血清salusin-α,TRAb与子宫内膜异位症r-AFS分期的相关性及对其诊断的预测价值

Correlations of serum salusin-α and TRAb with r-AFS staging of endometriosis and their predictive values for diagnosis of the disease

摘要

目的 探讨血清心血管活性肽-α(salusin-α)、促甲状腺素受体抗体(TRAb)与子宫内膜异位症(EMT)美国生育协会修订(r-AFS)分期的相关性及对EMT的诊断价值。方法 前瞻性选取2022年1月至2023年11月鄂东医疗集团黄石市中医医院收治的82例EMT患者为EMT组,另选取同期健康体检女性94例为对照组。使用酶联免疫吸附分析(ELISA)检测血清salusin-α,化学发光法检测血清TRAb。Spearman法分析血清salusin-α、TRAb、糖类抗原(CA)-125水平与r-AFS分期的相关性;多因素Logistic回归分析EMT发生的影响因素;受试者工作特征(ROC)曲线分析血清salusin-α、TRAb和CA-125水平对Ⅲ~Ⅳ期EMT的诊断价值。结果 EMT组血清salusin-α水平明显低于对照组(t=11.041,P<0.05),TRAb水平明显高于对照组(t=10.849,P<0.05)。EMT组糖类抗原(CA)-125、白细胞介素(IL)-6、IL-8表达以及经期>6天、痛经占比明显高于对照组(t/χ²=24.765、18.613、8.674、6.273、9.777,P<0.05),CD4⁺/CD8⁺低于对照组(t=8.284,P<0.05)。与Ⅰ~Ⅱ期EMT患者相比,Ⅲ~Ⅳ期者血清salusin-α水平降低(t=9.355,P<0.001),TRAb和CA-125水平升高(t=8.085、5.855,P<0.001)。多因素Logistic分析显示,salusin-α、CD4⁺/CD8⁺是EMT发生的独立保护因素(OR值分别为0.931、0.883,P<0.001),TRAb、CA-125、IL-6、IL-8、和痛经是EMT发生的独立危险因素(OR值分别为1.743、1.972、1.958、1.519、1.425,P<0.05)。ROC分析显示,血清salusin-α、TRAb和CA-125联合诊断Ⅲ~Ⅳ期EMT的灵敏度为88.00%,特异度为80.00%,曲线下面积(AUC)为0.896,优于salusin-α、TRAb和CA-125单独诊断(Z值分别为2.460、2.212、2.558,P<0.05)。结论 子宫内膜异位症患者血清salusin-α水平较低,TRAb水平较高,且血清salusin-α和TRAb与子宫内膜异位症分期有关,并对子宫内膜异位症具有一定诊断价值。

Abstract

Objective To explore correlations of serum salusin-α and thyrotropin receptor antibody (TRAb) with the revised-American Fertility Association (r-AFS) staging of endometriosis (EMT), and their diagnostic values for the disease. Methods A total of 82 EMT patients who admitted to Huangshi Municipal Traditional Chinese Medicine Hospital, Eastern Hubei Medical Group from January 2022 to November 2023 were prospectively selected as EMT group, and 94 healthy women who underwent physical examination in the same period were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was applied to detect serum salusin-α level, and chemiluminescence method was applied to detect serum TRAb level. Spearman correlation analysis was used to analyze correlations of serum salusin-α, TRAb and carbohydrate antigen (CA-125) levels with r-AFS staging. Multivariate Logistic regression was applied to analyze influencing factors for occurrence of EMT. Receiver operating characteristic (ROC) curve was used to analyze diagnostic values of serum salusin-α, TRAb and CA-125 levels for stage Ⅲ-Ⅳ of EMT. Results The serum salusin-α level of the women in the EMT group was significantly lower than that in the control group (t=11.041, P<0.05), while the serum TRAb level was significantly higher than that in the control group (t=10.849, P<0.05). The expression levels of CA-125, interleukin-6 (IL-6) and interleukin-8 (IL-8), and the proportions of menstrual period >6 days and dysmenorrhea in the EMT group were significantly higher than those in the control group (t/χ²=24.765, 18.613, 8.674, 6.273 and 9.777 respectively, all P<0.05), while CD4⁺/CD8⁺ ratio was lower than that in the control group (t=8.284, P<0.05). Compared with these patients with EMT in stage Ⅰ-Ⅱ, the serum salusin-α level descended in those patients with EMT in stage Ⅲ-Ⅳ (t=9.355, P<0.001), while their serum TRAb and CA-125 levels elevated (t=8.085 and 5.855 respectively, both P<0.001). Multivariate Logistic analysis showed that salusin-α and CD4⁺/CD8⁺ ratio were independent protective factors for occurrence of EMT (OR=0.931 and 0.883 respectively, both P<0.05), while TRAb, CA-125, IL-6, IL-8 and dysmenorrhea were independent risk factors for occurrence of EMT (OR=1.743, 1.972, 1.958, 1.519 and 1.425 respectively, all P<0.05). The ROC curve analysis showed that the sensitivity, the specificity and the area under the curve (AUC) of combination of serum salusin-α, TRAb and CA-125 levels for diagnosing stage Ⅲ-Ⅳ of EMT were 88.00%, 80.00% and 0.896 respectively, which were superior to those of single serum salusin-α, single TRAb and single CA-125 levels alone (Z=2.460, 2.212 and 2.558 respectively, all P<0.05). Conclusion The serum salusin-α level descends while the serum TRAb level elevates in EMT patients, and their serum levels are related to EMT staging. The combined detection of the two indexes has certain diagnostic values for EMT.

