深部浸润型子宫内膜异位症临床特征及其血清炎性因子表达

Clinical characteristics and expression of serum inflammatory factors of patients with deep invasive endometriosis

目的:分析深部浸润型子宫内膜异位症(DIE)的临床特征及血清炎性因子水平变化.方法:回顾性收集2018年3月—2020年2月在本院行手术治疗的子宫内膜异位症患者244例,分为DIE组与非DIE组,比较临床资料、手术情况及血清白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及转化生长因子-β(TGF-β)水平.结果:DIE组年龄、病程时间、血清糖类抗原CA125水平均高于非DIE组,DIE组痛经程度、性交痛、经期腹泻发生率高于非DIE组,妇科检查阴道壁蓝色结节、宫骶韧带触痛结节、后穹隆触痛结节检出率高于非DIE组(均P<0.05),患者体质指数、慢性盆腔痛、肛门坠胀、泌尿系症状发生率及妇科检查子宫固定检出率两组无差异(P>0.05);术中r-AFS分期及盆腔粘连程度高于非DIE组,血清IL-8、TNF-α、TGF-β水平高于非DIE组(均P<0.05),合并卵巢异位囊肿比例两组无差异(P>0.05).重度痛经、妇科检查≥2项阳性、血清CA125、IL-8、TNF-α、TGF-β升高是发生DIE的独立影响因素(P<0.05).结论:DIE患者的临床特征有异于非DIE,重度痛经、妇科检查阳性≥2项、血清CA125及炎性因子异常升高提示DIE的可能性大.

Objective: To analyze the clinical characteristics and the changes of serum inflammatory factors levels of patients with deep infiltrating endometriosis(DIE). Methods: 244 patients with endometriosis who underwent surgical treatment from March 2018 to February 2020 were collected retrospectively. These patients were divided into group A(patients with DIE) and group B(patients without DIE). The clinical data, the operative situation, and the levels of serum interleukin-8(IL-8),tumor necrosis factor-α(TNF-α), and transforming growth factor-β(TGF-β)of the patients were compared between the two groups. Results: The age, the duration of endometriosis, and the serum CA125 level of the patients in group A were significantly higher than those of the patients in group B. The degree of dysmenorrhea, and the pain rate during intercourse and the incidence of the diarrhea during menstruation of the patients in group A were significantly higher than those of the patients in group B. The detection rate of the blue nodules in vaginal wall, the tenderness nodules of the uterine sacral ligament, and the tenderness nodules of the uterine posterior fornix by gynecological examination of the patients in group A were significantly higher than those of the patients in group B(all P<0.05). There were no significant differences in the value of body mass index, the incidences of chronic pelvic pain, anal belly, and urinary symptoms, and the rate of uterine fixation by gynecological examination of the patients between the two groups(P>0.05). The R-AFS stage and the pelvic adhesion degree of the patients in group A during operation were significantly higher than those of the patients in group B, and the serum IL-8, TNF-α, and TGF-β levels of the patients were significantly higher than those of the patients in group B(all P<0.05). There was no significant difference in the rate of complicated with ectopic ovarian cyst of the patients between the two groups(P>0.05). The severe dysmenorrhea,≥2positive results of gynecological examination,and the elevation of serum CA125,IL-8,TNF-α,and TGF-βlevels were the independent factors affecting the occurrence of DIE(P <0.05).Conclusion:The clinical characteristics of the patients with DIE are diffrent from those of the patients without DIE.The patient with severe dysmenorrhea,≥2positive results of gynecological examination,or the elevation of serum CA125and inflammatory factor levels has high possibility of DIE.