The effect of NLRP3 inflammatory reaction mediated by depression on the clinical outcome of patients with Endometriosis
Objective To study the effect of depression mediated inflammation of N0D like receptor heat domain related protein 3(NLRP3)on the clinical outcome of patients with Endometriosis.Methods 80 patients with EMs who visited our hospital from January 2020 to January 2023 were selected as research objects.According to whether the patients were complicated with depression,they were divided in-to non depression EMs group(n=29)and depression EMs group(n=51).50 healthy women were taken as health groups.The peripheral blood NLRP3 and related factors[Cysteine protease,interleukin(IL)-1]in three groups were detected β、Analyze the relationship be-tween the expression level of IL-18 and the degree of disease in EMs patients with depression.After 3-6 months of treatment,51 depression EMs patients were divided into two subgroups based on their disease outcomes:the excellent outcome group and the poor outcome group.The clinical data,NLRP3,and related factor expression differences between the two subgroups were compared.Results Depression EMs group NLRP3[2.43±0.34 vs.1.78±0.21 vs.1.00±0.08],Caspase-1[2.56±0.32 vs.1.69±0.18 vs.1.00±0.12],IL-1β[(9.08±1.54)ng/ml vs.(6.65±0.87)ng/mlvs.(2.11±0.24)ng/ml],IL-18[(10.32±1.43)ng/ml vs.(6.75±1.00)ng/ml vs.The ex-pression level of(3.42±0.54)ng/ml]was higher than that of non-depressed EMs group and healthy group(F=43.443,48.470,47.439,47.934,P＜0.05).The expression of NLRP3 and related factors is related to the severity of depressive EMs patients,and com-pared with EMs stage Ⅰ to Ⅱ,Patients with EMs stage Ⅲ-Ⅳ had NLRP3[2.95±0.28 vs.2.02±0.32],Caspase-1[3.12±0.45 vs.1.98±0.32],IL-1β[(9.79±1.02)ng/ml vs.The expression levels of 8.43±0.76)ng/ml]and IL-18[(11.34±1.23)ng/ml vs.(9.03±0.87)ng/ml]were increased(t=11.050,10.090,5.242,7.493,P＜0.05).Compared to people with mild/moderate depres-sion,NLRP3[3.24±0.46 vs.2.76±0.53 vs.1.99±0.21],Caspase-1[3.52±0.35 vs.2.67±0.25vs.1.87±0.21],IL-1β[10.21±1.32)ng/ml in patients with major depression vs.(8.76±0.82)ng/ml vs.(5.98±0.67)ng/ml],IL-18[(11.76±1.43)ng/ml vs.(10.09±1.00)ng/ml vs.(8.75±0.69)ng/ml]expression level was increased(F=15.065,24.887,17.476,11.574,P＜0.05).The diameter of cyst in the poor outcome group was higher than that in the good outcome group,and the proportion of EMs stage Ⅲ-Ⅳ,se-vere pain,pelvic adhesion,AMH,CA125,EMAb level,and major depression were higher than those in the good outcome group(P＜0.05).Compared with the good outcome group,Outcome poor group[3.45±0.87vs 1.76±0.32],Caspase-1[3.42±0.64 vs.1.43±0.21],IL-1 β[(11.32±2.34)ng/ml vs.(6.12±0.43)ng/ml]and IL-18[(12.31±3.87)ng/ml vs.(7.96±0.86)ng/ml]were increased(t=8.825,14.270,10.490,5.276,P＜0.05).NLRP3 was better than Caspase-1,IL-1 β and IL-18 in predicting the clin-ical outcome of EMs patients with depression(P＜0.05).The combined prediction of clinical outcomes of the four items was superior to that of the single item(AUC=0.867,sensitivity 88.09％,specificity 86.50％,P＜0.05).Depression degree,NLRP3,Caspase-1,IL-1 βand IL-18 were all independent risk factors for poor clinical outcomes in EMs patients with depression(P＜0.05).Conclusion The worse-ning of EMs patients'condition is related to the NLRP3 inflammatory response mediated by depression.Depression induces an increase in NL-RP3 and regulates downstream related factors such as Caspase-1 and IL-1β、The expression of IL-18 forms an inflammatory microenviron-ment,ultimately affecting the clinical outcome of patients.
NOD like receptor hot protein domain related protein 3Cysteine protease 1Interleukin-1βInterleukin-18Depres-sionEndometriosisClinical outcome
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