子宫内膜异位症患者血清和腹腔液中甲壳质酶蛋白-40的表达及其临床意义

doi:10.3877/cma.j.issn.1673-5250.2015.03.016

目的

检测子宫内膜异位症(EMS)患者血清和腹腔液中甲壳质酶蛋白(YKL)-40和CA₁₂₅水平，并探讨YKL-40、CA₁₂₅和EMS患者临床病理学特征间的关系及其相关性。

方法

选取2012年3月至2014年3月江苏省徐州市中心医院生殖医学中心收治的确诊为EMS的50例患者为研究对象，并纳入EMS组。选取同期在本院就诊并确诊为子宫良性肿瘤的40例患者纳入对照组。两组患者的年龄、体质指数、痛经所占比例、不孕所占比例及不孕时间比较，差异均无统计学意义(P>0.05)。本研究遵循的程序符合江苏省徐州市中心医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象的知情同意，并与之签署临床研究知情同意书。采用电化学发光法对患者血清和腹腔液CA₁₂₅水平进行测定，采用酶联免疫吸附试验(ELISA)法对患者血清和腹腔液YKL-40水平进行检测，并进行统计学分析，同时分析EMS患者CA₁₂₅与YKL-40水平的相关性关系。

结果

①EMS组患者血清和腹腔液CA₁₂₅及YKL-40水平均高于对照组，并且差异均有统计学意义(P<0.05)。②EMS组中Ⅲ～Ⅳ期患者血清和腹腔液CA₁₂₅和YKL-40水平明显高于Ⅰ～Ⅱ期，并且差异均有统计学意义(P<0.05)；EMS组中Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者的血清YKL-40水平分别高于对照组，EMS组中Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者的腹腔液中CA₁₂₅、YKL-40水平分别高于对照组，并且差异均有统计学意义(P<0.05)。③Spearman相关分析显示，EMS患者血清和腹腔液CA₁₂₅和YKL-40水平间呈显著正相关关系(r＝0.504，0.401；P<0.01)。

结论

血清和腹腔液YKL-40水平有望成为EMS辅助诊断、提示其临床分期的检测指标。

关键词: 子宫内膜异位症, YKL-40, 临床分期

Objective

To investigate the expression levels of YKL-40 and CA₁₂₅ in the serum and peritoneal fluid of patients with endometriosis (EMS), and discuss the relationship between YKL-40, and CA₁₂₅.

Methods

From March 2012 to March 2014, a total of 50 cases with EMS were included into this study (EMS group). At the same time, another 40 cases with benign uterus tumor were included into control group. There were no significant differences between two groups in the aspects of age, body mass index, the constituent ratio of algomenorrhea, the constituent ratio of infertility, and duration of infertility (P>0.05). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Xuzhou Central Hospital, Affiliated Reproductive Medical Central of Southeast University. Informed consent was obtained from each patient. Serum and peritoneal fluid levels of YKL-40 in both two groups were detected by enzyme-linked immunosorbent assay (ELISA), and serum and peritoneal fluid levels of CA₁₂₅ were detected by electrochemiluminescence method. The relationship between CA₁₂₅, YKL-40 and EMS were analyzed by Spearman correlation analysis.

Results

①The serum and peritoneal fluid levels of CA₁₂₅ and YKL-40 in EMS group were both significantly higher than those of control group, which with significant differences (P<0.05). ②The serum and peritoneal fluid levels of CA₁₂₅ and YKL-40 in stage Ⅲ-Ⅳ of EMS group were significantly higher than those of stage Ⅰ-Ⅱ, which with significant differences (P<0.05). The serum levels of YKL-40 in stage Ⅰ-Ⅱ, stage Ⅲ-Ⅳwere significantly higher than those of control group, and the peritoneal fluid levels of YKL-40, CA₁₂₅ in stage Ⅰ-Ⅱ, stage Ⅲ-Ⅳwere significantly higher than those of control group, respectively, which both with significant differences (P<0.05). ③Serum and peritoneal fluid levels of YKL-40 showed positive correlation with CA₁₂₅ (r=0.504, 0.401; P<0.01) by Spearman correlation analysis (P<0.05).

Conclusions

The serum and peritoneal fluid levels of YKL-40 might be an useful diagnosing and prompting clinical staging biomarker of EMS.

