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子宫内膜异位症(内异症)是育龄期妇女常见的良性疾病之一,育龄期妇女的发病率为10%~15%,主要表现为骨盆疼痛、痛经及不孕等[1]。33%的女性不孕者患有内异症,因此内异症对不孕造成的影响不容小觑[2]。内异症为一种炎症性疾病,炎症因子可能成为诊断的潜在标志物。有研究[3]显示,在内异症病人的腹腔液和阴道分泌物中细菌内毒素的水平显著高于非内异症病人。内异症病人的异位组织和腹腔液中的巨噬细胞、白细胞介素和肿瘤坏死因子水平升高[4-6]。另外,内异症病人的血小板与淋巴细胞比值(PLR)和中性粒细胞与淋巴细胞比值(NLR)均有所升高[7-8]。内异症病人的血浆纤维蛋白原(FIB)水平升高,凝血酶时间(PT)和部分凝血酶原时间(APTT)缩短,提示内异症病人体内可能存在高凝状态。在本研究中我们主要检测内异症病人外周血中炎症因子、凝血因子和癌抗原125(CA125)的水平,探讨其在内异症发病中及诊断中的作用。现作报道。
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2组病人在年龄、体质量指数和流产次数方面差异均无统计学意义(P>0.05),在孕次和产次方面,内异症组均多于对照组,差异均有统计学意义(P < 0.01)(见表 1)。
分组 n 年龄/岁 体质指数/ (kg/m2) 孕次 产次 流产次数 内异症组 216 34(30, 40) 21.1(19.4, 24.6) 2(1, 2) 1(0, 1) 1(0, 2) 对照组 117 3(31, 39) 21.9(19.5, 24.0) 2(1, 3) 1(0, 2) 1(0, 1) Zc — 0.13 1.65 3.61 2.75 1.57 P — >0.05 >0.05 < 0.01 < 0.01 >0.05 表 1 内异症组与对照组临床特点的比较[M(P25, P75)]
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内异症组炎症因子检测指标PLR、NLR、D-D、CRP和血沉水平均高于对照组,凝血因子检测指标PT、TT和FIB时间均短于对照组,差异均有统计学意义(P < 0.01),2组间PLT水平和APTT差异均无统计学意义(P>0.05)(见表 2)。
分组 n PLT/(×109/L) NLR PLR D-D/(mg/L) CRP/(mg/L) 红细胞沉降率/ (mm/h) PT/s APTT/s TT/s FIB/(g/L) 内异症组 216 215(185, 273) 2.2(1.7, 3.2) 142(110, 178) 0.8(0.6, 2.1) 0.6(0.3, 1.2) 10(7, 14) 12.5(12.1, 13.4) 35.5(33.7, 38.1) 15.2(14.3, 15.9) 3.2(2.8, 3.7) 对照组 117 226(191, 267) 2.1(1.5, 2.8) 127(102, 167) 0.6(0.4, 1.3) 0.4(0.2, 0.8) 8(6, 12) 13.2(12.4, 13.6) 35.2(34.2, 38.3) 15.7(15.2, 16.3) 2.7(2.5, 3.1) Zc — 1.62 3.42 3.52 4.05 2.15 3.86 2.15 0.61 3.88 6.16 P — >0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 < 0.01 < 0.01 表 2 内异症组与对照组炎症因子及凝血因子的比较[M(P25, P75)]
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内异症组CA125的水平[47(31, 84)kU/L]高于对照组[13(10, 21)]kU/L,差异具有统计学意义(Zc=3.24,P < 0.01)。
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内异症组Ⅳ期与Ⅲ期病人比较,PLT和PLR水平较高,PT时间较短,FIB较高,差异均有统计学意义(P < 0.05~P < 0.01);2组NLR和D-D、APTT和TT的水平差异均无统计学意义(P>0.05)(见表 3)。
分组 n PLT/(×109/L) NLR PLR D-D/(mg/L) PT/s APTT/s TT/s FIB/(g/L) Ⅲ期 140 220(185, 274) 2.2(1.6, 3.4) 130(108, 165) 0.7(0.4, 1.7) 12.9(12.4, 13.6) 35.4(33.7, 38.2) 15.4(14.9, 15.8) 3.0(2.6, 3.4) Ⅳ期 76 247(190, 292) 2.5(1.8, 3.4) 157(112, 194) 1.1(0.6, 2.5) 12.6(12.1, 13.2) 35.2(33.0, 39.2) 15.4(15.0, 16.1) 3.3(2.8, 3.7) Zc — 2.42 1.26 3.2 1.04 2.15 0.87 0.31 3.15 P — < 0.05 >0.05 < 0.01 >0.05 < 0.05 >0.05 >0.05 < 0.01 表 3 内异症Ⅲ期和Ⅳ期病人的炎症因子和凝血因子的比较[M(P25, P75)]
