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中华妇幼临床医学杂志(电子版) ›› 2026, Vol. 22 ›› Issue (02) : 140 -147. doi: 10.3877/cma.j.issn.1673-5250.2026.02.006

论著

子宫内膜息肉患者外周血环状RNA ATRNL1与卵泡抑素表达水平及其对宫腔镜下电切术后复发的预测价值
陈伟1,2, 方杰3,†()   
  1. 1江苏大学，镇江　212013
    2丹阳市人民医院妇产科，丹阳　212300
    3江苏大学附属医院妇科，镇江　212000
  • 收稿日期:2025-03-07 修回日期:2025-12-01 出版日期:2026-04-01
  • 通信作者: 方杰

Expression levels of peripheral blood circular RNA ATRNL1 and follistatin in patients with endometrial polyp and their predictive value for recurrence after hysteroscopic resection

Wei Chen1,2, Jie Fang3,†()   

  1. 1Jiangsu University, Zhenjiang 212013, Jiangsu Province, China
    2Department of Obstetrics and Gynecology, The People′s Hospital of Danyang, Danyang 212300, Jiangsu Province, China
    3Department of Gynecology, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
  • Received:2025-03-07 Revised:2025-12-01 Published:2026-04-01
  • Corresponding author: Jie Fang
  • Supported by:
    Jiangsu Provincial Science and Technology Program(BK20210038)
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引用本文：

陈伟, 方杰. 子宫内膜息肉患者外周血环状RNA ATRNL1与卵泡抑素表达水平及其对宫腔镜下电切术后复发的预测价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2026, 22(02): 140-147.

Wei Chen, Jie Fang. Expression levels of peripheral blood circular RNA ATRNL1 and follistatin in patients with endometrial polyp and their predictive value for recurrence after hysteroscopic resection[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2026, 22(02): 140-147.

目的

探讨子宫内膜息肉(EP)患者外周血环状RNA(circRNA)ATRNL1与卵泡抑素(FST)表达水平及其对宫腔镜下EP电切术后(本研究将其简称为术后)6个月内复发的预测价值。

方法

选择2024年1至4月于丹阳市人民医院接受宫腔镜下电切术治疗的85例EP患者为研究对象，术后均对其随访6个月。采用回顾性分析方法，根据患者术后6个月内EP是否复发，将其分为复发组(n＝12)和未复发组(n＝73)。采用t检验及χ2检验，对2组患者一般临床资料、血清circATRNL1及FST水平进行组间比较，并对术前与术后6个月血清促卵泡激素(FSH)、雌二醇及黄体生成素(LH)水平，子宫内膜组织转化生长因子(TGF)-β及血管内皮生长因子(VEGF)相对表达量，以及子宫内膜厚度进行组间及组内比较。采用多因素非条件logistic回归分析法，对影响EP患者术后复发的独立危险因素进行分析；采用受试者工作特征(ROC)曲线评估血清circATRNL1、FST水平单独及二者联合，对EP患者术后EP复发的预测价值。本研究经丹阳市人民医院医学伦理委员会批准(审批文号：20250430)。所有患者对诊治知情同意。

结果

①复发组EP患者血清circATRNL1及FST水平，均高于未复发组，并且差异均有统计学意义(P<0.05)。②组间比较结果显示，术后6个月，复发组EP患者血清FSH、雌二醇及LH水平，子宫内膜组织TGF-β相对表达量，以及子宫内膜厚度，均高于未复发组，并且差异均有统计学意义(P<0.05)；组内比较结果显示，对于复发组或未复发组，均显示术后6个月上述5项指标水平及子宫内膜组织VEGF相对表达量，均低于术前，并且差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析显示，EP患者血清circATRNL1水平升高(OR＝4.080，95%CI：1.745~9.539，P＝0.005)，血清FST水平升高(OR＝4.536，95%CI：1.939~10.605，P＝0.004)，血清FSH水平升高(OR＝4.563，95%CI：1.952~10.669，P＝0.006)，血清雌二醇水平升高(OR＝5.028，95%CI：2.150~11.756，P＝0.006)，血清LH水平升高(OR＝4.604，95%CI：1.969~10.765，P＝0.003)，子宫内膜组织TGF-β相对表达量增高(OR＝4.865，95%CI：2.081~11.374，P＝0.002)，子宫内膜厚度增加(OR＝4.914，95%CI：2.101~11.488，P＝0.007)，均为影响EP患者宫腔镜下电切术后6个月内复发的独立危险因素。④ROC曲线分析结果显示，血清circATRNL1、FST水平单独及二者联合，对于预测EP患者宫腔镜下电切术后6个月内复发的敏感度分别为75.0%、72.2%、75.0%，特异度分别为76.7%、64.4%、84.9%，曲线下面积(AUC)分别为0.819(95%CI：0.738~0.899)，0.724(95%CI：0.615~0.833)，0.842(95%CI：0.759~0.925)。

