Primary Exploration Of The Clinical Value Of Neutrophil-To-Lymphocyte Ratio In Endometriosis

Objective To explore the clinical value of neutrophil-to-lymphocyte ratio (NLR) in endometriosis (EM).Methods Fifty-one confirmed cases of EM at First Affiliated Hospitalof Guangxi Medical University from January 2000 to December 2009 were reviewed. Their cases were confirmed pathologically either after conservative operations, i.e., reserving fertility, or semi conservative operations reserving ovarian functions. According to the r-AFS system formulated by the American Fertility Society (AFS), among those cases,29 were minimal-to-mild endometriosis patients (stagesâ… andâ…¡); 30 cases belonged to moderate stage (stagesâ…¢andâ…£); 61 cases were diagnosed with benign ovarian tumors in which,45 cases got dermoid cyst,13 cases serous cystadenomas and 3 cases mucinous cystadenomas; and 64 healthy cases going through all the health checks in this period. Before operations, the blood routines and CA125 of all the patients were recorded; the sensitivity and specificity of different white blood cell (WBC) counts, neutrophil-to-lymphocyte ratio, serum CA125 were evaluated according to the receiver-operating characteristic curves (ROC) analysis. And conducting the correlations of combined markers (either NLR or serum CA125 is masccline) and the severity of endometriosis, and evaluating the value of NLR in pathogenesis of EM.Results 1. The level of NLR in endometriosis was obviously higher than those of benign ovarian tumors group and control group(P< 0.001), and there was no obvious difference between the latter two groups in terms of statistics (P=0.202). There were no significantly statistical differences in NLR in minimal-to-mild endometriosis group and the moderate-to-severe one (P=0.757). 2. The level of CA125 in endometriosis was obviously higher than those of benign ovarian tumors group and control group (P< 0.001), and those latter two groups showed no sign of statistical differences(P=0.457). The level of CA125 in minimal-to-mild endometriosis group wassignificantly lower than that of the moderate-to-severe group (P=0.001).3.When the diagnosis cutoff value of endometriosis by NLR was 1.6, then its sensitivity was 88.1% and specificity was 64.8%; when the diagnosiscutoff value of endometriosis by CA125 was 35IU/ml, sensitivity stood at 47.5% and the specificity 100% respectively, the sensitivity of the combined marker was 91.5% and the specificity was 64.8% respectively. Among NLR,CA125,combined marker, the combined marker has the highest sensitivity, NLR is following, and their sensitivities are obvious higher than the sensitivity of CA125 (the former x2=10.61, P<0.01; the latter x2=9.2, P<0.05). But the specificity of CA125 is higher than NLR and the combined marker, there are significantly statistical differences among them (x 2=21.35, P<0.01). NLR and combined marker showed no sign of statistical differences (x2=0.02, P>0.05).4. The positive rate of NLR in minimal-to-mild endometriosis group was 89.7%(26/29), and the figure of CA125 stood at 31% (9/29), so there was an obvious difference between their positive rates(x 2=20.82, P< 0.01), and combined markers had 27 (93.1%)positive cases which had significantly statistical differences with positive rates of CA12s(x2=23.73, p < 0.01), but did not have any statistical differences with NLR(x2=0.22, p> 0.017).5. In the moderate-to-severe group, the positive rate of NLR was 86.7% (26/30), positive rate of CA125 was 63.3%(19/30), and positive rate of combined marker was 90%(27/30); therefore there was no obvious difference among those three groups in statistics (P> 0.017).6. Among those groups of different stages, there were no significantly statistical differences in positive rates of NLR (P=0.723), either were combined markers (P=0.669); However, the statistical differences in positive rates of CA125 were quite significant (P=0.026).7. Conducting relative analysis of NLR, CA125, combined markers and the severity of endometriosis, no obvious correlation between NLR, combined markers and stages of the disease were observed (P>0.05), but there was significant correlation between CA125 and stages of the disease (r=0.999, P=0.001).Conclusion The determination of NLR may be a convenient marker in the diagnosis of endometriosis, especially in the diagnosis of minimal-to-mild endometriosis, it may bear more value. Meanwhile, this study also indicates that abnormal inflammatory reaction and immunodeficiency are features of patients with endometriosis.