Objective  To explore the diagnostic value of immune-inflammatory indicators in endometriosis (EMs) and to construct a prediction model.

Methods  Women who visited the department of health management medicine and the department of obstetrics and gynecology of the First People's Hospital of Foshan from January 2021 to June 2024 were selected as research subjects. They were divided into EMs group and Non EMs group according to the EMs diagnostic criteria, and the clinical data of the two groups were compared. The subjects were randomly divided into a training set and a validation set at a ratio of 7  ∶  3. Univariate and multivariate Logistic regression analysis and Lasso regression were used to screen predictive variables, and a prediction model was constructed. The receiver operating characteristic curve (ROC) and its area under the curve (AUC), calibration curve, and decision curve were used to evaluate the prediction efficiency of the model.

Results  A total of 6,570 subjects were included, including 6,090 in the Non EMs group and 480 in the EMs group. There were 4,599 cases in the training set and 1,971 cases in the validation set. Multivariate logistic regression analysis showed that white blood cell count [OR=2.997, 95%CI (1.165, 7.709)], lymphocyte count [OR=6.625, 95%CI (3.436, 12.774)], neutrophil count [OR=3.248, 95%CI (1.082, 9.753)], monocyte count [OR=4.269, 95%CI (1.291, 14.111)], C-reactive protein [OR=7.226, 95%CI (1.840, 28.382)], carbohydrate antigen 125 [OR=1.603, 95%CI (1.112, 2.311)], Carbohydrate antigen 19-9 [OR=1.470, 95%CI (1.091, 1.980)], interleukin-18 [OR=6.251, 95%CI (1.698, 23.015)], and tumor necrosis factor-α [OR=4.435, 95%CI (1.619, 12.146)] may be the influencing factors of EMs. The prediction model finally included three variables, lymphocyte count, C-reactive protein, and tumor necrosis factor-α. ROC analysis showed that the sensitivity of the model in the training set was 78.18%, the specificity was 75.94%, and the AUC was 0.814. The sensitivity of the model in the validation set was 80.95%, the specificity was 66.29%, and the AUC was 0.786. The calibration curve showed that the predicted probability fit well with the actual probability. The clinical decision curve showed that the model could bring clinical benefits within a certain threshold range.

Conclusion  The prediction model constructed with three immune-inflammatory indicators of lymphocyte count, C-reactive protein and tumor necrosis factor-α has good diagnostic efficacy and can provide a reference for the early diagnosis of EMs.

1.张瑞,王文娜,陈立乔,等. T淋巴细胞、炎症细胞因子与卵巢子宫内膜异位症的相关性及诊断价值[J].西部医学, 2024, 36(7): 1047-1051, 1057. [Zhang R, Wang WN, Chen LQ, et al. Research on the correlation and diagnostic value of T lymphocyte and inflammatory cytokines in peripheral blood to ovarian endometriosis[J]. Medical Journal of West China, 2024, 36(7): 1047-1051, 1057.] DOI: 10.3969/j.issn.1672-3511.2024.07.021.

2.Li PS, Peng XM, Niu XX, et al. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial[J]. Fertil Steril, 2023, 119(5): 815-823. DOI: 10.1016/j.fertnstert.2023.01.034.

3.潘甚豪, 李炎坤, 伍哲维, 等. 子宫内膜异位症患者新鲜胚胎移植临床妊娠率预测模型的建立与验证[J]. 南方医科大学学报, 2024, 44(7): 1407-1415. [Pan SH, Li YK, Wu ZW, et al. Establishment of a predictive nomogram for clinical pregnancy rate in patients with endometriosis undergoing fresh embryo transfer[J]. Journal of Southern Medical University, 2024, 44(7): 1407-1415.] DOI: 10.12122/j.issn.1673-4254.2024.07.21.

4.Wang JX, Shen Y, Wang XL, et al. Causal relationship between endometriosis with infertility and ankylosing spondylitis[J]. Sci Rep, 2023, 13(1): 13412. DOI: 10.1038/s41598-023-40647-y.

5.张红彬, 孟欣雨, 田捧, 等. TVS三步法系统超声评估深部子宫内膜异位症的价值初探[J]. 中国临床医学影像杂志, 2024, 35(5): 343-346. [Zhang HB, Meng XY, Tian P, et  al. A preliminary study on the value of TVS three-step system ultrasound in the evaluation of deep endometriosis[J]. Journal of China Clinic Medical Imaging, 2024, 35(5):343-346.] DOI: 10.12117/jccmi.2024.05.009.

6.沈艳, 陈美红, 张晓玲. 腹腔镜保守手术联合地诺孕素治疗子宫内膜异位症的疗效及生活质量研究[J]. 中国生育健康杂志, 2024, 35(5): 475-477. [Shen Y, Chen MH, Zhang XL. Study on the efficacy and quality of life of laparoscopic conservative surgery combined with dinorgestrel in the treatment of endometriosis[J]. Chinese Journal of Reproductive Health, 2024, 35(5): 475-477.] DOI: 10.3969/j.issn.1671-878X.2024.05.015.

7.方圆, 周红儿, 韩华. 前列腺素E2白细胞介素-1β及白细胞介素-18水平在子宫内膜异位症中的表达及意义[J]. 中国妇幼保健, 2024, 39(16): 3137-3140. [Fang Y, Zhou HE, Han H. Expression and significance of prostaglandin E2 interleukin-1β and interleukin-18 levels in endometriosis[J]. Maternal and Child Health Care of China, 2024, 39(16): 3137-3140.] DOI: 10.19829/j.zgfybj.issn.1001-4411.2024.16.034.

