Clinical Value of Body Mass Index and Waist-Hip Ratio in Clinicopathological Characteristics and Prognosis of Uterine Leiomyomata

Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2021, Article ID 8156288, 6 pages https://doi.org/10.1155/2021/8156288

Research Article Clinical Value of Body Mass Index and Waist-Hip Ratio in Clinicopathological Characteristics and Prognosis of Uterine Leiomyomata

Hanyi Pan ,1 Feiyong Qin,2 and Fengyun Deng3

1Department of Gynecology, Aﬃliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi 533000, China 2Department of Gynecology, (e People’s Hospital of Tianlin County, Baise, Guangxi 533000, China 3Department of Anesthesiology, (e People’s Hospital of Tiandong County, Baise, Guangxi 531500, China

Correspondence should be addressed to Hanyi Pan; [email protected]

Received 12 July 2021; Accepted 5 August 2021; Published 12 August 2021

Academic Editor: Songwen Tan

Copyright © 2021 Hanyi Pan et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective. To explore the relationship between body mass index (BMI) and waist-to-hip ratio (WHR) and clinicopathological characteristics and prognosis of uterine leiomyomata (UL). Methods. A retrospective analysis of the clinical data of 133 patients with UL admitted to our hospital from September 2018 to August 2019. According to the BMI standard, the patients were divided into the normal group (n � 32), the super-recombination group (n � 45), and the obesity group (n � 56). According to WHR, the patients were divided into the normal body group (n � 32) and the obesity body group (n � 101). +e prognosis of all patients with UL at 3 months postoperatively was evaluated. +e relationship between BMI patients and clinical characteristics in different groups was compared, and univariate analysis and multivariate logistic regression model were used to analyze the factors affecting the prognosis of UL patients. Results. +e proportion of UL patients in the overweight/obese group was higher than that of the normal group, the proportion of the obese body group was higher than that of the normal body group, and the proportion of the good prognosis group was higher than that of the poor prognosis group (P < 0.05). +e difference between the overweight/obese group and the normal group and the obese body group and the normal body group was irregular vaginal bleeding, the number of tumors, and the diameter of the lesion (P < 0.05), and the differences between the degenerations in the obese body group and the normal body group were statistically significant (P < 0.05). Multivariate analysis showed that BMI, WHR, surgical method, and tumor location were all independent risk factors that affected the prognosis of the surgery (P < 0.05). Conclusion. Elevated BMI and WHR can be accompanied by an increased risk of UL. Obesity is a risk factor for UL. Overweight/obese women are more clinically pathological than normal patients, and overweight/obese patients have worse surgical prognosis than normal patients. In order to reduce the prevalence of UL and improve the clinicopathological characteristics and prognosis of patients, clinically obese women should be instructed to use reasonable diet and exercise to control weight.