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在Ⅲ、Ⅳ期内异症病人诊断中绘制ROC曲线,PLR、NLR、PT和TT的AUC值分别为0.514、0.542、0.523和0.562,考虑到其诊断价值较低,未予以进一步的统计。CA125、FIB单独及联合检测诊断Ⅲ、Ⅳ期内异症的AUC值为0.905、0.684和0.920,CA125单独检测的敏感度为81.8%,FIB单独检测的灵敏度为50.4%,联合检测的灵敏度为84.6%。
子宫内膜异位症病人炎症因子和凝血因子的水平变化及临床意义
Changes and clinical significance of the levels of inflammatory factors and coagulation factors in patients with endometriosis
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摘要:
目的检测子宫内膜异位症(内异症)病人外周血中炎症因子和凝血因子的水平,进一步探讨炎症因子和凝血因子在内异症中的作用及临床诊断价值。 方法选取经手术后确诊为Ⅲ期、Ⅳ期内异症的病人216例(内异症组),和病理学检测确诊为良性囊肿的病人117例(对照组)。比较2组病人的一般临床资料、外周血中炎症因子、凝血因子和癌抗原125(CA125)的水平。比较不同分期病人间的炎症因子和凝血因子的水平。受试者工作特征曲线评估CA125、纤维蛋白原水平(FIB)单独及联合检测对Ⅲ期、Ⅳ期内异症病人的诊断价值。 结果内异症组孕次和产次均多于对照组(P < 0.01)。内异症组中性粒细胞淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、D-二聚体(D-D)、C-反应蛋白(CRP)和红细胞沉降率均高于对照组,内异症组凝血酶原时间(PT)和凝血酶时间(TT)时间均短于对照组,FIB和CA125水平均高于对照组,差异均有统计学意义(P < 0.01)。Ⅳ期内异症组与Ⅲ期内异症组比较,血小板和PLR水平较高,PT时间较短,FIB较高,差异均有统计学意义(P < 0.05~P < 0.01),2组NLR和D-D、活化部分凝血酶原时间和TT的水平差异均无统计学差异(P>0.05)。CA125联合FIB检测诊断内异症的灵敏度为84.6%,CA125单独检测的灵敏度为81.9%,FIB单独检测的灵敏度为50.4%。 结论炎症因子和凝血因子在内异症组中表达异常,且与内异症的分期相关,CA125和FIB的联合检测可提高诊断内异症的灵敏度。 Abstract:ObjectiveTo detect the levels of inflammatory factors and coagulation factors in peripheral blood of patients with endometriosis, and further explore the role of inflammatory factors and coagulation factors in endometriosis and its clinical diagnostic value. MethodsA total of 216 patients diagnosed as stage Ⅲ and Ⅳ endometriosis after surgery and 117 patients with benign cysts diagnosed by pathology were divided into the endometriosis group and control group, respectively.The general clinical data, levels of inflammatory factors, coagulation factors and cancer antigen 125(CA125) in peripheral blood were compared between two groups.The levels of inflammatory and coagulation factors were compared among patients of different stages.The ROC curve was used to evaluate the diagnostic value of CA125 and fibrinogen level(FIB) alone or combined in patients with stage Ⅲ and Ⅳ. ResultsThe number of pregnancies and births in endometriosis group were higher than those in control group(P < 0.01).The neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR), D-dimer(D-D), C-reactive protein(CRP) and erythrocyte sedimentation rate in endometriosis group were higher than those in control group(P < 0.01).The prothrombin time(PT) and thrombin time(TT) in endometriosis