2022 年第 10 期 第 17 卷

子宫内膜异位症患者外周血血栓素A2和T细胞免疫球蛋白黏蛋白分子3水平与病情严重程度的关系  

Relationship between the levels of thromboxane A2, T cell immunoglobulin mucin molecule 3 in peripheral blood and the severity of endometriosis

作者：朱慧赵纯曹曦霞华桦徐琳

英文作者：Zhu Hui Zhao Chun Cao Xixia Hua Hua Xu Lin

单位：南京医科大学附属妇产医院生殖健康科，南京210000

英文单位：Department of Reproductive Health Women′s Hospital of Nanjing Medical University Nanjing 210000 China

关键词：子宫内膜异位症；血栓素A2；T细胞免疫球蛋白黏蛋白分子3；生育指数

英文关键词：Endometriosis;ThromboxaneA2;Tcellimmunoglobulinmucinmolecule3;Fertilityindex

• 摘要：

• 目的 探讨子宫内膜异位症患者外周血血栓素A2（TXA2）、T细胞免疫球蛋白黏蛋白分子3（Tim-3）水平与病情严重程度的关系。方法 选取2018年1月至2020年12月于南京医科大学附属妇产医院接受腹腔镜手术治疗和病理确诊的126例子宫内膜异位症患者作为研究对象，根据美国生育协会分期标准进行分期，Ⅰ～Ⅱ期为轻度组（71例）、Ⅲ～Ⅳ期为重度组（55例）。采用放射免疫法检测外周血TXA2水平，采用酶联免疫吸附试验法检测炎症因子［白细胞介素6（IL-6）、IL-17］水平，流式细胞仪检测外周血T细胞上Tim-3表达水平。评估子宫内膜异位症生育指数（EFI）。采用Spearman相关性方法分析血清TXA2、Tim-3表达水平与炎症因子以及EFI评分的相关性，应用Logistic回归方法分析各指标与子宫内膜异位症严重程度的关系。结果 重度组患者外周血TXA2、IL-6、IL-17水平高于轻度组，而EFI评分低于轻度组，差异均有统计学意义（均P＜0.001）。2组患者CD+4T细胞上Tim-3表达水平比较差异无统计学意义（P=0.339），而重度组患者CD+8T细胞上Tim-3表达水平高于轻度组［（17.2±4.1）%比（14.4±3.6）%］，差异有统计学意义（P＜0.001）。Spearman相关性分析显示，TXA2、CD+8T细胞上Tim-3表达水平与IL-6、IL-17水平呈正相关，与EFI评分呈负相关（均P＜0.001）。Logistic回归分析结果显示，TXA2、CD+8T细胞上Tim-3、IL-6、IL-17均是子宫内膜异位症病情严重的危险因素（比值比=1.893、2.323、1.754、1.818，95%置信区间：1.106～3.288、1.048～5.149、1.066～2.886、1.163～2.843，P=0.020、0.038、0.027、0.009），而EFI评分为保护因素（比值比=0.590，95%置信区间：0.392～0.887，P=0.011）。结论 子宫内膜异位症患者外周血TXA2以及CD+8T细胞表面Tim-3异常表达，与机体炎症反应以及妊娠情况密切相关，是患者病情严重的危险因素。

• Objective  To explore the relationship between the levels of thromboxane A2 (TXA2), T cell immunoglobulin mucin molecule 3 (Tim-3) in peripheral blood and the severity of endometriosis. Methods Totally 126 patients with endometriosis who underwent laparoscopic surgery and pathological diagnosis in Women′s Hospital of Nanjing Medical University from January 2018 to December 2020 were selected as the research objects. According to the American Fertility Association staging standard, they were divided into the mild group (stage Ⅰ-Ⅱ, 71 cases) and the severe group (stage Ⅲ-Ⅳ, 55 cases). The TXA2 level in peripheral blood was detected by radioimmunoassay, inflammatory factor［interleukin-6 (IL-6), IL-17］ levels were detected by enzyme-linked immunosorbent assay, Tim-3 expression level on peripheral blood T cells was detected by flow cytometry, and endometriosis fertility index (EFI) was evaluated. Spearman correlation analysis was used to analyze the correlation of the expression levels of serum TXA2 and Tim-3 with inflammatory factors and EFI score. Logistic regression analysis was used to analyze the relationship between each index and the severity of endometriosis. Results The levels of TXA2, IL-6 and IL-17 in peripheral blood in severe group were significantly higher than those in mild group, while the EFI score was significantly lower than that in control group (all P＜0.001). There was no significant difference in the expression level of Tim-3 on CD+4 T cells between the two groups (P=0.339), but the expression level of Tim-3 on CD+8 T cells in severe group was higher than that in mild group［（17.2±4.1）% vs （14.4±3.6）%］ (P＜0.001). Spearman correlation analysis showed that levels of TXA2 and Tim-3 on CD+8 T cells were positively correlated with levels of IL-6 and IL-17, and those were negatively correlated with EFI score (all P＜0.001). Logistic regression analysis showed that TXA2, Tim-3 on CD+8 T cells, IL-6 and IL-17 were risk factors for the severity of endometriosis (odds ratio=1.893, 2.323, 1.754, 1.818, 95% confidence interval: 1.106-3.288, 1.048-5.149, 1.066-2.886, 1.163-2.843, P=0.020, 0.038, 0.027, 0.009), while EFI score was a protective factor (odds ratio=0.590, 95% confidence interval: 0.392-0.887, P=0.011). Conclusion The abnormal expression of TXA2 and Tim-3 on the surface of CD+8 T cells in patients with endometriosis is closely related to the body′s inflammatory response and pregnancy, which are the risk factors affecting the severity.