1. Introduction hypertension are all important predisposing factors of the disease [3]. Body mass index (BMI) and waist-to-hip ratio Uterine leiomyomata (UL) is mainly a benign tumor of (WHR) are important indicators for judging female obesity. smooth muscle hyperplasia, which occurs in the female Obesity is recognized as a major high-risk factor for chronic reproductive system of childbearing age. It is mainly diseases. In the female reproductive system, obesity also manifested by increased menstrual flow, pelvic mass, ab- aggravates the symptoms of pelvic organ prolapse and stress dominal pain, and infertility [1, 2]. At present, the cause of urinary incontinence and increases the risk of endometrial UL is still not fully understood, but as a hormone-dependent polyps and symptomatic uterine fibroids [4]. In recent years, tumor, estrogen is the main factor that promotes the growth the incidence of UL has increased year by year. Surgery is the of fibroids. At the same time, obesity, diabetes, and main treatment for UL, and its prognosis is the focus of 2 Evidence-Based Complementary and Alternative Medicine clinical attention [5–7]. +e prognosis of UL resection is WHR � waist circumference (cm)/hip circumference (cm) related to many factors such as the patient’s physique, was calculated. According to the WHR, patients were di- menstrual condition, tumor nature, and surgical method vided into 2 groups: WHR ≤0.88 was the normal body type [8, 9]. +e body of obese patients has been in a chronic low- group, and WHR >0.88 was the obesity body type group. All grade inflammatory state for a long time. +e inflammatory patients received conventional treatment such as anti-in- factors continue to stimulate the body to cause abnormal fection, promotion of incision healing, and correction of changes in the body, which affects the efficacy of surgery, is acid-base imbalance and electrolyte imbalance. +e prog- not conducive to the recovery of patients after surgery, and nosis of UL patients was evaluated by a combination of increases the incidence of complications [10]. In recent telephone and outpatient follow-up 3 months after surgery. years, the analysis of the relationship between overweight/ Follow-up patients received routine gynecological exami- obesity and the onset of uterine fibroids has been reported, nation and gynecological B-ultrasound. +e evaluation in- but the reports of independent research on the BMI, WHR, cludes recent complications, symptom relief, and tumor and clinicopathological characteristics of UL and the impact recurrence. on the prognosis of surgical patients are poorly understood. +is study aims to explore the relationship between BMI, WHR, and UL clinicopathological characteristics and their 2.5. Observation Index. +e patient’s preoperative BMI level impact on the prognosis of UL resection in order to provide and WHR level were recorded. +e relationship between the a reference for UL treatment. +e specific report is as BMI level, WHR level, and clinicopathological character- follows. istics such as irregular vaginal bleeding, multiple tumors, combined adenomyosis, tumor degeneration, tumor location, and clinicopathological characteristics of lesions 2. Materials and Methods ≥40 mm in diameter was analyzed. +e relationship between 2.1. Normal Information. +e clinical data of 133 UL pa- the BMI level, WHR level, surgical method, etc., and tients who were admitted to our hospital for surgical prognosis was analyzed. +e follow-up of all patients for 3 treatment from September 2018 to August 2019 were col- months after surgery was evaluated. Among them, patients lected and sorted out. +e patients were 35–57 years old, with improved clinical symptoms, no recent complications, average age was 46.18 ± 6.27 years, weight was 45–80 kg, and no tumor recurrence were defined as the good prognosis average weight was 61.22 ± 10.41 kg, height was 150–171 cm, group. Patients with no improvement in clinical symptoms, and average height was 165.24 ± 8.34 cm. 72 patients were recent complications, and tumor recurrence were defined as treated by laparoscopic UL resection, and 61 patients were the poor prognosis group. treated by open UL resection. +is study was approved by the ethics committee of our hospital, and all patients and 2.6.StatisticalMethods. SPSS 22.0 software was used for data their families signed an informed consent form. processing, the count data were expressed as the number of cases (%), and pairwise comparisons and multiple group 2 2.2. Inclusion Criteria. +e inclusion criteria were as follows: comparisons all used χ test. Multivariate analysis adopts the ① age: 30–65 years; ② obvious clinical manifestations, such multiple logistic regression model. P < 0.05 indicates that the as increased menstrual flow, prolonged menstrual period, difference is statistically significant. lower abdominal mass, lower abdomen pain, and compression symptoms, confirmed as UL through gynecological 3. Results examination and postoperative pathological examination. 3.1. BMI Score, WHR Score, and Prognosis Distribution of UL Patients. +e number of UL patients in the overweight/ 2.3. Exclusion Criteria. +e exclusion criteria were as fol- obesity group was higher than that in the normal group, and lows: ① with severe abnormalities of cardiopulmonary the difference was statistically significant (P < 0.05). +e function and liver and kidney functions; ② cancerous number of patients in the obesity body type group was transformation or other gynecological malignancies; ③ higher than that in the normal body type group, and the abnormal blood coagulation mechanism; ④ combined with difference was statistically significant (P < 0.05). +e good severe infectious diseases; ⑤ combined with mental illness. prognosis group was higher than the poor prognosis group, and the difference was statistically significant (P < 0.05), as shown in Table 1. 2.4. Research Method. Information about height, weight, waist circumference, hip circumference, and corresponding clinical signs of all patients at the time of admission was 3.2. Comparison of Clinicopathological Characteristics be- collected. BMI was used to evaluate the degree of systemic tween Different BMI and UL. +e incidences of irregular obesity in patients, BMI (kg/m2) � weight (kg)/height2 (m2). vaginal bleeding, multiple tumors, and lesion diameters According to the Chinese adult BMI standard, patients were ≥40 mm in the overweight/obesity group were higher than divided into 3 groups: BMI< 24.0 kg/m2 was the normal those in the normal group, and the differences were sta- group, 24.0 kg/m2≤BMI<28.0 kg/m2 was the overweight tistically significant (P < 0.05). +ere was no significant group, and BMI ≥28.0 kg/m2 was the obesity group. difference between the three groups of patients in Evidence-Based Complementary and Alternative Medicine 3

