子宫内膜异位症患者血清IGFBP-7、NGAL水平及对术后复发的预测价值

Serum levels of IGFBP-7 and NGAL of patients with endometriosis and their predictive values for postoperative recurrence of the disease

摘要

目的 探究子宫内膜异位症(EMs)患者血清胰岛素样生长因子结合蛋白7(IGFBP-7)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平及对术后复发的预测价值。方法 选取2019年1月至2020年1月唐山市妇幼保健院收治的106例EMs患者作为EMs组,根据美国生育学会(AFS)分期标准进行EMs分期,Ⅰ期35例,Ⅱ期32例,Ⅲ期21例,Ⅳ期18例.选择同期在本院体检健康的106例女性志愿者为对照组.对所有EMs患者术后进行为期三年的随访,发现复发者有60例(Ⅱ期28例,Ⅲ期17例,Ⅳ期15例),未复发者46例.采用酶联免疫吸附试验(ELISA)检测血清IGFBP-7、NGAL的表达水平;受试者工作特征(ROC)曲线分析血清IGFBP-7、NGAL对EMs患者术后复发的预测价值。结果 与对照组相比,EMs组患者血清中IGFBP-7、NGAL表达水平升高,差异有统计学意义(t值分别为24.077、24.362,P<0.05);IGFBP-7、NGAL的表达水平在EMs患者Ⅰ期组、Ⅱ期组、Ⅲ期组、Ⅳ期组分别逐渐升高,差异有统计学意义(F值分别为35.170、30.837,P<0.05);与未复发组相比,复发组患者IGFBP-7、NGAL表达水平升高,差异有统计学意义(t值分别为14.206、8.876,P<0.05);Ⅱ期、Ⅲ期、Ⅳ期患者进行分组比较,结果显示与未复发组相比,复发组患者IGFBP-7、NGAL表达水平均升高,差异有统计学意义(t值介于2.087~5.658之间,P<0.05);ROC曲线显示,IGFBP-7、NGAL两者联合预测的曲线下面积(AUC)为0.927,高于IGFBP-7(AUC为0.892)、NGAL(AUC为0.746)单独预测值(Z值分别为20.819、4.328,P<0.05)。结论 EMs患者血清中IGFBP-7、NGAL表达水平显著升高,二者联合对EMs患者术后复发具有一定的预测价值.

Abstract

Objective To detect serum levels of insulin-like growth factor binding protein 7 (IGFBP-7) and neutrophil gelatinase associated lipocalin (NGAL) of patients with endometriosis (EMs) and to analyze their predictive values for postoperative recurrence of the disease. Methods A total of 106 EMs patients who admitted to Tangshan Municipal Maternal and Child Health Hospital from January 2019 to January 2020 were selected as EMs group. According to staging criteria for EMs of American Fertility Society (AFS), 35 patients were diagnosed as stage I of EMs, 32 patients were diagnosed as stage Ⅱ of EMs, 21 patients were diagnosed as stage Ⅲ of EMs and 18 patients were diagnosed as stage IV of EMs. A total of 106 healthy female volunteers who received physical health examination in our hospital in the same period were selected as control group. All EMs patients were followed up for three years after operation. 60 patients recurred after operation (recurrence group, including 28 cases of stage Ⅱ of EMs, 17 cases of stage Ⅲ of EMs and 15 cases of stage Ⅳ of EMs) and 46 patients didn't recur. Enzyme-linked immunosorbent assay (ELISA) was used to detect expression levels of serum IGFBP-7 and NGAL. Receiver operating characteristic (ROC) curve was used to analyze predictive values of serum IGFBP-7 and NGAL for postoperative recurrence in EMs patients. Results Compared with the control group, the expression levels of IGFBP-7 and NGAL in serum of EMs patients were higher, and the differences were statistically significant (t=24.077 and 24.362 respectively, both P<0.05). The expression levels of IGFBP-7 and NGAL in EMs patients in stage Ⅰ group, stage Ⅱ group, stage Ⅲ group and stage Ⅳ group increased gradually, and the differences were statistically significant (F=35.170 and 30.837 respectively, both P<0.05). Compared with the non-recurrence group, after operation, the expression levels of IGFBP-7 and NGAL in the recurrence group were higher, and the differences were statistically significant (t=14.206 and 8.876 respectively, both P<0.05). The expression levels of IGFBP-7 and NGAL of the patients with stages Ⅱ, Ⅲ and Ⅳ of EMs after operation were compared between the recurrence group and the non-recurrence group respectively, and the results showed that the expression levels of IGFBP-7 and NGAL in the recurrence group were higher than those in the non-recurrence group, and there were statistically significant differences (t=2.087 to 5.658, all P<0.05). ROC curve showed that the area under the curve (AUC) of combination of IGFBP-7 and NGAL for predicting recurrence of EMs after operation was 0.927, which was higher than those predicted by single IGFBP-7 and single NGAL alone (Z=20.819 and 4.328 respectively, both P<0.05). Conclusion The expression levels of IGFBP-7 and NGAL in serum of EMs patients increase significantly, and the combined detection of serum IGFBP-7 and NGAL levels had certain predictive value for postoperative recurrence of EMs in EMs patients.

关键词

子宫内膜异位症 / 胰岛素样生长因子结合蛋白7 / 中性粒细胞明胶酶相关脂质运载蛋白 / 术后 / 复发

Key words

endometriosis / insulin like growth factor binding protein 7 / neutrophil gelatinase associated lipocalin / postoperative / recurrence

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基金资助

河北省医学科学研究课题计划(20231745)