The relationship of VEGF,IL-6 and endometriosis and the therapeutic effect of levonorgestrel intrauterine system on endometriosis with dysmenorrhea
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目的 探讨血清VEGF、IL-6水平与子宫内膜异位症(EMT)的关系和左炔诺孕酮宫内节育系统(LNG-IUS)对EMT合并痛经的临床治疗效果.方法 80例确诊为EMT的患者(EMT组)根据VAS疼痛评分,分为EMT未合并痛经组(38例)和EMT合并痛经组(42例);同时选取30例健康育龄女性作为对照组.收集相关临床资料,采用ELISA法检测血清VEGF和IL-6水平.采用多因素logistic回归分析EMT发生的影响因素,ROC曲线评估VEGF和IL-6对EMT发生的诊断价值.EMT合并痛经组患者予以LNG-IUS治疗,观察6、12个月后血清VEGF、IL-6水平及VAS疼痛评分变化,并分析血清VEGF和IL-6水平与VAS疼痛评分的相关性.结果 EMT组血清VEGF和IL-6水平高于对照组(P＜0.05).VEGF和IL-6水平升高是EMT发生的独立危险因素(P＜0.05).VEGF联合IL-6检测诊断EMT发生的AUC为0.818(P＜0.05),取最佳诊断界值为0.638时,对应的灵敏度和特异度分别为95.0％和66.7％.EMT合并痛经组治疗前血清VEGF和IL-6水平高于EMT未合并痛经组(P＜0.05).与治疗前相比,EMT合并痛经组治疗6、12个月后血清VEGF、IL-6水平及VAS疼痛评分降低(P＜0.05),并且治疗12个月后各指标降低更加明显(P＜0.05).EMT合并痛经组VEGF、IL-6水平与VAS疼痛评分均呈正相关(rs=0.478、0.415,P＜0.05);VEGF与IL-6水平亦呈正相关(rs=0.470,P＜0.05).结论 血清VEGF和IL-6参与EMT的发生和发展过程,并对EMT具有较高的诊断价值;LNG-IUS可显著降低EMT合并痛经患者血清VEGF、IL-6水平及 VAS 疼痛评分.
Objective To investigate the relationship of serum VEGF and IL-6 levels with endometriosis(EMT)and the therapeutic effect of levonorgestrel intrauterine system(LNG-IUS)on EMT with dysmenorrhea.Methods According to VAS pain score,80 patients with EMT(group A)were divided into two groups of A1(EMT without dysmenorrhea,38 cases)and A2(EMT with dysmenorrhea,42 cases).Another 30 healthy women of childbearing age were taken as the controls(group C).The basic clinical data were collected,and the levels of serum VEGF and IL-6 were detected by ELISA.The influencing factors for EMT were analyzed by multivariate logistic regression.The diagnostic value of VEGF and IL-6 in EMT was analyzed by ROC curve.The patients in group A2 were treated with LNG-IUS.The levels of serum VEGF and IL-6 and VAS pain scores were observed in the 6th and 12th month after treatment,and the correlation among them were analyzed.Results The levels of serum VEGF and IL-6 in group A were higher than those in group C(P＜0.05).The increased levels of VEGF and IL-6 were the independent risk factors for the occurrence of EMT(P＜0.05).The AUC value of combined detection of VEGF and IL-6 in the diagnosis of EMT was 0.818(P＜0.05),and taking 0.638 as the cut-off value,the corresponding sensitivity and specificity were 95.0％and 66.7％,respectively.The levels of serum VEGF and IL-6 before treatment in group A2 were higher than those in group A1(P＜0.05).Compared with before,the levels of serum VEGF and IL-6 and VAS pain score were decreased in the 6th and 12th month after treatment(P＜0.05),which were obviously lower in the 12th month after treatment(P＜0.05).The levels of VEGF and IL-6 in group A2 were positively correlated with VAS pain score(r,=0.478 and 0.415,P＜0.05),and the level of VEGF was also positively correlated with that of IL-6(r,=0.470,P＜0.05).Conclusion Serum VEGF and IL-6 participate in the development and progression of EMT and have higher diagnostic value for EMT.LNG-IUS can significantly decrease the levels of serum VEGF and IL-6 and VAS pain score in the patients with EMT and dysmenorrhea.
EndometriosisDysmenorrheaVascular endothelial growth factorInterleukin-6Levonorgestrel intrauterine system
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