标题：IL-32、PAI-1、VEGF在子宫内膜异位症患者血清中的表达及临床意义

      作者：蒋伶 1，窦曦 1，陈勇 1，徐敏 2    1.乐山市市中区人民医院妇产科，四川 乐山 614000；2.中国医学科学院北京协和医学院输血研究所，四川 成都 610052

      卷次： 2019年30卷7期

      【摘要】 目的 探讨子宫内膜异位症(EMs)患者血清白细胞介素-32 (IL-32)、血管内皮生长因子(VEGF)、纤溶酶原激活物抑制因子-1 (PAI-1)的表达情况及临床意义。方法 选取2018年1~4月期间到乐山市市中区人民医院经腹腔镜手术及术后病理证实为子宫内膜异位症患者30例作为EMs组，选取同期且年龄结构相仿的健康人群30例作为对照组。采用ELISA法检测两组受检者血清中 IL-32、PAI-1、VEGF水平，采用相关性分析及受试者工作曲线(ROC)评价血清中 IL-32、PAI-1、VEGF在子宫内膜异位症诊断中的价值。结果 EMs组患者血清 IL-32、PAI-1和VEGF表达水平分别为(38.92±14.87) ng/L、(194.07±61.65) mg/L、(210.63±37.00) ng/L，明显高于对照组的(16.11±4.23) ng/L、(48.97±17.05) mg/L、(107.16±24.84) ng/L，差异均有统计学意义(P<0.05)；随着R-AFS分期逐渐升高，EMs组患者的血清 IL-32、PAI-1、VEGF表达水平呈逐渐升高趋势，其中Ⅲ~Ⅳ期患者血清 IL-32、PAI-1和VEGF表达水平分别为(48.40±14.91) ng/L、(229.89±55.31) mg/L、(237.44±20.74) ng/L，明显高于Ⅰ~Ⅱ期患者的(29.43±6.54) ng/L、(158.26±45.44) mg/L、(183.81±29.42) ng/L，差异均有统计学意义(P<0.05)；相关性分析显示，血清 IL-32、PAI-1、VEGF与子宫内膜异位症分期均呈明显正相关性，其中Ⅰ~Ⅱ期患者血清 IL-32、PAI-1、VEGF与分期的相关系数分别为 r=0.773、0.742、0.711，Ⅲ~Ⅳ期患者血清 IL-32、PAI-1、VEGF与分期的相关系数分别为 r=0.65、0.773、0.65 (P均<0.05)；血清 IL-32、PAI-1、VEGF三种指标联合检测诊断EM的ROC曲线AUC值为 0.823，较单独检测血清 IL-32(0.737)、PAI-1 (0.747)、VEGF (0.756)的AUC值高。结论 血清 IL-32、PAI-1、VEGF表达水平升高与EMs的发生发展密切相关，三种指标联合检测有助于提高EMs的诊断和病情评估水平。
      【关键词】 子宫内膜异位症；白介素-32；纤溶酶原激活物抑制因子-1；血管内皮生长因子；相关性；临床意义
      【中图分类号】 R711.74 【文献标识码】 A 【文章编号】 1003—6350（2019）07—0817—04

Expression and clinical significance of interleukin-32, plasminogen activator inhibitor-1 and vascular endothelialgrowth factor in serum of patients with endometriosis.
JIANG Ling 1，DOU Xi 1，CHEN Yong 1，XU Min 2. 1. Departmentof Obstetrics and Gynecology, Leshan Shizhong District People's Hospital, Leshan 614000, Sichuan, CHINA; 2. Institute ofBlood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, Sichuan, CHINA
【Abstract】 Objective To explore the expression and clinical significance of serum interleukin-32 (IL-32), vas-cular endothelial growth factor (VEGF), and plasminogen activator inhibitor-1 (PAI-1) in patients with endometriosis(EMs). Methods From January to April 2018, 30 patients with endometriosis confirmed by laparoscopic surgery andpostoperative pathology in Leshan Shizhong District People's Hospital were selected as the EMs group; 30 health peoplewith similar age structure were selected as the control group. Serum levels of IL-32, PAI-1, and VEGF were measuredby ELISA. Correlation analysis and receiver operating curve (ROC) were used to evaluate the value of serum IL-32,PAI-1, and VEGF in the diagnosis of endometriosis. Results The levels of serum IL-32, PAI-1, and VEGF were re-spectively (38.92±14.87) ng/L, (194.07±61.65) mg/L, and (210.63±37.00) ng/L in the EMs group, which were signifi-cantly higher than corresponding (16.11±4.23) ng/L, (48.97±17.05) mg/L, and (107.16±24.84) ng/L in the control group(P<0.05). With the gradual increase of R-AFS stage, the expression levels of serum IL-32, PAI-1, and VEGF in EMsgroup increased gradually. The expression levels of serum IL-32, PAI-1, and VEGF in patients with stage Ⅲ~Ⅳ wererespectively (48.40±14.91) ng/L, (229.89±55.31) mg/L, and (237.44±20.74) ng/L, which were significantly higher thancorresponding (29.43±6.54) ng/L, (158.26±45.44) mg/L, and (183.81±29.42) ng/L in patients with stage Ⅰ~Ⅱ (P<0.05). Correlation analysis showed that serum IL-32, PAI-1, and VEGF were positively correlated with endometriosisstaging. The correlation coefficients (r) of serum IL-32, PAI-1, VEGF and staging in patients with stageⅠ~Ⅱ were re-spectively 0.773, 0.742, and 0.711; those of patients with stage Ⅲ~Ⅳ were 0.65, 0.773, and 0.65, respectively (P<0.05). The AUC value of the ROC curve used to detect the combined indicator of serum IL-32, PAI-1 and VEGF for di-agnosing EM was 0.823, which was higher than the separated AUC value of IL-32 (0.737), PAI-1 (0.747), and VEGF(0.756). Conclusion The elevated levels of serum IL-32, PAI-1 and VEGF are closely related to the occurrence anddevelopment of EMs. Combined detection of three indicators can improve the diagnosis and assessment of EMs.
      【Key words】 Endometriosis; Interleukin-32; Plasminogen activator inhibitor-1; Vascular e