC组和非EC组、早期EC组和晚期EC组的PNI、MLR、NLR、HE4、CEA、CA125进行分析。结果：（1）EC组PNI低于非EC组（P<0.05），MLR、NLR、HE4、CEA、CA125高于非EC组（P<0.05）。（2）早期EC组PNI高于晚期EC组（P<0.05），晚期EC组MLR、NLR、HE4、CEA均高于早期EC组（P<0.05）。（3）EC组PNI与MLR、NLR、CA125成负相关；MLR与 NLR、HE4成正相关；HE4与CEA呈正相关；CA125与MLR、NLR、HE4、CEA均成正相关。（4）PNI、MLR、NLR、HE4、CEA、CA125单独及联合诊断EC的AUC分别为0.575、0.706、0.810、0.872、0.618、0.703、0.933，敏感性分别为45.6%、55.6%、70.6%、69.9% 、50%、45.6%、83.8%，特异性分别为67.4%、78.2%、75.5%、92.5%、71.4%、87.5%、89.1%，单项指标NLR的敏感性最高，HE4的特异性最高，联合标记物的敏感性和特异性均较高。（5）6项指标联合检测时最佳临界值为0.436，阳性预测值为87.0%，阴性预测值为85.5%，漏诊率为16.2%，误诊率为11.6%，准确率为86.2%。结论：术前PNI、MLR、NLR、HE4、CEA、CA125单独及联合检测可以对EC进行预测诊断，其中对6项指标进行联合检测相较于单项检测具有更高的特异性和敏感性，联合检测可以弥补单项检测的不足、相互补充，提高EC早期诊断效率，且检测简单，无创、临床值得推广。

Abstract: ob＜x＞jective: To study the sole and combined effect of the Prognostic Nutritional Index (PNI), MLR, NLR, HE4, CEA, CA125 on the diagnosis of Endometrial Cancer. Methods: We retrospectively analyzed 136 patients with EC and 147 patients with normal endometrium between 2016 and 2021 in our institution. Clinical characteristics and PNI, MLR, NLR, HE4, CEA, CA125 were tested with the t-test and non-parametric test; The correlation analysis of PNI, MLR, NLR, HE4, CA125 and CEA was performed using Spearman correlation analysis; PNI, MLR, NLR, HE4, CEA, CA125 alone and in combination for EC were evaluated with ROC curve analysis; The confusion matrix was used to calculate the negative predictive value, positive predictive value, missed diagnosis rate, misdiagnosis rate and accuracy rate of the five indexes combined. Results: PNI was lower in the EC group than in the non-EC group and MLR, NLR, HE4, CEA were higher than in the non-EC group (P<0.05). PNI was higher in the early EC group than in the late EC group (P<0.05); MLR, NLR, HE4, CEA were all higher in the late EC group than in the early EC group(P<0.05). PNI was negatively correlated with MLR、NLR and CA125 in the EC group (r=-0.340, P<0.001) (r=-0.298, P<0.001)（r=-0.245，P=0.004）; MLR was positively correlated with NLR and HE4 (r=0.540, P<0.001) (r=0.268, P=0.002); HE4 was also positively correlated with CEA (r=0.287; P=0.001). CA125 was positively correlated with MLR (r=0.254，P=0.003), NLR (r=0.325，P＜0.0001) , HE4 (r=0.387，P＜0.0001), CEA (r=0.170，P=0.048). The AUC of PNI, MLR, NLR, HE4, CEA, CA125 alone and in combination were 0.575, 0.706, 0.810, 0.872, 0.618, 0.703, 0.933. The sensitivities were 45.6%, 55.6%, 0.6%, 69.9%, 50%, 45.6%, 83.8% respectively and the specificities were 67.4%, 78.2%, 75.5%, 92.5%, 71.4%, 87.5%, 89.1% respectively. The best critical value when the 6 indicators were combined was 0.436, with a positive predictive value of 87.0%, a negative predictive value of 85.5%, a missed diagnosis rate of 16.2%, a misdiagnosis rate of 11.6% and an accuracy rate of 86.2%. Conclusion: PNI, MLR, NLR, HE4, CEA, CA125 alone and in combination can be used for the predictive diagnosis of EC. The combined test of the six indicators has higher specificity and sensitivity compared with the single indicator test.

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