激活素A和卵泡抑素在子宫内膜异位症中的诊断价值

Diagnostic value of serum activin A and follistatin levels indifferent types of endometriosis

目的：探讨人激活素 A 和卵泡抑素在腹膜型，卵巢型及深部浸润型子宫内膜异位症中的临床诊断价值。方法子宫内膜异位症患者139例，分成腹膜型内异症组28例，卵巢型内异症组61例，深部浸润型内异症组50例，月经规律的健康女性（对照组）75例，均采集外周静脉血，采用酶联免疫测定试剂盒分析血清中激活素A 和卵泡抑素。结果卵巢内异症组激活素 A 水平[（0．22±0．01）ng／ml]明显高于对照组[（0．17±0．01）ng／ml]、腹膜型内异症组[（0．19±0．01）ng／ml]及深部浸润型内异症组[（0．16±0．02）ng／ml]，差异有统计学意义；子宫内膜异位症患者卵泡抑素与对照组比较，差异无统计学意义；深部浸润型内异症组卵泡抑素水平[（1．50±0．17）ng／ml]低于腹膜型内异症组[（2．24±0．42）ng／ml]和卵巢内异症组[（2．34±0．32）ng／ml]，差异有统计学意义；激活素 A和卵泡抑素诊断卵巢内异症的 ROC 曲线下面积分别为0．700（95％ CI 为0．605～0．794）和0．620（95％ CI 为0．510～0．730），二者联合应用不能提高子宫内膜异位症的诊断特异度和灵敏度。结论激活素 A 和卵泡抑素水平在腹膜型内异症和深部浸润型内异症中无明显改变，对诊断卵巢型内异症的准确率有限。

Objective To explore the clinical value of activin A and follistatin levels in women with peritoneal, ovarian and deep inltrating endometriosis. Methods One hundred and thirty﹣nine patients with endometriosis were divided into three groups：peritoneal endometriosis （n =28）,ovarian endometrioma （n =61 ）,and deep inltrating endometriosis （n =50）.Seventy﹣five health women were included as the control group.Peripheral vein blood samples were collected for activin A and follistatin assessment by enzyme immunoassay kits. Results The ovarian endometrioma group [（0.22 ±0.01）ng/ml]had serum activin A levels signicantly higher than healthy controls [（0.17 ±0.01 ）ng/ml]. Serum follistatin levels of all patients with endometriosis did not differ from healthy controls.However,follistatin levels in the endometrioma group [（2.24 ±0.42）ng/ml]were higher than that in the deep endometriosis group [（1.50 ±0.17）ng/ml].The area under the receiver﹣operating characteristic （ROC）curve of activin A was 0.700 （95% CI：0.605﹣0.794）,while that of follistatin was 0.620 （95% CI：0.51﹣0.73）for the diagnosis of ovarian endometrioma.The combination of the two markers did not improve diagnostic accuracy. Conclusion The present study demonstrated that serum activin A and follistatin are not signicantly altered in peritoneal or deepinltrating endometriosis and have limited diagnostic accuracy in the diagnosis of ovarian endometrioma.