结论

外周血circATRNL1和FST水平异常升高，与EP发展有关，对EP患者宫腔镜下电切术后6个月内复发具有一定预测价值。

关键词: 子宫内膜增生, RNA,环状, 卵泡抑素, ROC曲线, 复发, 危险因素, 女(雌)性
Objective

To investigate the expression levels of circular RNA (circRNA) ATRNL1 and follistatin (FST) in peripheral blood of patients with endometrial polyp (EP), and to evaluate their ability to predict recurrence within 6 months after hysteroscopic electrosurgical resection.

Methods

A total of 85 patients with EP who underwent hysteroscopic resection at the People′s Hospital of Danyang from January to April in 2024 were enrolled and followed up for 6 months postoperatively. A retrospective analysis was conducted. According to whether the patients experienced a recurrence of EP within 6 months after surgery, they were divided into recurrence group (n=12) and non-recurrence group (n=73). The t test and chi-square test were applied to compare the general clinical data and serum levels of circATRNL1 and FST between two groups. Additionally, serum follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), relative expression levels of transforming growth factor (TGF)-β and vascular endothelial growth factor (VEGF) in endometrial tissue, as well as endometrial thickness before and 6 months after surgery, were compared inter-group and intra-group. Multivariate unconditional logistic regression analysis was conducted to identify independent risk factors for postoperative recurrence. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of serum circATRNL1 and FST individually and in combination. This study was approved by the Ethics Committee of the People′s Hospital of Danyang (Approval No. 20250430), and informed consent was obtained from all participants.

Results

① Serum circATRNL1 and FST levels of EP patients in recurrence group were higher than those in non-recurrence group, and the differences were statistically significant (P<0.05). ② Inter-group comparison showed that at 6 months after surgery, the serum levels of FSH, estradiol, and LH, relative expression level of TGF-β in endometrial tissue, and endometrial thickness of EP patients in recurrence group were higher or thicker than those in non-recurrence group, and the differences were statistically significant (P<0.05). Intra-group comparison showed that, in both groups, these 5 parameters above as well as relative expression level of VEGF in endometrial tissue at 6 months after surgery were lower than those before surgery, and the differences were statistically significant (P<0.05). ③ Multivariate unconditional logistic regression analysis demonstrated that elevated serum circATRNL1 level (OR=4.080, 95%CI: 1.745-9.539, P=0.005), elevated serum FST level (OR=4.536, 95%CI: 1.939-10.605, P=0.004), elevated serum FSH level (OR=4.563, 95%CI: 1.952-10.669, P=0.006), elevated serum estradiol level (OR=5.028, 95%CI: 2.150-11.756, P=0.006), elevated serum LH level (OR=4.604, 95%CI: 1.969-10.765, P=0.003), higher expression level of TGF-β in endometrial tissue (OR=4.865, 95%CI: 2.081-11.374, P=0.002), and greater endometrial thickness (OR=4.914, 95%CI: 2.101-11.488, P=0.007) were all independent risk factors for EP recurrence within 6 months after surgery. ④ ROC curve analysis showed that the sensitivity of serum circATRNL1 level, serum FST level, and their combination in predicting EP recurrence within 6 months after hysteroscopic resection were 75.0%, 72.2%, and 75.0%, respectively, while the specificity values were 76.7%, 64.4%, and 84.9%, respectively. The corresponding area under the curve (AUC) were 0.819 (95%CI: 0.738-0.899), 0.724 (95%CI: 0.615-0.833), and 0.842 (95%CI: 0.759-0.925), respectively.

