血清IL-17水平对醋酸炔诺酮治疗子宫内膜异位症患者疼痛效果的影响

Assessment of the effect of serum IL-17 levels on the efficacy of norethindrone acetate in the treatment of pain in patients with endometriosis

目的:分析血清白介素(interleukin,IL)-17水平对醋酸炔诺酮缓解子宫内膜异位症(endometriosis,EMS)患者疼痛效果的影响。方法:选择2020年10月至2022年10月于镇江市第四人民医院妇科就诊的EMS患者105例(EMS组),另选择同期健康体检者80例(对照组),采用ELISA法检测两组血清IL-17水平;采用视觉模拟评分法(Visual Analogue Scale,VAS)对EMS组行疼痛评分,并分析血清IL-17水平与r-AFS分期、VAS疼痛评分的相关性。EMS患者采用醋酸炔诺酮治疗1个月,根据治疗前和治疗后VAS疼痛评分,将其分为有效组(n=65)和无效组(n=40),采用Logistic回归分析治疗前血清IL-17水平对醋酸炔诺酮缓解EMS疼痛疗效的影响,并绘制ROC曲线。结果:治疗前,EMS组血清IL-17水平显著高于对照组(P<0.05),且血清IL-17水平与r-AFS分期呈正相关(r=0.764,P<0.05),与VAS疼痛评分呈弱相关(r=0.251,P<0.05);有效组治疗前血清IL-17水平显著低于无效组(P<0.05);治疗前血清IL-17水平升高是EMS患者醋酸炔诺酮缓解疼痛有效的危险因素(β=0.560,OR=1.751,P<0.05),ROC曲线下面积为0.814,敏感度为84.62%,特异度为72.50%,最佳截断值为62.36 pg/mL。结论:血清IL-17水平与EMS发生发展相关,可良好预测醋酸炔诺酮对EMS患者疼痛症状的疗效。

Objective:To assess the effect of serum interleukin-17(IL-17)levels for the effectiveness of norethindrone acetate in alleviating pain in patients with endometriosis(EMS).Methods:A total of 105 EMS patients(EMS group)and 80 healthy subjects(control group)were selected from the Fourth People′s Hospital of Zhenjiang from October 2020 to October 2022.Serum IL-17 levels were detected by ELISA in both two groups.The Visual Analogue Scale(VAS)was used to assess pain in the EMS group,and the correlation between pre-treatment serum IL-17 levels,r-AFS classification,and VAS pain scores was analyzed.EMS patients were treated with norethindrone acetate for 1 month.According to VAS pain scores before and after treatment,EMS patients were divided into effective group(n=65)and ineffective group(n=40).Logistic regression analysis was performed to evaluate the impact of pre-treatment serum IL-17 levels on the effectiveness of norethindrone acetate in alleviating EMS pain,and a ROC curve was plotted.Results:Before treatment,serum IL-17 level in EMS group was significantly higher than that in control group(P<0.05),and serum IL-17 level was positively correlated with r-AFS classification(r=0.764,P<0.05),and weakly correlated with VAS pain score(r=0.251,P<0.05).The serum IL-17 level in the effective group was significantly lower than that in the ineffective group before treatment(P<0.05).The increase of serum IL-17 level before treatment was a risk factor for the failure of norethindrone acetate to relieve pain in EMS patients(β=0.560,OR=1.751,P<0.05).The area under ROC curve was 0.814,with a sensitivity of 84.62%and a specificity of 72.50%.The optimal cutoff value was 62.36 pg/mL.Conclusion:Serum IL-17 levels are closely related to the development of EMS and could be a good predictor of the efficacy of norethindrone acetate on pain symptoms in EMS patients.