Key words: Endometriosis, YKL-40, Clinical staging

表1 两组患者基本临床资料比较(±s)

Table 1 Comparison of general clinical data between two groups (±s)

组别	例数	年龄(岁)	体质指数(kg/m²)	痛经[例数(%)]	不孕[例数(%)]	不孕时间(个月)
EMS组	50	30.3±6.1	22.7±3.2	36(72.0)	17(34.0)	52.1±17.3
对照组	40	32.2±7.4	23.9±2.8	28(70.0)	13(32.5)	51.4±18.7
t值/χ²值	?	1.31	1.89	0.04	0.02	0.18
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05

表1 两组患者基本临床资料比较(±s)

Table 1 Comparison of general clinical data between two groups (±s)

组别	例数	年龄(岁)	体质指数(kg/m²)	痛经[例数(%)]	不孕[例数(%)]	不孕时间(个月)
EMS组	50	30.3±6.1	22.7±3.2	36(72.0)	17(34.0)	52.1±17.3
对照组	40	32.2±7.4	23.9±2.8	28(70.0)	13(32.5)	51.4±18.7
t值/χ²值	?	1.31	1.89	0.04	0.02	0.18
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组患者CA₁₂₅和YKL-40水平比较(±s)

Table 2 Comparison of CA₁₂₅ and YKL-40 levels between two groups(±s)

组别	例数	血清		腹腔液
组别	例数	CA₁₂₅(U/mL)	YKL-40 (ng/mL)	CA₁₂₅(U/mL)	YKL-40 (ng/mL)
EMS组	50	83.1±62.0	87.4±19.6	231.4±30.0	169.3±24.7
对照组	40	33.2±9.5	44.1±13.0	56.2± 6.4	53.9±12.5
t值	?	5.61	8.00	8.00	8.00
P值	?	<0.05	<0.05	<0.05	<0.05

表2 两组患者CA₁₂₅和YKL-40水平比较(±s)

Table 2 Comparison of CA₁₂₅ and YKL-40 levels between two groups(±s)

组别	例数	血清		腹腔液
组别	例数	CA₁₂₅(U/mL)	YKL-40 (ng/mL)	CA₁₂₅(U/mL)	YKL-40 (ng/mL)
EMS组	50	83.1±62.0	87.4±19.6	231.4±30.0	169.3±24.7
对照组	40	33.2±9.5	44.1±13.0	56.2± 6.4	53.9±12.5
t值	?	5.61	8.00	8.00	8.00
P值	?	<0.05	<0.05	<0.05	<0.05

表3 EMS组不同分期患者与对照组患者血清CA₁₂₅和YKL-40水平比较(±s)

Table 3 Comparison of levels of serum CA₁₂₅ and YKL-40 between two groups (±s)

组别		例数	CA₁₂₅(U/mL)	YKL-40 (ng/mL)
EMS组		?	?	?
?	Ⅰ～Ⅱ期	31	62.6±39.4^{a c}	74.3±10.2^{a d}
?	Ⅲ～Ⅳ期	19	121.3±23.5^b	106.5±12.3^d
对照组		40	33.2±9.5	44.1±13.0
F值		?	21.04	16.20
P值		?	<0.05	<0.05

表3 EMS组不同分期患者与对照组患者血清CA₁₂₅和YKL-40水平比较(±s)

Table 3 Comparison of levels of serum CA₁₂₅ and YKL-40 between two groups (±s)

组别		例数	CA₁₂₅(U/mL)	YKL-40 (ng/mL)
EMS组		?	?	?
?	Ⅰ～Ⅱ期	31	62.6±39.4^{a c}	74.3±10.2^{a d}
?	Ⅲ～Ⅳ期	19	121.3±23.5^b	106.5±12.3^d
对照组		40	33.2±9.5	44.1±13.0
F值		?	21.04	16.20
P值		?	<0.05	<0.05

表4 EMS组不同分期患者与对照组患者腹腔液CA₁₂₅和YKL-40水平比较(±s)

Table 4 Comparison of peritoneal fluid CA₁₂₅ and YKL-40 between two groups (±s)

组别		例数	CA₁₂₅(U/mL)	YKL-40 (ng/mL)
EMS组		?	?	?
?	Ⅰ～Ⅱ期	31	105.2±18.4^{a b}	93.5± 8.8^{a b}
?	Ⅲ～Ⅳ期	19	242.2±51.0^b	152.1±25.9^b
对照组		40	56.2±6.4	53.9± 12.5
F值		?	89.38	56.42
P值		?	<0.05	<0.05

表4 EMS组不同分期患者与对照组患者腹腔液CA₁₂₅和YKL-40水平比较(±s)

Table 4 Comparison of peritoneal fluid CA₁₂₅ and YKL-40 between two groups (±s)

组别		例数	CA₁₂₅(U/mL)	YKL-40 (ng/mL)
EMS组		?	?	?
?	Ⅰ～Ⅱ期	31	105.2±18.4^{a b}	93.5± 8.8^{a b}
?	Ⅲ～Ⅳ期	19	242.2±51.0^b	152.1±25.9^b
对照组		40	56.2±6.4	53.9± 12.5
F值		?	89.38	56.42
P值		?	<0.05	<0.05

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Expression levels and clinical significance of YKL-40 in serum and peritoneal fluid of patients with endometriosis

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Expression levels and clinical significance of YKL-40 in serum and peritoneal fluid of patients with endometriosis