Table 1: BMI score, WHR score, and prognosis of UL patients In recent years, the incidence of female obesity and (n (%)). overweight has increased, and the most practical anthro- Group n Ratio (%) χ2 P pometric indicators for clinically estimating the degree of obesity are BMI and WHR [14, 15]. Estrogen is one of the BMI 9.767 0.008 Normal group 32 24.06 main factors in the occurrence and progression of UL. Overweight group 45 33.83a Estrogen acts on the uterus to accelerate the growth of Obesity group 56 42.11a tumors and even cause pathological changes in the endo- WHR 8.148 ≤0.001 metrium [16, 17]. Obesity promotes the formation of tumors Normal body type group 32 24.06 by causing disorders of blood lipid regulation and activation Obesity body type group 101 75.94b of inflammatory signaling pathways. At the same time, the Prognosis 9.364 ≤0.001 cytokines released by the surrounding adipose tissue of Poor prognosis group 19 14.29 obese women can cause the body to increase the secretion of Good prognosis group 114 85.71c estrogen and reduce the production of sex hormone-binding Compared with the normal group, aP < 0.05. Compared with the normal globulin in the liver, which leads to the increase of free body type group, bP < 0.05. Compared with the poor prognosis group, estrogen in surrounding blood and increases UL incidence cP < 0.05. through different pathophysiological changes [18, 19]. +e results of this study showed that the ratio of the overweight/ menopause, tumor degeneration, tumor location, and obesity group in UL patients was higher than that of the adenomyosis (P > 0.05), as shown in Table 2. normal group, and the ratio of the obesity group was higher than that of the normal group. It is speculated that the increase of BMI and WHR may be related to the onset of UL, 3.3. Comparison of Clinicopathological Characteristics be- and proper weight control can help prevent the occurrence tween Different WHR and UL. +e incidences of irregular of UL. +is study was grouped by BMI, and it was found that vaginal bleeding, multiple tumors, tumor degeneration, and the overweight/obesity group had a higher incidence of lesion diameter ≥40 mm in the obesity body type group were irregular vaginal bleeding, multiple tumors, and lesion di- higher than those in the normal body type group, and the ameter ≥40 mm compared with the normal group. Grouped differences were statistically significant (P < 0.05). +ere was by WHR, it was found that the incidence of irregular vaginal no significant difference between the two groups of patients bleeding, multiple tumors, tumor degeneration, and lesion in menopause, tumor location, and adenomyosis (P > 0.05), diameter ≥40 mm in the obesity body type group was higher as shown in Table 3. than that in the normal body type group. +e results show that regardless of the type of obesity, obesity is accompanied by an increase in peripheral adipose tissue, thereby in- 3.4. Analysis of Single Factors Affecting the Prognosis of UL creasing the risk of UL, and the clinicopathological char- Patients. +e difference between the good prognosis group acteristics are more obvious than those of normal weight and the poor prognosis group in BMI, WHR, surgical patients. methods, tumor number, and tumor location was statisti- +e current treatment for UL includes surgical therapy cally significant (P < 0.05). +ere was no significant differ- and drug therapy. Since the affected population is mostly ence between the good prognosis group and the poor females of childbearing age who have fertility requirements, prognosis group of patients in lesion diameter and meno- UL resection which can remove the lesion and preserve the pause (P > 0.05), as shown in Table 4. uterus is currently the main treatment for UL [20, 21]. Although UL resection can effectively achieve the thera- 3.5. Analysis of Multiple Factors Affecting the Prognosis of UL peutic effect, it will cause certain trauma to the body, and the Patients. Multivariate logistic analysis showed that BMI function of various systems of the body will be imbalanced, (P � 0.048), WHR (P � 0.047), surgical methods which will affect the prognosis of patients [22, 23]. +e (P � 0.019), and tumor location (P � 0.038) were all inde- prognosis of UL resection mainly considers the healing of pendent risk factors affecting the prognosis of surgery the surgical incision and tumor recurrence. In obesity pa- (P < 0.05), as shown in Tables 5 and 6. tients, the sutures of the surgical incision are easy to fall off because of the abdomen adipose tissue, and the incision is 4. Discussion not easy to heal because of the poor blood circulation of the abdominal adipose tissue [24]. At the same time, obesity UL is one of the most common benign tumors of the re- patients often have abnormal blood lipid metabolism, and productive system in women, and its pathological features surgical incisions are susceptible to infection, which affects are mainly uterine smooth muscle hyperplasia [11]. Clinical the prognosis of patients [25, 26]. +e results of this study manifestations such as menstrual disorders, increased show that there are significant differences in BMI, WHR, menstrual flow, abdominal pain, and compression of ad- surgical methods, tumor number, and tumor location be- jacent organs in UL patients are mostly caused by prolif- tween the good prognosis group and the poor prognosis erating tumors [12]. At present, the specific causes of UL are group. After multivariate logistic analysis, BMI, WHR, not completely clear. Age, bad living habits, obesity, and surgical methods, and tumor location all affect the prognosis gynecological inflammation are all risk factors for UL [13]. risk of the UL factor. +e results show that the surgical 4 Evidence-Based Complementary and Alternative Medicine

