2023 年第 9 期 第 18 卷

血清CXC趋化因子配体14和肿瘤坏死因子超家族成员13水平对卵巢子宫内膜异位症患者术后复发的预测价值

Predictive value of serum CXC chemokine ligand 14 and tumor necrosis factor superfamily member 13 in postoperative recurrence in patients with ovarian endometriosis

作者：陈霄吴小颖安明

英文作者：Chen Xiao Wu Xiaoying An Ming

单位：四川大学华西三亚医院妇产科，三亚572000

英文单位：Department of Obstetrics and Gynecology West China (Sanya) Hospital Sichuan University Sanya 572000 China

关键词：子宫内膜异位症；CXC趋化因子配体14；肿瘤坏死因子超家族成员13

英文关键词：Endometriosis;CXCchemokineligand14;Tumornecrosisfactorsuperfamilymember13

• 摘要：

• 目的  探讨血清CXC趋化因子配体14（CXCL14）和肿瘤坏死因子超家族成员13（TNFSF13）水平对卵巢子宫内膜异位症（OEM）患者术后复发的预测价值。方法 选取2016年2月至2018年4月于四川大学华西三亚医院诊治的OEM患者90例为OEM组。根据美国生殖医学会修正的子宫内膜异位症分期（r-AFS分期）标准，将OEM患者分为Ⅰ～Ⅱ期（45例），Ⅲ～Ⅳ期（45例）。根据疼痛视觉模拟量表评分，将OEM患者的痛经程度分为轻度（1～3分，42例）、中度（4～7分，28例）和重度（8～10分，20例）。另选取同期本院体检健康的44名育龄期妇女作为对照组。记录OEM患者术后复发情况，检测受试者血清CXCL14、TNFSF13水平。分析OEM术后复发的影响因素以及血清CXCL14、TNFSF13对OEM术后复发的预测价值。结果 OEM组血清CXCL14水平低于对照组、TNFSF13水平高于对照组（均P＜0.001）。r-AFS分期Ⅲ～Ⅳ期患者血清CXCL14水平低于Ⅰ～Ⅱ期患者、TNFSF13水平高于Ⅰ～Ⅱ期患者；中重度痛经患者血清CXCL14水平低于轻度痛经患者、TNFSF13水平高于轻度痛经患者（均P＜0.001）。随访期间共34例患者复发，单因素分析结果显示r-AFS分期、痛经程度、术后用药、血清CXCL14和TNFSF13水平与OEM术后复发有关（均P<0.05）。多因素Cox回归分析结果显示，r-AFS分期、痛经程度、CXCL14、TNFSF13水平是OEM术后复发的独立危险因素，术后用药是独立保护因素（均P＜0.05）。受试者工作特征曲线分析结果显示，血清CXCL14、TNFSF13预测OEM术后复发的曲线下面积分别为0.741(95%置信区间：0.687～0.795)、0.728(95%置信区间：0.670～0.788)，二者联合检测的曲线下面积为0.872(95%置信区间：0.828～0.947)，联合检测的曲线下面积大于CXCL14、TNFSF13单独检测(均P＜0.001)。结论 OEM患者血清CXCL14水平降低，TNFSF13水平升高，二者是影响OEM术后复发的独立危险因素。血清CXCL14、TNFSF13联合检测对OEM术后复发具有较高的预测价值。

• Objective To investigate the predictive value of serum CXC chemokine ligand 14 (CXCL14) and tumor necrosis factor superfamily member 13 (TNFSF13) in postoperative recurrence in patients with ovarian endometriosis (OEM). Methods From February 2016 to April 2018, 90 patients with OEM admitted to West China (Sanya) Hospital, Sichuan University were selected as the OEM group. According to the revised American Fertility Society classification (r-AFS classification) standard, patients were divided into classification Ⅰ-Ⅱ(45 cases) and Ⅲ-Ⅳ(45 cases). According to scores of pain visual analogue scale, the degrees of dysmenorrhea of patients were divided into mild (1-3, 42 cases), moderate (4-7, 28 cases) and severe (8-10, 20 cases). Another 44 healthy women underwent physical examinations during the same period were enrolled as the control group. The postoperative recurrence of OEM in patients was recorded, and serum levels of CXCL14 and TNFSF13 of subjects were detected. Influencing factors of postoperative recurrence of OEM and the predictive value of serum CXCL14 and TNFSF13 on postoperative recurrence of OEM were analyzed. Results The serum level of CXCL14 in the OEM group was lower than that in the control group, and the level of TNFSF13 in the OEM group was higher than that in the control group (both P<0.05). The serum level of CXCL14 in patients with r-AFS classification Ⅲ-Ⅳ was lower than that in patients with r-AFS classification Ⅰ-Ⅱ, the level of TNFSF13 in patients with r-AFS classification Ⅲ-Ⅳ was higher than that in patients with r-AFS classification Ⅰ-Ⅱ, the serum level of CXCL14 in patients with moderate and severe dysmenorrhea was lower than that in patients with mild dysmenorrhea, and the level of TNFSF13 in patients with moderate and severe dysmenorrhea was higher than that in patients with mild dysmenorrhea (all P<0.001). There were 34 cases that had recurrence during follow-up period. Univariate analysis showed that r-AFS classification, degree of dysmenorrhea, postoperative medication and serum levels of CXCL14 and TNFSF13 were related to postoperative recurrence of OEM (all P<0.05). Multivariate Cox regression analysis showed that r-AFS classification, degree of dysmenorrhea and serum levels of CXCL14 and TNFSF13 were independent risk factors for postoperative recurrence of OEM, while postoperative medication was an independent protective factor (all P<0.05). Receiver operating characteristic curve analysis showed that areas under the curve of serum CXCL14 and TNFSF13 in predicting OEM recurrence were 0.741 (95% confidence interval: 0.687-0.795) and 0.728 (95% confidence interval: 0.670-0.788). The area of CXCL14 and TNFSF13 in combination was 0.872 (95% confidence interval: 0.828-0.947), and the area under the curve of combined detection was larger than that of CXCL14 and TNFSF13 alone (both P<0.001). Conclusions  sSerum CXCL14 decreases and TNFSF13 increases in patients with OEM. Those are independent risk factors of postoperative recurrence of OEM. The combined detection of serum CXCL14 and TNFSF13 has a high predictive value for postoperative recurrence of OEM.