E-cadherin、CA199及HE4在子宫内膜异位症患者血清中的表达及与自身抗体的相关性

摘要/Abstract

摘要： 目的：探究E-钙黏附蛋白（E-cadherin）、糖类抗原199（CA199）及人附睾分泌蛋白E4（HE4）在子宫内膜异位症（endometriosis，EM）患者血清的表达及与自身抗体的相关性。方法：选取2017年12月至2019年12月于我院治疗的156例EM患者，根据AFS分期分为Ⅰ期（n=31）、Ⅱ期（n=42）、Ⅲ期（n=47）、Ⅳ期（n=36），另选取健康体检者50例作为对照组，对比各组患者血清内分泌激素、炎症因子、E-cadherin、CA199、HE4水平及自身抗体，分析E-cadherin、CA199及HE4水平与内分泌激素、炎性因子水平及自身抗体的相关性。结果： Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期及对照组患者血清雌二醇（E2）、泌乳素（PRL）、胰岛素（INS）水平比较，差异均有统计学意义（P<0.05）；EM各分期患者血清卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）水平比较，差异均无统计学意义（P>0.05）；EM患者血清FSH、LH、T水平均低于对照组（P<0.05）。Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期及对照组患者血清白细胞介素-1β（IL-1β）、白细胞介素-18(IL-18)、单核细胞趋化蛋白1（MCP-1）及肿瘤坏死因子-α（TNF-α）水平比较差异均有统计学意义（P<0.05）。EM各临床分期患者血清E-cadherin、CA199及HE4水平均较对照组升高，各组比较差异均有统计学意义（P<0.05）。Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期患者抗精子抗体（ASAb）、抗绒毛膜促性腺激素抗体（HCGAb）、抗卵巢抗体（AOAb）、抗心磷脂抗体（ACAb）、抗子宫内膜抗体（EMAb）总阳性率升高，各组比较差异具有统计学意义（P<0.05）。相关性分析结果显示，血清E-cadherin、CA199及HE4水平与E2、INS、FSH水平存在负相关性，与PRL、IL-1β、IL-18、MCP-1及TNF-α水平存在正相关性（P<0.05）；E-cadherin、CA199及HE4水平与各自身免疫抗体阳性率存在正相关性（P<0.05）。结论： EM不同AFS分期患者血清内分泌激素、炎症因子水平及自身免疫抗体存在显著差异并与E-cadherin、CA199及HE4水平存在相关性，检测血清E-cadherin、CA199及HE4水平有助于了解EM患者病情严重程度。

关键词: font-size:medium, ">子宫内膜异位症；E-钙黏附蛋白；糖类抗原199；人附睾分泌蛋白E4；自身抗体

Abstract: Objective： To investigate the expression of E-cadherin， carbohydrate antigen 199 (CA199) and human epididymis secretory protein E4 (HE4) in patients with endometriosis (EM) and their correlation with autoantibodies. Methods： 156 patients with EM who were treated in our hospital from December 2017 to December 2019 were selected. According to the AFS stage， they were divided into stage Ⅰ(n=31)， stage Ⅱ(n=42)， stage Ⅲ (n=47)， and Stage Ⅳ (n=36). 50 healthy subjects were selected as the control group. The serum levels of endocrine hormones， inflammatory factors， E-cadherin， CA199， HE4 and autoantibodies were compared between each group. Correlation of the level of E-cadherin， CA199， HE4 and the level of endocrine hormones， inflammatory factors and autoantibodies were analyzed. Results： The serum levels of estradiol (E2)， prolactin (PRL)， and insulin (INS) of the patients in the stage Ⅰ group， stage Ⅱ group， stage Ⅲ group， stage Ⅳ group and the control group had statistical difference (P<0.05). There was no statistical difference in the levels of follicle stimulating hormone (FSH)， luteinizing hormone (LH)， and testosterone (T) in the EM patients of different stages (P>0.05). The serum levels of FSH， LH， and T of EM patients were lower than those in the control group (P<0.05). The serum level of interleukin-1β (IL-1β)， interleukin-18(IL-18)， monocyte chemoattractant protein 1(MCP-1) and tumor necrosis factor-α (TNF-α) of EM patients in stage Ⅰ， stage Ⅱ， stage Ⅲ， stage Ⅳand the control group had statistical difference (P<0.05). The serum levels of E-cadherin， CA199 and HE4 of EM patients of different stages were higher than those in the control group， and the differences between each groups were statistically significant (P<0.05). The positive rate of anti-sperm antibody (ASAb)， anti-chorionic gonadotropin antibody (HCGAb)， anti-ovarian antibody (AOAb)， anti-cardiolipin antibody (ACAb)， and anti-endometrial antibody (EMAb) of EM patients in stage I， stage II， stage III， and stage IV were obviously higher than those of the control group， and each group had statistical difference(P<0.05). Correlation analysis showed that the serum level of E-cadherin， CA199 and HE4 had negative correlations with the level of E2， INS and FSH， and had positive correlations with the level of PRL， IL-1β， IL-18， MCP-1 and TNF-α (P<0.05 ). The serum level of E-cadherin， CA199 and HE4 were positively correlated with the positive rate of autoantibodies (P<0.05). Conclusion： The serum level of endocrine hormones， inflammatory factors and autoantibodies of EM patients in different AFS stages have significant differences and have correlation with the levels of E-cadherin， CA199 and HE4. Detection of E-cadherin， CA199 and HE4 levels in serum helps to understand the severity of EM.