8.吴红琴, 冯亚玲, 顾浩, 等. C反应蛋白、糖类抗原125、糖类抗原19-9对卵巢子宫内膜异位囊肿和盆腔炎性包块的鉴别诊断价值[J]. 中国医药导报, 2024, 21(19):101-105. [Wu HQ, Feng YL, Gu H, et al. Differential diagnostic value of C-reactive protein, carbohydrate antigen 125, and carbohydrate antigen 19 -9 in ovarian endometriotic cyst and pelvic inflammatory mass[J]. China Medical Herald, 2024, 21(19):101-105.] DOI: 10.20047/j.issn1673-7210.2024.19.20.

9.陈儒新, 傅杨, 张嘉慧, 等. 子宫内膜异位症患者卵巢功能、炎症水平特征及与复发性流产的相关性研究[J]. 国际检验医学杂志, 2024, 45(11): 1392-1395. [Chen RX, Fu  Y, Zhang JH, et al. The characteristics of ovarian function and inflammation in patients with endometriosis and their correlation with recurrent abortion[J]. International Journal of Laboratory Medicine, 2024, 45(11): 1392-1395.] DOI: 10.3969/j.issn.1673-4130.2024.11.022.

10.中华中医药学会,赵瑞华,冷金花. 子宫内膜异位症中西医结合诊疗指南(2024年版)[J]. 中国实用妇科与产科杂志, 2024, 40(12): 1195-1203. [Zhonghua Chinese Medicine Society, Zhao RH, Leng JH. Guidelines for the integrated diagnosis and treatment of endometriosis in traditional Chinese and western medicine (2024 Edition)[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2024, 40(12): 1195-1203.] DOI: 10.19538/j.fk2024120112.

11.刘丽周, 黑海波, 闵玉玉, 等. 卵巢子宫内膜异位症患者腹腔镜保守手术后复发预测模型的建立及验证[J]. 宁夏医学杂志, 2024, 46(2): 113-116. [Liu LZ, Hei HB, Min YY, et al. Establishment and verification of prediction model for recurrent patients with ovarian endometriosis after laparoscopic conservative surgery[J]. Ningxia Medical Journal, 2024, 46(2): 113-116.] DOI: 10.13621/j.1001-5949.2024.02.0113.

12.韩莉莉. 穴位埋线联合坤泰胶囊辅助促性腺激素释放激素类似物治疗子宫内膜异位症的临床研究[J]. 数理医药学杂志, 2022, 35(9): 1408-1410. [Han LL. Clinical study on acupoint catgut embedding+kuntai capsule assisted gonadotropin releasing hormone analog in the treatment of endometriosis[J]. Journal of Mathematical Medicine, 2022, 35(9): 1408-1410.] DOI: 10.3969/j.issn.1004-4337.2022.09.047.

13.Scioscia M, Huscher CGS, Brusca F, et al. Preservation of the inferior mesenteric artery in laparoscopic nerve-sparing colorectal surgery for endometriosis[J]. Sci Rep, 2022, 12(1): 3146-3151. DOI: 10.1038/s41598-022-07237-w.

14.Jiang N, Xie H, Lin J, et al. Diagnosis and nursing intervention of gynecological ovarian endometriosis with magnetic resonance imaging under artificial intelligence algorithm[J]. Comput Intell Neurosci, 2022, 2022: 3123310-3123318. DOI: 10.1155/2022/3123310.

15.Vahid-Dastjerdi M, Hosseini R, Rodi H, et al. Comparison of the effectiveness of dienogest with medroxyprogesterone acetate in the treatment of pelvic pain and recurrence of endometriosis after laparoscopic surgery[J]. Arch Gynecol Obstet, 2023, 308(1): 149-155. DOI: 10.1007/s00404-022-06898-2.

16.Zhang J, Wang J, Zhang J, et al. Developing a predictive model for minimal or mild endometriosis as a clinical screening tool in infertile women: uterosacral tenderness as a key predictor[J]. J Minim Invasive Gynecol, 2024, 31(3): 227-236. DOI: 10.1016/j.jmig.2023.12.008.

17.Lycke M, Ulfenborg B, Malchau Lauesgaard J, et al. Consideration should be given to smoking, endometriosis, renal function (eGFR) and age when interpreting CA125 and HE4 in ovarian tumor diagnostics[J]. Clin Chem Lab Med, 2021, 59(12): 1954-1962. DOI: 10.1515/cclm-2021-0510.

18.Wang Y, Nicholes K, Shih IM. The origin and pathogenesis of endometriosis[J]. Annu Rev Pathol, 2020, 15(1): 71-95. DOI: 10.1146/annurev-pathmechdis-012419-032654.

19.Li J, Feng J, Li Z, et al. B cell lymphoma 6 promotes hepatocellular carcinoma progression by inhibiting tumor infiltrating CD4+ T cell cytotoxicity through ESM1[J]. NPJ Precis Oncol, 2024, 8(1): 139. DOI: 10.1038/s41698-024-00625-7.

20.Dang Y, Zhang S. Causal relationship between endometriosis and inflammatory bowel disease: a Mendelian randomization analyses[J]. Clin Transl Med, 2024, 14(1): e1496. DOI: 10.1002/ctm2.1496.

21.Koval S, Mysnychenko O V, Penkova M Y U. An increase in blood levels of vascular endothelial growth factor and highly sensitive C-reactive protein in patients with hypertension and obesity is associated with the left ventricular hypertrophy[J]. Eur J Prev Cardiol, 2021, 28(1): 139. DOI: 10.1093/eurjpc/zwab061.139.

22.Peng Y, Ma J, Lin J. Activation of the CXCL16/CXCR6 Axis by TNF-α contributes to ectopic endometrial stromal cells migration and invasion[J]. Reprod Sci, 2019, 26(3): 420-427. DOI: 10.1177/1933719118776797.