关键词

子宫内膜异位症 / 心血管活性肽-α / 促甲状腺素受体抗体 / 分期 / 诊断

Key words

endometriosis / salusin-α / thyrotropin receptor antibody / staging / diagnosis

参考文献

[1] Pascoal E, Wessels J M, Aas-Eng M K, et al. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research[J]. Ultrasound Obstet Gynecol, 2022, 60(3): 309-327.

[2] 马园园, 陈良凤, 梁娜. 子宫内膜异位症患者血清KRAS和SIRT1水平与疾病进展的关系及其诊断价值分析[J]. 中国优生与遗传杂志, 2023, 31(4): 822-826.

[3] Chiaffarino F, Cipriani S, Ricci E, et al. Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis[J]. Arch Gynecol Obstet, 2021, 303(1): 17-25.

[4] Zakhari A, Delpero E, McKeown S, et al. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis[J]. Hum Reprod Update, 2021, 27(1): 96-107.

[5] 李建丽, 史莉玲. 超声在深部浸润型子宫内膜异位症中的应用进展[J]. 中国妇幼健康研究, 2022, 33(1): 169-172.

[6] Tocoglu A G, Dogan B, Tuzun S, et al. The relationship between Salusin-α, Salusin-β, and Klotho levels with subclinical atherosclerosis in ankylosing spondylitis[J]. Eur Rev Med Pharmacol Sci, 2023, 27(20): 9838-9845.

[7] Huang Y, Jin B, Huang Y, et al. Consistency between thyrotropin receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) levels in patients with Graves disease[J]. Lab Med, 2022, 53(4): 412-416.

[8] American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine Classification of Endometriosis: 1996[J]. Fertil Steril, 1997, 67(5): 817-821.

[9] 中国医师协会妇产科医师分会, 中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症诊治指南(第三版)[J]. 中华妇产科杂志, 2021, 56(12): 812-824.

[10] Van Barneveld E, Manders J, Van Osch F H M, et al. Depression, anxiety, and correlating factors in endometriosis: A systematic review and meta-analysis[J]. J Womens Health (Larchmt), 2022, 31(2): 219-230.

[11] 冷婷, 强锐, 徐俊驰, 等. IL-33/ST2在子宫内膜异位症中的表达及诊断效能分析[J]. 标记免疫分析与临床, 2023, 30(7): 1122-1126.

[12] Argun D, Argun F, Borku Uysal B. Evaluation of salusin-α and salusin-β levels in patients with type 2 diabetes mellitus and determination of the impact of severity of hyperglycemia on salusin levels[J]. Ir J Med Sci, 2021, 190(4): 1403-1411.

[13] Alpsoy S, Dogan B, Ozkaramanli Gur D, et al. Assessment of salusin alpha and salusin beta levels in patients with newly diagnosed dipper and non-dipper hypertension[J]. Clin Exp Hypertens, 2021, 3(1): 42-48.

[14] 荣淑宁, 郭丹, 靳晓丽. 血压变异性和Salusin-α与妊娠期高血压疾病及不良妊娠结局的关系[J]. 中华高血压杂志, 2023, 31(11): 1086-1089.

[15] Akbaba E, Sezgin B, Edgünlü T. The role of adropin, salusin-α, netrin-1 and nesfatin-1 in endometriosis and their association with insulin resistance[J]. Turk J Obstet Gynecol, 2021, 18(3): 175-180.

[16] Svensson A, Garcia-Etxebarria K, Akesson A, et al. Applicability of polygenic risk scores in endometriosis clinical presentation[J]. BMC Womens Health, 2022, 22(1): 208-217.

[17] 杨宗桥. TSH、TPOAb、TRAb联合检测对自身免疫性甲状腺疾病的诊断价值[J]. 检验医学与临床, 2023, 20(14): 2108-2110.

[18] Svensson A, Roth B, Kronvall L, et al. TSH receptor antibodies (TRAb): a potential new biomarker for endometriosis[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 278: 115-121.

[19] 尤小燕, 张静华, 靳园园, 等. 多囊卵巢综合征合并不良妊娠与自身免疫调控异常的关系[J]. 中国临床医生杂志, 2023, 51(8): 992-996.

[20] Guralp O, Kaya B, Tüten N, et al. Non-invasive diagnosis of endometriosis and moderate-severe endometriosis with serum CA125, endocan, YKL-40, and copeptin quadruple panel[J]. J Obstet Gynaecol, 2021, 41(6): 927-932.

[21] Ghodsi M, Hojati V, Attaranzadeh A, et al. Evaluation of IL-3, IL-5, and IL-6 concentration in the follicular fluid of women with endometriosis: A cross-sectional study[J]. Int J Reprod Biomed, 2022, 20(3): 213-220.

[22] 张瑞. T淋巴细胞、炎症细胞因子与卵巢子宫内膜异位症的相关性研究及诊断价值[D]. 新疆: 新疆医科大学, 2023.