Conclusions

Abnormally elevated levels of circATRNL1 and FST in peripheral blood are associated with the progression of EP, and demonstrate potential value in predicting EP recurrence within 6 months after hysteroscopic resection.

Key words: Endometrial hyperplasia, RNA, circular, Follistatin, ROC curve, Recurrence, Risk factors, Female
表1 2组EP患者一般临床资料及术前血清circATRNL1、FST水平比较
组别 例数 年龄(岁，±s) 病程(月，±s) 息肉最大径(mm，±s) 息肉为单发[例数(%)] 剖宫产术分娩史[例数(%)] 术前血清circATRNL1相对表达量(±s) 术前血清FST(μg/L，±s)
复发组 12 32.1±4.6 13.1±2.5 16.1±2.8 5(41.7) 9(75.0) 2.4±0.4 3.7±0.5
未复发组 73 33.2±4.1 12.8±2.1 14.9±3.0 33(45.2) 48(65.8) 1.3±0.3 2.0±0.4
统计量   t＝0.86 t＝0.37 t＝1.22 χ2＝0.05 χ2＝0.40 t＝11.09 t＝13.74
P值   0.391 0.710 0.225 0.819 0.528 <0.001 <0.001
表2 2组EP患者6项指标术前及术后6个月水平的组间及组内比较(±s)
组别 例数 血清FSH(IU/L) 血清雌二醇(pg/mL)
术前 术后6个月 t值 P值 术前 术后6个月 t值 P值
复发组 12 7.4±1.6 5.4±1.2 3.56 0.005 164.3±26.3 105.0±12.4 6.99 <0.001
未复发组 73 7.3±1.5 4.2±1.2 13.61 <0.001 161.1±23.7 92.0±12.4 21.61 <0.001
t值   0.15 3.18     0.42 3.35    
P值   0.885 0.002     0.675 0.001    
组别 例数 血清LH(IU/L) 子宫内膜组织TGF-β相对表达量
术前 术后6个月 t值 P值 术前 术后6个月 t值 P值
复发组 12 6.9±1.3 5.7±2.0 3.51 0.010 139.1±26.5 118.5±19.1 2.57 0.043
未复发组 73 7.1±1.5 4.0±1.6 12.31 <0.001 138.4±25.7 104.2±18.7 8.82 <0.001
t值   0.47 3.22     0.08 2.44    
P值   0.639 0.002     0.938 0.018    
组别 例数 子宫内膜组织VEGF相对表达量 子宫内膜厚度(mm)
术前 术后6个月 t值 P值 术前 术后6个月 t值 P值
复发组 12 137.6±19.3 106.9±20.6 3.67 0.004 16.6±2.5 9.5±2.2 7.26 <0.001
未复发组 73 135.5±20.1 95.9±21.9 11.02 <0.001 16.0±2.1 8.3±1.7 24.13 <0.001
t值   0.34 1.62     0.83 2.22    
P值   0.739 0.108     0.407 0.029    
表3 影响EP患者宫腔镜下电切术后6个月内复发的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
血清circATRNL1水平 1.406 0.672 4.378 0.005 4.080 1.745~9.539
血清FST水平 1.512 0.693 4.760 0.004 4.536 1.939~10.605
血清FSH水平 1.514 0.754 4.053 0.006 4.563 1.952~10.669
血清雌二醇水平 1.615 0.802 4.055 0.006 5.028 2.150~11.756
血清LH水平 1.527 0.683 4.998 0.003 4.604 1.969~10.765
子宫内膜组织TGF-β相对表达量 1.582 0.693 5.211 0.002 4.865 2.081~11.374
子宫内膜厚度 1.592 0.795 4.010 0.007 4.914 2.101~11.488
常数项 －1.787 1.259 2.015 0.156 － －
图1 血清circATRNL1、FST水平单独及联合预测EP患者宫腔镜下电切术后6个月内复发的ROC曲线注：circATRNL1为环状RNA ATRNL1，FST为卵泡抑素，EP为子宫内膜息肉，ROC曲线为受试者工作特征曲线
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