group were shorter than those in control group(P < 0.01), and the levels of FIB and CA125 levels in endometriosis group were higher than those in control group(P < 0.01).Compared with stage Ⅲ group, the levels of PLT and PLR were higher, the PT time was shorter, and the FIB was higher in stage Ⅳ group(P < 0.05 to P < 0.01).The differences of the levels of NLR and D-D, APTT and TT between stage Ⅲ group and stage Ⅳ group were not statistically significant(P>0.05).In the diagnosis of endometriosis, the sensitivity of CA125 combined with FIB was 84.6%, the sensitivity of CA125 was 81.9%, the sensitivity of FIB was 50.4%. ConclusionsThe expression of inflammatory and coagulation factors is abnormal in the endometriosis group, and which is correlated with the stage of endometriosis.The combined detection of CA125 and FIB can improve the sensitivity of the diagnosis of endometriosis. -
Key words:
- endometriosis /
- inflammatory factor /
- coagulation factor /
- cancer antigen 125 /
- fibrinogen
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表 1 内异症组与对照组临床特点的比较[M(P25, P75)]
分组 n 年龄/岁 体质指数/ (kg/m2) 孕次 产次 流产次数 内异症组 216 34(30, 40) 21.1(19.4, 24.6) 2(1, 2) 1(0, 1) 1(0, 2) 对照组 117 3(31, 39) 21.9(19.5, 24.0) 2(1, 3) 1(0, 2) 1(0, 1) Zc — 0.13 1.65 3.61 2.75 1.57 P — >0.05 >0.05 < 0.01 < 0.01 >0.05 表 2 内异症组与对照组炎症因子及凝血因子的比较[M(P25, P75)]
分组 n PLT/(×109/L) NLR PLR D-D/(mg/L) CRP/(mg/L) 红细胞沉降率/ (mm/h) PT/s APTT/s TT/s FIB/(g/L) 内异症组 216 215(185, 273) 2.2(1.7, 3.2) 142(110, 178) 0.8(0.6, 2.1) 0.6(0.3, 1.2) 10(7, 14) 12.5(12.1, 13.4) 35.5(33.7, 38.1) 15.2(14.3, 15.9) 3.2(2.8, 3.7) 对照组 117 226(191, 267) 2.1(1.5, 2.8) 127(102, 167) 0.6(0.4, 1.3) 0.4(0.2, 0.8) 8(6, 12) 13.2(12.4, 13.6) 35.2(34.2, 38.3) 15.7(15.2, 16.3) 2.7(2.5, 3.1) Zc — 1.62 3.42 3.52 4.05 2.15 3.86 2.15 0.61 3.88 6.16 P — >0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 < 0.01 < 0.01 表 3 内异症Ⅲ期和Ⅳ期病人的炎症因子和凝血因子的比较[M(P25, P75)]
分组 n PLT/(×109/L) NLR PLR D-D/(mg/L) PT/s APTT/s TT/s FIB/(g/L) Ⅲ期 140 220(185, 274) 2.2(1.6, 3.4) 130(108, 165) 0.7(0.4, 1.7) 12.9(12.4, 13.6) 35.4(33.7, 38.2) 15.4(14.9, 15.8) 3.0(2.6, 3.4) Ⅳ期 76 247(190, 292) 2.5(1.8, 3.4) 157(112, 194) 1.1(0.6, 2.5) 12.6(12.1, 13.2) 35.2(33.0, 39.2) 15.4(15.0, 16.1) 3.3(2.8, 3.7) Zc — 2.42 1.26 3.2 1.04 2.15 0.87 0.31 3.15 P — < 0.05 >0.05 < 0.01 >0.05 < 0.05 >0.05 >0.05 < 0.01 -
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