Table 2: Comparison of clinicopathological characteristics between diﬀerent BMI and UL (n (%)). Clinicopathological characteristics n Normal group (n � 32) Overweight group (n � 45) Obesity group (n � 56) χ2 P Menopause 0.290 0.865 Yes 28 6 (18.75%) 9 (20.00%) 13 (23.21%) No 105 26 (81.25%) 36 (80.00%) 43 (76.79%) Irregular vaginal bleeding 8.703 0.013 Yes 108 21 (65.63%) 36 (80.00%) 51 (91.07%) No 25 11 (34.38%) 9 (20.00%) 5 (8.93%) Number of tumors 6.491 0.039 Single shot 70 22 (68.75%) 25 (55.56%) 23 (41.07%) Multiple shots 63 10 (31.25%) 20 (44.44%) 33 (58.93%) Tumor degeneration 1.101 0.577 Yes 24 4 (12.50%) 8 (17.78%) 12 (21.43%) No 109 28 (87.50%) 37 (82.22%) 44 (78.57%) Tumor location 1.675 0.433 Muscle wall 102 25 (78.13%) 37 (82.22%) 40 (71.43%) Subserosal 31 7 (21.88%) 8 (17.78%) 16 (28.57%) With adenomyosis 0.263 0.877 Yes 19 4 (12.50%) 6 (13.33%) 9 (16.07%) No 114 28 (87.50%) 39 (86.67%) 47 (83.93%) Lesion diameter 7.560 0.023 ≥40 mm 81 13 (40.63%) 29 (64.44%) 39 (69.64%) <40 mm 52 19 (59.38%) 16 (35.56%) 17 (30.36%)

