铁代谢与卵巢子宫内膜异位症的相关性研究

Study on the correlation between iron metabolism and ovarian endometriosis

目的探讨血清铁(SI)、铁蛋白(FER)、转铁蛋白(TF)等铁代谢指标水平与卵巢子宫内膜异位症(OEMs)发生及发展的相关性。方法选取2018年11月至2022年6月于吉林大学第二医院妇科首诊且术后经病理确诊为OEMs囊肿、卵巢良性肿瘤(BOT)、子宫内膜异位症相关性卵巢癌(EAOC)的75例患者为病例组,选择同期的健康体检者40例为健康组;病例组按照病理诊断分别纳入OEMs组(n=33)、BOT组(n=33)及EAOC组(n=9)。收集各组研究对象的临床资料,采用全自动生化分析仪检测并比较各组的血清铁代谢指标水平,包括SI、FER、TF及不饱和铁结合力(UIBC)等。结果一般资料分析,各组间血红蛋白(HB)水平及年龄均无统计学差异(P>0.05)。铁代谢指标检测结果显示,OEMs组患者血清TF、UIBC及总铁结合力(TIBC)水平均高于EAOC组,SI、FER低于EAOC组,但两组间仅UIBC和TIBC水平有显著性差异(P<0.01);OEMs组患者血清SI水平显著低于BOT组,而UIBC水平显著高于BOT组(P均<0.01);OEMs组与健康组比较,各项血清铁代谢指标均无统计学差异(P>0.05)。EAOC组的FER显著高于健康组(P<0.05),而TIBC显著低于健康组(P<0.01);EAOC组患者与BOT组比较,各项血清铁代谢指标均无统计学差异(P>0.05)。受试者工作特征曲线(ROC)分析显示,铁代谢各指标联合鉴别OEMs和BOT的曲线下面积(AUC)为0.766,特异度为84.8%,灵敏度为60.6%,约登指数为45.5%;联合鉴别OEMs与EAOC时,AUC为0.879,特异度为88.9%,灵敏度为75.8%,约登指数为64.6%。结论OEMs患者与健康人群血清铁代谢指标之间差异不明显;与BOT患者相比,OEMs患者SI下降,伴随UIBC代偿性升高。OEMs发展过渡到EAOC的过程中,伴有FER的堆积及机体转铁能力的下降。铁代谢各指标联合检测有利于鉴别OEMs与BOT,且鉴别OEMs与EAOC的价值更大。

Objective:To explore the correlation between the iron metabolism indicators such as serum iron(SI),ferritin(FER),transferrin(TF)and the occurrence and development of ovarian endometriosis(OEMs).Methods:The 75patients who were first pathologically diagnosed with OEMs cysts,ovarian benign tumors(BOT),and endometriosis associated ovarian cancer(EAOC)in the Second Hospital of Jilin University from November 2018to June 2022were selected as the case group,and 40healthy women during the same period were selected as the health group.The case group was divided into the OEMs group(n=33),BOT group(n=33),and EAOC group(n=9).The clinical information from each group was collected.An automatic biochemical analyzer was used to detect iron metabolism indicators.SI,FER,TF,and unsaturated iron binding capacity(UIBC)of each group were compared and analyzed.Results:There were no significant differences in the age and hemoglobin among these groups(P>0.05).The detection results of iron metabolism indicators showed that the serum total iron binding capacity(TIBC)and UIBC in the OEMs group were significantly higher than those in the EAOC group(P<0.01).The serum SI level in the OEMs group was significantly lower than that in the BOT group,while the UIBC level was significantly higher than that in the BOT group(P<0.01).There was no significant difference of iron metabolism indicators between the OEMs group and the health group(P>0.05).In the EAOC group,the TIBC level was significantly lower than that of the healthy group(P<0.01),and the FER was significantly higher than that of the healthy group(P<0.05).There was no significant difference of iron metabolism indicators between the EAOC group and the BOT group.The receiver operating characteristic curve(ROC)showed that the area under the curve(AUC)for identifying OEMs and BOT by combining various indicators of iron metabolism was 0.766,with specificity of 84.8%,sensitivity of 60.6%,and the Jordan index was 45.5%.When combined identifying OEMs and EAOC,the AUC was 0.879,with specificity 88.9%,sensitivity 75.8%,and the Jordan index 64.6%.Conclusions:There was no significant difference in iron metabolism indicators between OEMs patients and healthy women.Compared with BOT patients,OEMs patients have a decrease in SI,accompanied by a compensatory increase in UIBC.During the transition from OEMs to EAOC,there is a accumulation of FER and a decrease of transfer iron ability.The combined detection of various indicators of iron metabolism is beneficial for distinguishing OEMs from BOT,and the value of distinguishing OEMs from EAOC is greater.