血清炎症因子和免疫球蛋白水平变化对子宫内膜异位症患者预后影响及其临床意义分析

摘要

目的：探讨血清炎症因子和免疫球蛋白水平变化对子宫内膜异位症患者预后影响及其临床意义。方法随机选取2010－01～2013－12间在我院行腹腔镜手术治疗的78例子宫内膜异位症患者作为观察组，另选取30例同期健康查体者作为对照组。检测两组血清IL－6、TNF－α等炎症因子和IgA、IgG及IgM等免疫球蛋白水平。术后12 d、24 d和36 d时复查以上项目。统计观察组患者1年内复发率和有生育需求患者妊娠率，比较不同复发和妊娠情况患者血清炎症因子和免疫球蛋白水平变化并分析子宫内膜异位症患者血清炎症因子和免疫球蛋白水平对其预后的预测价值。结果与对照组比较，观察组术前血清IL－6、TNF－α等炎症因子和IgA、IgG等免疫球蛋白水平均升高，IgM水平则下降，差异有统计学意义（P＜0．05）。与术前比较，观察组术后12 d、24 d和36 d的炎症因子和IgG水平均下降（ P＜0．05）。观察组患者1年内复发率和有生育需求患者妊娠率分别为12．82％和75．71％，其中复发和妊娠失败患者术前和术后炎症因子及IgG水平均高于无复发和妊娠成功患者（ P＜0．05）。子宫内膜异位症患者血清IL－6、TNF－α和IgG水平联合预测其复发和妊娠成功率的ROC曲线下面积、灵敏度和准确性均较高，提示子宫内膜异位症患者血清炎症因子和免疫球蛋白水平预测其预后的价值良好。结论血清IL－6、TNF－α和IgG水平在子宫内膜异位症患者中升高且对患者复发、术后妊娠成功率等预后的预测的价值良好，这可能与IL－6和TNF－α可导致免疫性病理损伤和TNF－α对卵巢分泌调节作用等相关，因此血清IL－6、TNF－α和IgG可作为子宫内膜异位症患者预后评估及制定治疗方法的参考依据。%Objective To investigate the impact of serum inflammatory factors and immune globulin level on prognosis of patients with endometriosisanditsclinicalsignificance.Methods 78patientswithendometriosisandtreatedwithlaparoscopicsurgicaltreatmentinour hospital from 2010 January to 2013 December, were randomly selected as observation group, and 30 healthy women with same age were se-lected as the control group.serum IL-6, TNF-αand inflammation factors and IgA, IgG, IgM and other immune globulin level of two groups were detected.The above project of observation group postoperative 12 d, 24 d and 36 d were detected again.Recurrence rate and pregnancy rate of patients demand fertility within 1 year in observation group were statistically analyzed.Serum inflammatory factors and im-munoglobulin level of patients with or without recurrence and pregnancies were compared.And value of serum inflammatory factors and immunoglobulin level predicting prognosis of endometriosis patients was analyzed.Results Compared with control group, preoperative serumIL -6, TNF -α, IgA, and IgG of observation group were elevated, while serum IgM level dropped, and the difference was statisticallysignificant (P <0.05).Compared with the preoperative, and postoperative12 d, 24 d and 36 d serum IL -6, TNF -α, and IgG level ofobservation group were decreased (P <0.05).1 year recurrence rate and pregnancy rate of patients demand fertility in observation groupwere 12.82% and 75.71% respectively, and serum IL -6, TNF -α, and IgG level of patients with pregnancy failure and recurrence werehigher than that of patients with no recurrence and successful pregnancy (P <0.05).Area under the curve, sensitivity and accuracy of serumIL -6, TNF -αand IgG levels predicting prognosis of patients with endometriosis were high, thus value of serum IL -6, TNF -αandIgG levels predicting prognosis of patients with endometriosis was good.Conclusion Serum IL -6, TNF -αand IgG levels increased inpatients with endometriosis and value of serum IL -6, TNF -αand IgG levels predicting prognosis of patients with endometriosis is good.The above result may be related to that the IL -6 and TNF -αcan lead to immune pathological injury and function of TNF -αon ovariansecretion regulation.Thus serum IL -6, TNF -αand IgG can be a basis in evaluating patients prognosis and planning of treating method.