新疆医科大学学报

目的 研究生育期女性发生子宫内膜息肉(Endometrial polyps, EP)的影响因素，探究EP患者血清中孕激素受体(Progesterone receptor, PR)表达水平与免疫炎症指数的相关性。方法 以2021年12月-2023年12月间在太原钢铁(集团)有限公司总医院妇产科行宫腔镜下子宫内膜活检的201例生育期女性为研究对象。根据患者是否发生EP分为EP组(130例)和非EP组(71例)。比较2组临床资料、血清中PR表达水平及系统性免疫炎症指数(Systemic immune-inflammation index, SⅡ)的差异。将EP组患者根据宫腔镜手术中的息肉数量分为多发EP组(62例)和单发EP组(68例),比较2组一般资料；采用二元Logistic回归分析生育期女性发生EP的独立影响因素，采用亚组分层分析血清中PR表达水平与SⅡ对生育期女性发生EP的相关性。采用局部加权回归散点平滑(Lowess)曲线拟合PR与SⅡ的关系，采用工作特征曲线(Receiver operating characteristic,ROC)分析血清PR水平和SⅡ对生育期女性发生EP的预测效能。结果 EP组与非EP组比较，年龄、产次、子宫腺肌症、高血压、中性粒细胞(NEUT)、淋巴细胞(LYM)、SⅡ、雌激素(ER)、孕激素(PR)差异有统计学意义(P<0.05);多发EP组与单发EP组比较，PR、雌激素受体(Estrogen receptor, ER)水平、EP数量以及SⅡ差异有统计学意义(P<0.05)。多因素Logistic回归分析显示，年龄、有子宫腺肌症、SⅡ是生育期女性发生EP的危险因子，PR是发生EP的保护因子(P<0.05)。森林图交互作用分析显示，年龄和子宫腺肌症对SⅡ与生育期EP的相关性没有交互影响(P_交互>0.05),PR水平对SⅡ与生育期EP的相关性存在交互作用(P_交互<0.05)。Lowess曲线拟合分析显示，PR与EP数量呈负相关；SⅡ与EP数量呈正相关(P<0.05)。ROC曲线分析显示，PR和SⅡ对生育期子宫内膜息肉的预测效能均较好，两者联合使用预测效能最佳(P<0.05),AUC值为0.91。结论 年龄、有子宫腺肌症、SⅡ是生育期是发生EP的独立危险因素，PR是发生EP的保护因素，对生育期女性发生EP具有较好的预测效能。PR与SⅡ共同影响生育期EP的增殖，为EP的临床诊断与治疗提供了参考依据。

Objective To study the influencing factors of endometrial polyps(EP) in women of childbearing age, and further to explore the correlation between the expression level of progesterone receptor(PR) in the serum of such patients and the immune inflammatory index. Methods A total of 201 women of childbearing age who underwent hysteroscopic endometrial biopsy in the hospital from December 2021 to December 2023 were selected as research subjects. According to whether the patients were diagnosed with EP, the patients were divided into EP group(130 cases) and non-EP group(71 cases). The differences in clinical data, the expression level of PR in serum and SⅡ were compared and analyzed. The patients in EP group were divided into multiple EP group(62 cases) and single EP group(68 cases) based on the number of polyps during hysteroscopic surgery, and the general data of the 2 groups of the patients were compared. Binary Logistic regression was used to analyze the independent influencing factors of EP in women of childbearing age, and subgroup stratification was used to analyze the correlation between the expression level of PR in serum and SⅡ on the occurrence of EP in women of childbearing age. The relationship between PR and SⅡ was fitted using the Lowess curve, and the predictive efficacy of serum PR levels and SⅡ for the occurrence of EP in women of childbearing age was analyzed by using the receiver operating characteristic(ROC) curve. Results A comparative analysis of the patients in the EP group and the non-EP group revealed that there were statistically significant differences in age, frequency of birth, adenomyosis, hypertension, NEUT, LYM, SⅡ, ER and PR(P<0.05). There were statistically significant differences in PR, ER levels, the number of eps and SⅡ between multiple EP group and single EP group(P<0.05). Multivariate Logistic regression analysis showed that age, presence of adenomyosis and SⅡ were risk factors for the occurrence of EP, while PR was a protective factor for EP(P<0.05). Forest plot interaction analysis showed that age and the presence of adenomyosis had no interaction effect on the correlation between SⅡ and EP during the reproductive period(P_interaction>0.05), while PR level had a significant interaction effect on the correlation between SⅡ and EP during the reproductive period(P_interaction<0.05). Lowess analysis showed that PR was negatively correlated with the number of eps. The quantity of SⅡ was positively correlated with that of EP(P<0.05). ROC curve analysis showed that both PR and SⅡ had good predictive efficacy for endometrial polyps during the reproductive period. The combined use of the 2 had the best predictive efficacy, with an AUC value of 0.91. Conclusion Age, presence of adenomyosis and SⅡ are independent risk factors for the occurrence of EP. PR is a protective factor for the occurrence of EP and has a good predictive efficacy for the occurrence of EP in women of childbearing age. PR and SⅡ jointly affect the proliferation of EP during the reproductive period, providing a new reference basis for the clinical diagnosis and treatment of EP.