Table 3: Comparison of clinicopathological characteristics between diﬀerent WHR and UL (n (%)). Clinicopathological characteristics n Normal body type group (n � 32) Obesity body type group (n � 101) χ2 P Menopause 1.268 0.260 Yes 28 9 (28.13%) 19 (18.81%) No 105 23 (71.88%) 82 (81.19%) Irregular vaginal bleeding 6.700 0.010 Yes 108 21 (65.63%) 87 (86.14%) No 25 11 (34.38%) 14 (13.86%) Number of tumors 8.457 0.004 Single shot 70 24 (75.00%) 46 (45.54%) Multiple shots 63 8 (25.00%) 55 (54.46%) Tumor degeneration 7.598 0.006 Yes 24 11 (34.38%) 13 (12.87%) No 109 21 (65.63%) 88 (87.13%) Tumor location 0.490 0.484 Muscle wall 102 26 (81.25%) 76 (75.25%) Subserosal 31 6 (18.75%) 25 (24.75%) With adenomyosis 1.982 0.159 Yes 19 7 (21.88%) 12 (11.88%) No 114 25 (78.13%) 89 (88.12%) Lesion diameter 12.453 ≤0.001 ≥40 mm 81 11 (34.38%) 70 (69.31%) <40 mm 52 21 (65.63%) 31 (30.69%) prognosis of UL patients can be aﬀected by many factors, obvious clinicopathological characteristics than normal and patients with overweight/obesity, open surgery, and patients and have worse surgical prognosis than normal tumors located between the muscle walls are more likely to patients. In order to reduce the prevalence of UL and im- have a poor prognosis. prove the clinical and pathological characteristics of patients In summary, elevated BMI and WHR can be accom- and the prognosis of surgery, obesity women should be panied by an increased risk of UL. Obesity is a risk factor for clinically instructed to eat and exercise appropriately to the onset of UL. Overweight/obesity women have more control their weight. Evidence-Based Complementary and Alternative Medicine 5

Table 4: Univariate analysis of the prognosis of UL patients (n (%)). Factors n Good prognosis group (n � 114) Poor prognosis group (n � 19) χ2 P BMI 6.404 0.041 Normal 32 30 (26.32%) 2 (10.53%) Overweight 45 41 (35.96%) 4 (21.05%) Obesity 56 43 (37.72%) 13 (68.42%) WHR 4.287 0.038 Normal body type 32 31 (27.19%) 1 (5.26%) Obesity body type 101 83 (72.81%) 18 (94.74%) Surgical methods 13.127 ≤0.001 Laparoscopy 72 64 (60.53%) 8 (15.79%) Open abdomen 61 50 (39.47%) 11 (84.21%) Number of tumors 16.361 ≤0.001 Single shot 70 69 (60.53%) 2 (410.53%) Multiple shots 63 45 (39.47%) 17 (89.47%) Tumor location 4.038 0.044 Muscle wall 102 84 (73.68%) 18 (94.74%) Subserosal 31 30 (26.32%) 1 (5.26%) Lesion diameter 1.705 0.192 ≥40 mm 81 72 (63.16%) 9 (47.37%) <40 mm 52 42 (36.84%) 10 (52.63%) Menopause 0.369 0.543 Yes 28 23 (21.93%) 3 (15.79%) No 105 91 (78.07%) 16 (84.21%)

Table 5: Assignment for multivariate analysis of factors. Factors Variables Assignment BMI X1 Normal � 0, overweight � 1, obesity � 2 WHR X2 Normal body type � 0, obesity body type � 1 Surgical methods X3 Laparoscopy � 0, open abdomen � 1 Number of tumors X4 Single shot � 0, multiple shots � 1 Tumor location X5 Muscle wall � 0, subserosal � 1

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