腹腔积液中Relaxin、TGF-β_(1)水平与子宫内膜异位症盆腔粘连的相关性  

Relationship of relaxin and TGF-β_(1) in peritoneum fluid with pelvic adhesions in patients with ovarian endometriosis

作　　者：周慧娟 马振芳 ZHOU Hui-juan;MA Zhen-fang(Dept.of Obstetrics and Gynecology,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 201204,China)

机构地区：[1]同济大学附属第一妇婴保健院妇产科,上海201204

出　　处：《同济大学学报（医学版）》2021年第5期664-671,共8页Journal of Tongji University(Medical Science)

基　　金：上海市市级医疗卫生学科建设项目(2017ZZ02015)。

摘　　要：目的探讨腹腔积液中Relaxin、TGF-β_(1)水平与子宫内膜异位症(endometriosis,EMT)盆腔粘连的相关性。方法选取经手术治疗的卵巢子宫内膜异位囊肿患者185例作为EMT组,同期术后病理为非EMT患者135例作为对照(非EMT组)。EMT组根据术中盆腔粘连程度分为EMT-A组(无或仅有轻度盆腔粘连,EMT r-AFSⅠ~Ⅱ期,88例)和EMT-B组(中重度盆腔粘连,EMT r-AFSⅢ~Ⅳ期,97例)。采用ELISA及PCR分别检测腹腔积液及外周血各组Relaxin、TGF-β_(1)蛋白及mRNA的表达,并在体外观察Relaxin、TGF-β_(1)对EMT基质细胞增殖的影响。结果EMT组腹腔积液中TGF-β_(1)水平显著高于非EMT组,EMT-B组TGF-β_(1)水平显著高于EMT-A组(P<0.05);EMT组腹腔积液中Relaxin水平显著低于非EMT组,EMT-B组Relaxin水平显著低于EMT-A组(P<0.05)。EMT组治疗前Relaxin mRNA相对表达量显著低于治疗后1个月,而TGF-β_(1)mRNA相对表达量治疗前显著高于治疗后1个月(均P<0.05);治疗后1个月,EMT组及非EMT组Relaxin、TGF-β_(1)mRNA相对表达量差异均无统计学意义(P>0.05)。在鉴别EMT-A组及EMT-B组的判断中,TGF-β_(1)的曲线下面积为0.7779(95%CI:0.6973~0.8585),诊断界值为71.5 g/L;Relaxin的曲线下面积为0.7865(95%CI:0.7134~0.8596),诊断界值为19.0 g/L;Relaxin与TGF-β_(1)联合诊断的ROC曲线下面积为0.8505(95%CI:0.7833~0.9176)。Logistic回归分析显示,TGF-β_(1)为EMT盆腔粘连的独立危险因素,而Relaxin是保护因素(均P<0.05)。结论腹腔积液TGF-β_(1)及Relaxin水平与EMT患者盆腔粘连程度关系密切;两者联合对鉴别EMT患者盆腔粘连程度及预后有较好的效能。Objective To investigate the correlation of relaxin and TGF-β_(1) levels in peritoneum fluid with pelvic adhesion of ovarian endometriosis.Methods One hundred and eighty-five patients with ovarian endometriosis cyst(EMT group)and 135 patients without endometriosis(non-EMT group)were enrolled in the study.According to the degree of pelvic adhesion,the EMT group was further divided into group A(without or with mild pelvic adhesion,endometriosis r-AFS stageⅠ-Ⅱ,n=88)and group B(moderate and severe pelvic adhesion,endometriosis r-AFS stageⅢ-Ⅳ,n=97).The expression of relaxin and TGF-β_(1) protein and mRNA in peritoneum fluid and peripheral blood were detected with ELISA and RT-PCR,respectively.The effect of relaxin and TGF-β_(1) on the proliferation of eutopic endomentrium stromal cells was also studied.Results The expression of TGF-β_(1) in peritoneum fluid of EMT-B group was higher than that in EMT-A group,and the expression in EM group was higher than that in non-EMT group(all P<0.05).The expression of relaxin in peritoneum fluid of EMT-B group was significant lower than that in EMT-A group,while the expression in EMT group was significant lower than that in non-EMT group(all P<0.05).The relative expression levels of relaxin mRNA in serum were significant lower in EMT group before treatment than those after treatment;while the levels of TGF-β_(1) mRNA were significant higher in EMT group before treatment(P<0.05).One month after treatment there were no significant differences in relative expression levels of relaxin and TGF-β_(1)mRNA in serum between EMT group and non-EMT group(P>0.05).For the differential diagnosis between group EMT-A and EMT-B,the area under the ROC curve(AUC)of TGF-β_(1) was 0.7779(95%CI:0.6973-0.8585)and the cut-off value was 71.5 g/L;the AUC of relaxin was 0.7865(95%CI:0.7134-0.8596),and the diagnostic cut-off value was 19.0 g/L;the AUC of TGF-β_(1) combined with relaxin was 0.8505(95%CI:0.7833-0.9176).Logistic regression analysis showed that TGF-β_(1) was an independent risk fa

关 键 词：子宫内膜异位症 盆腔粘连 RELAXIN TGF-β_(1) 

分 类 号：R711.71[医药卫生—妇产科学]