子宫内膜异位症患者血清neuropilin-1、neuropilin-2与病情及不孕关系

Relationship between the levels of serum neuropilin-1 and neuropilin-2 of patients with endometriosis and their severity of endometriosis and infertility

目的:探讨子宫内膜异位症(EMs)患者外周血清中neuropilin-1(NRP-1)、neuropilin-2(NRP-2)与病情程度和合并不孕的关系。方法:选择2016年1月-2017年7月在本院住院的EMs患者104例为EMs组,健康体检育龄女性104例为对照组。采用美国生殖协会分期标准(R-AFS)将EMs患者分为Ⅰ期(24例)、Ⅱ期(22例)、Ⅲ期(30例)和Ⅳ期(28例),合并不孕症组(45例)和非不孕症组(59例)。采用酶联免疫吸附测定法检测血清NRP-1、NRP-2水平,受试者工作特征曲线(ROC曲线)评估诊断EMs合并不孕价值,采用多因素logistic回归分析EMs合并不孕的相关因素。结果:EMs组与对照组年龄、糖尿病、高血压、家族肿瘤史比较未见差异(P>0.05)。EMs组血清NRP-1、NRP-2水平高于对照组,且随着EMs病情加重水平增加,EMs合并不孕症患者水平高于非合并不孕者(均P<0.05)。ROC曲线分析,NRP-1、NRP-2预测EMs合并不孕症的ROC曲线下面积分别为0.82(95%CI:0.74~0.92)和0.72(95%CI:0.63~0.81),最佳截点值27.02μg/L和22.84μg/L,此时诊断EMs合并不孕症的灵敏度分别为81.3%和70.3%,特异度分别为81.7%和71.1%。NRP-1>27.02μg/L、NRP-2>22.84μg/L是EMs合并不孕症的危险因素(P<0.05)。结论:EMs患者血清NRP-1、NRP-2异常升高且与患者病情和不孕呈正相关,二者对EMs合并不孕有一定预测价值。

Objective:To investigate the relationship between the levels of neuropilin-1 and neuropilin-2 in peripheral blood of patients with endometriosis(EMs)and their severity of EMs and infertility.Methods:104 patients with EMs were selected in study group,and 104 healthy women of childbearing age were selected in control group from January 2016 to July 2017.The patients in the study group were further divided into group A(24 cases with EMs stage I),group B(22 cases with EMs stage II),group C(30 cases with EMs stage III),and group D(28 cases with EMs stage IV)according to the American Reproductive Society staging standard(R-AFS).The patients in the study group were further divided into group 1(45 cases with infertility)and group 2(59 cases without infertility).The serum neuropilin-1 and neuropilin-2 levels were determined by enzyme-linked immunoassay.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of the serum neuropilin-1 and neuropilin-2 levels of the patients for their EMs and infertility occurrences.Multivariate logistic regression was used to analyze the related factors of infertility complicated with EMs of the patients.Results:There were no significant differences in age,diabetes mellitus history,hypertension history,and family tumor history of the patients between the study group and the control group(P>0.05).The levels of serum neuropilin-1 and neuropilin-2 of the patients in the study group were significantly higher than those of the patients in the control group,and which had increased with the aggravation of EMs.The levels of serum neuropilin-1 and neuropilin-2 of the patients in group 1 were significantly higher than those of the patients in group 2(all P<0.05).ROC curve analysis showed that the area under ROC curve of neuropilin-1 level and neuropilin-2 level for predicting EMs complicated with infertility was 0.82(95%CI:0.74-0.92)and 0.72(95%CI:0.63-0.81).When the optimal cut-off points of neuropilin-1 level was 27.02μg/L,the sensitivity and the specificity of neuropilin-1 level and NRP-2 level for predicting EMs complicated with infertility were 81.3%and81.7%.When the optimal cut-off points of neuropilin-1 level was 22.84μg/L,the sensitivity and the specificity of NRP-2 level for predicting complicated with infertility were 70.3%and 71.1%.The neuropilin-1 level>27.02μg/L and the neuropilin-2 level>22.84μg/L were the risk factors of EMs complicated with infertility(P<0.05).Conclusion:The abnormal increasing of the levels of serum neuropilin-1 and neuropilin-2 of the patients with EMs are positively correlated with their severity of EMs and infertility,which have certain predictive value for EMs complicated with infertility of the patients.