EMs不孕患者异位子宫内膜组织ICAM-1、HIF-1α表达及血清水平的临床意义

Expressions and clinical significances of intercellular adhesion molecule-1 and hypoxia-inducible factor-1αin the endometrial tissue of infertility patients with endometriosis

目的:分析细胞黏附分子-1(ICAM-1)、缺氧诱导因子-1α(HIF-1α)在子宫内膜异位症(EMs)不孕患者异位内膜及血清中的表达及临床意义。方法:选取2021年4月-2023年4月本院收治并行腹腔镜手术的EMs不孕患者85例异位子宫内膜组织为观察组,根据美国生育学会内异症分期标准(r-AFS)分为Ⅰ~Ⅱ期46例,Ⅲ~Ⅳ期39例;单纯输卵管因素不孕症行宫腔镜检查患者70例子宫内膜组织对照组。采用逆转录聚合酶链反应(RT-PCR)法检测内膜组织中ICAM-1、HIF-1αmRNA表达,Western blot法检测ICAM-1、HIF-1α蛋白表达,采用酶联免疫吸附法(ELISA)检测血清sICAM-1、HIF-1α水平,绘制受试者工作曲线(ROC)分析血清ICAM-1、HIF-1α水平对EMs不孕的预测价值,并分析ICAM-1与HIF-1α的相关性。结果:观察组子宫内膜组织中ICAM-1、HIF-1αmRNA(2.71±0.22、0.87±0.23)表达高于对照组(0.37±0.12、0.47±0.15),ICAM-1、HIF-1α蛋白(2.37±0.07、0.81±0.20)高于对照组(0.10±0.03、0.35±0.10),血清sICAM-1、HIF-1α水平(278.42±32.05 ng/ml、90.95±10.77 ng/ml)高于对照组(194.60±19.55 ng/ml、11.03±3.34 ng/ml),且观察组Ⅲ~Ⅳ期患者血清sICAM-1、HIF-1α水平高于Ⅰ~Ⅱ期患者(均P<0.05)。ROC曲线分析显示,血清sICAM-1联合HIF-1α检测预测EMs不孕的曲线下面积(0.865)、敏感度(92.0%)、特异度(65.0%)均高于单独指标检测(均P<0.05)。pearson相关分析显示,ICAM-1mRNA与HIF-1α的mRNA、蛋白及血清水平均无相关性(均P>0.05)。结论:ICAM-1、HIF-1α的表达异常可能在EMs不孕发生发展中具有重要作用,且血清sICAM-1、HIF-1α水平随EMs病情程度的加重而升高,且联合检测对EMs不孕有一定预测价值。

Objective:To analyze the expressions and the clinical significances of intercellular adhesion molecule-1(ICAM-1)and hypoxia-inducible factor-lα(HIF-1a)in the endometrial tissue of infertility patients with endometriosis(EMs).Methods:A total of 85 infertile patients with EMs who had undergone laparoscopic surgery from April 2021 to April 2023 were selected in observation group,and among them,there were 46 cases with stage I-Il of Ems in group A and 39 cases with stage II-IV of Ems in group B according to the American fertility society staging criteria(r-AFS).In addition,70 patients with infertility because of simple tubal factor who had undergone hysteroscopy during the same time were selected in control group.The expressions of ICAM-1 mRNA and HIF-lαmRNA in the endometrial tissues of the patients in the two groups were detected by reverse transcription polymerase chain reaction(RT-PCR)method.The expressions of ICAM-1 protein and HIF-lαprotein in the endometrial tissues of the patients in the two groups were detected by Western blot method.The serum ICAM-1 and HIF-lαlevels of the patients in the two groups were detected by ELISA.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive values of the ICAM-1 and HIF-lαlevels of the patients with EMs for their infertility.The correlation between the ICAM-1 level of the infertility patients with EMs and their HIF-1alevel.Results:The expressions of ICAM-1 and HIF-lamRNA in the endometrial tissue(2.71±0.22 and 0.87±0.23)of the patients in the observation group were significantly higher than those(0.37±0.12 and 0.47±0.15)of the patients in the control group.The expressions of ICAM-1 and HIF-lαprotein(2.37±0.07 and 0.81±0.20)of the patients in the observation group were significantly higher than those(0.10±0.03 and 0.35±0.10)of the patients in the control group.The levels of serum sICAM-1 and HIF-1α(278.42±32.05 ng/ml and 90.95±10.77 ng/ml)of the patients in the observation group were significantly higher than those(194.60±19.55 ng/ml and 11.03±3.34 ng/ml)of the patients in the control group.The serum levels of sICAM-1 and HIF-1αof the patients in group B were significantly higher than those of the patients in group A(all P<0.05).ROC curve analysis showed that the area under the curve,the sensitivity and the specificity of the levels of serum sICAM-1 and HIF-lαof the patients with EMs for predicting their infertility were 0.865,92.0%and 65.0%,respectively,and which were significantly higher than those of the serum sICAM-1 level or the serum HIF-lαlevel alone(all P<0.05).Pearson correlation analysis showed that there was no correlation between the ICAM-1mRNA level of the patients and their HIF-1αmRNA level,HIF-1αprotein level or serum HIF-1alevel(all P>0.05).Conclusion:The abnormal expression of ICAM-1 and HIF-lαof the patients with EMs may play an important role in the occurrence and development of their infertility.The levels of serum ICAM-1 and HIF-lαof the infertility patients increase with the severity of their EMs,and which have certain value for predicting the infertility of the patients because of EMs.