Key words: Endometriosis, E-cadherin;Carbohydrate antigen 199;Human epididymis secretory protein E4, Autoantibodies

中图分类号:

张安能, 杨慧健, 孙宏超. E-cadherin、CA199及HE4在子宫内膜异位症患者血清中的表达及与自身抗体的相关性[J]. 中国医药导刊, 2021, 23(9): 647-652.

ZHANG Anneng, YANG Huijian, SUN Hongchao. The Expression of E-cadherin， CA199 and HE4 in the Serum of Endometriosis Patients and Its Correlation with Autoantibodies[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(9): 647-652.

参考文献

[1]袁增，王立杰.子宫内膜异位症临床诊断和早期治疗相关问题[J].中国实用妇科与产科杂志，2021，37(3):296-301.
     [2]汪逸纯，张真真，万贵平.子宫内膜异位症致疼痛的发生机制及治疗方法研究进展[J].中国医药科学，2021，11(4):39-42.
     [3]张璐，王婷，丁晶文.血清激活素A、卵泡抑素和胎盘生长因子在子宫内膜异位症中的临床价值[J].检验医学与临床，2021，18(14):2022-2025.
     [4]张艳，钱慧，蔡燕，等.子宫内膜异位症合并下生殖道感染患者外周血Th17/Treg和血清细胞因子变化[J].中华医院感染学杂志，2020，30(16):2511-2514.
     [5]陈思凯，郑萍，冷金花.子宫内膜异位症相关疼痛的免疫学研究进展[J].实用妇产科杂志，2019，35(11):828-831.
     [6]曹颖丽，石婷，胡蓉，等.MALAT1在子宫内膜异位症中的表达及研究[J].临床检验杂志，2017，35(11):849-852.
     [7]梁梦珊，朱耀魁.子宫内膜异位症发病机制的研究现状[J].中华妇幼临床医学杂志(电子版)，2021，17(2):138-141.
     [8]Saliminejad K，Edalatkhah H，Kamali K，et al.Association of common variations of the E-cadherin with endometriosis[J]. Gynecological Endocrinology， 2015， 31(11):899-902.
     [9]郑芝祥，范馥芳，李俊妹，等.血清CA125和CA199与子宫内膜异位症患者术后妊娠率关系研究[J].中国实用妇科与产科杂志，2016，32(11):1121-1123.
     [10]Khodaverdi S，Amini-Moghaddam S，Almassi Nokiani F，et al.Adnexal mass with extremely high levels of CA-125 and CA19-9 but normal Human Epididymis Protein 4 (HE4) and Risk of Ovarian Malignancy Algorithm (ROMA): Endometriosis or ovarian malignancy? A case report[J]. International Journal of Reproductive Biomedicine，2018，16(6):413-416.
     [11]中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症的诊断与治疗规范[J]. 中华妇产科杂志， 2007， 42(9):645-648.
     [12]American Fertility Society. Revised American Fertility Society classification of endometriosis: 1985[J]. Fertil Steril， 1985，43(3):351-352
     [13]张辉.血清癌抗原125、癌抗原19-9、催乳素联合检测在子宫内膜异位症诊断中的价值[J].中华肿瘤防治杂志，2018，25(S1):118-119.
     [14]李苗，邸媛媛，邓清华，等.子宫内膜异位症并不孕患者血清内分泌激素水平及自身免疫抗体分析[J].中国妇幼保健，2018，33(14):3274-3276.
     [15]韩彦洁，蒋彦，杨倩，等.氧化应激对子宫内膜异位症患者体外受精-胚胎移植妊娠结局的影响[J].中国妇产科临床杂志，2020，21(2):138-140.
     [16]Wang C，Zhang J，Fok KL，et al.CD147 induces epithelial-to-mesenchymal transition by disassembling cellular apoptosis susceptibility protein/E-cadherin/β-catenin complex in human endometriosis[J]. The American Journal of Pathology，2018，188(7):1597-1607.
     [17]Zhu X，Li Y，Zhou R，et al.Knockdown of E-cadherin expression of endometrial epithelial cells may activate Wnt/β-catenin pathway in vitro[J].Archives of Gynecology and Obstetrics， 2018，297(1):117-123.
     [18]杨艳琳，王屹雯，颜望碧.化瘀消癥汤结合醋酸亮丙瑞林微球治疗子宫内膜异位症的临床疗效及对血清CA125和CA199的影响[J].四川中医，2019，37(12):162-165.
     [19]屈雪，秦晓松.血清人附睾蛋白4和糖类抗原125在子宫内膜异位症相关性卵巢癌中的应用价值[J].实用医学杂志，2018，34(18):3067-3069.
     [20]Dochez V， Caillon H， Vaucel E， et al. Biomarkers and algorithms for diagnosis of ovarian cancer: CA125， HE4， RMI and ROMA， a review[J]. Journal of Ovarian Research，2019，12(1):28.

快速检索引用检索图表检索高级检索