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  • 周慧娟,马振芳.腹腔积液中Relaxin、TGF-β1水平与子宫内膜异位症盆腔粘连的相关性[J].同济大学学报(医学版),2021,42(5):664-671.    [点击复制]
  • ZHOU Hui-juan,MA Zhen-fang.Relationship of relaxin and TGF-β1 in peritoneum fluid with pelvic adhesions in patients with ovarian endometriosis[J].同济大学学报(医学版),2021,42(5):664-671.   [点击复制]
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腹腔积液中Relaxin、TGF-β1水平与子宫内膜异位症盆腔粘连的相关性
周慧娟,马振芳
0
(同济大学附属第一妇婴保健院妇产科,上海201204)
摘要:
目的探讨腹腔积液中Relaxin、TGF-β1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-AFS Ⅰ~Ⅱ期,88例)和EMT-B组(中重度盆腔粘连,EMT r-AFS Ⅲ~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-β1蛋白及mRNA的表达,并在体外观察Relaxin、TGF-β1对EMT基质细胞增殖的影响。结果EMT组腹腔积液中TGF-β1水平显著高于非EMT组,EMT-B组TGF-β1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-β1 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-β1 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-β1的曲线下面积为0.777 9(95%CI: 0.697 3~0.858 5),诊断界值为71.5 g/L;Relaxin的曲线下面积为0.786 5(95%CI: 0.713 4~0.859 6),诊断界值为19.0 g/L;Relaxin与TGF-β1联合诊断的ROC曲线下面积为0.850 5(95%CI: 0.783 3~0.917 6)。Logistic回归分析显示,TGF-β1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-β1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。
关键词:  子宫内膜异位症  盆腔粘连  Relaxin  TGF-β1
DOI:10.12289/j.issn.1008-0392.21139
投稿时间:2021-04-09
基金项目:上海市市级医疗卫生学科建设项目(2017ZZ02015)
Relationship of relaxin and TGF-β1 in peritoneum fluid with pelvic adhesions in patients with ovarian endometriosis
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)
Abstract:
ObjectiveTo investigate the correlation of relaxin and TGF-β1 levels in peritoneum fluid with pelvic adhesion of ovarian endometriosis. MethodsOne 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 stage Ⅰ-Ⅱ, n=88) and group B(moderate and severe pelvic adhesion, endometriosis r-AFS stage Ⅲ-Ⅳ, n=97). The expression of relaxin and TGF-β1 protein and mRNA in peritoneum fluid and peripheral blood were detected with ELISA and RT-PCR, respectively. The effect of relaxin and TGF-β1 on the proliferation of eutopic endomentrium stromal cells was also studied. ResultsThe expression of TGF-β1 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-β1 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-β1mRNA 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-β1 was 0.777 9(95%CI: 0.697 3-0.858 5) and the cut-off value was 71.5 g/L; the AUC of relaxin was 0.786 5(95%CI: 0.713 4-0.859 6), and the diagnostic cut-off value was 19.0 g/L; the AUC of TGF-β1 combined with relaxin was 0.850 5(95%CI: 0.783 3-0.917 6). Logistic regression analysis showed that TGF-β1 was an independent risk factor of endometriosis pelvic adhesion, while relaxin was a protective factor(P<0.05). ConclusionThe degree of pelvic adhesion in patients with endometriosis is closely correlated with relaxin and TGF-β1 levels in peritoneum fluid. The combination of relaxin and TGF-β1 is effective in diagnosis of pelvic adhesion in patients with endometriosis.
Key words:  endometriosis  pelvic adhesion  relaxin  transforming growth factor-β1

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