摘要
目的探讨凝血指标与子宫内膜异位症(内异症)盆腔粘连的相关性。方法回顾性分析2016年6月至2018年2月于浙江大学医学院附属妇产科医院经手术治疗的内异症患者408例的临床资料,评价凝血指标的变化与盆腔粘连严重程度的相关性。结果有盆腔粘连的内异症患者血浆纤维蛋白原(FIB)高于无粘连者[3.1(2.7～4.5)g/L vs. 2.8(2.6～3.2)g/L,P<0.01],血浆凝血酶原时间(PT)短于无粘连者[12.9(12.5～13.3)s vs. 13.1(12.7～13.5)s,P<0.01],血小板计数(PLT)和活化部分凝血酶原时间(APTT)差异无统计学意义(P>0.05)。FIB与盆腔粘连评分呈正相关(r=0.248,P<0.01)。在盆腔粘连的判断中,FIB的曲线下面积(AUC)为0.630,诊断界值为2.87g/L,FIB≥2.87g/L的内异症患者盆腔粘连的发生率增加(χ2=15.4,P<0.01)。结论凝血指标与内异症的盆腔粘连存在相关性,尤其FIB与盆腔粘连的发生发展相关,可协助判断内异症所致的盆腔粘连的严重程度。
Objective To investigate the correlation between coagulation parameters and pelvic adhesions in endometriosis.Methods The clinical data of 408 patients with endometriosis who underwent surgery in Women's Hospital School of Medicine Zhejiang University from June 2016 to February 2018 were retrospectively analyzed to evaluate the correlation between coagulation parameters and the severity of pelvic adhesions.Results In endometriosis cases,the levels of plasma fibrinogen(FIB)in patients with pelvic adhesions were significantly shorter than those without pelvic adhesions[median:3.1 g/L(range:2.7-4.5 g/L)vs. 2.8 g/L(range:2.6-3.2 g/L),respectively;P<0.01],the plasma prothrombin time(PT)in patients with pelvic adhesions were significantly shorter than those without pelvic adhesions[median:12.9 s(range:12.5-13.3 s)and 13.1 s(range:12.7-13.5 s),respectively;P<0.01],while there was no difference in the levels of platelet count(PLT)or activated partial prothrombin time(APTT)(P>0.05). FIB was positively correlated with pelvic adhesion scores(r=0.248,P<0.01).In the judgment of pelvic adhesion,the area under the curve(AUC)of FIB was 0.630,and the cut-off value was 2.87 g/L.The incidence of adhesions in patients with FIB greater than 2.87 g/L increased(χ2=15.4,P<0.01).Conclusion Coagulation parameters was correlated with the pelvic adhesions in endometriosis,especially fibrinogen,which may help to judge the severity of pelvic adhesions caused by endometriosis.
引文
[1]Dunselman GAJ,Vermeulen N,Becker C,et al.ESHRE guideline:management of women with endometriosis[J].Hum Reprod,2014,29(3):400-412.
[2]沈铿,马丁.妇产科学[M].3版.北京:人民卫生出版社,2016:355-363.
[3]郝敏,赵卫红,王永红.子宫内膜异位症患者盆腔粘连与疼痛的相关性[J].中华妇产科杂志,2009,44(5):333-336.
[4]Ding D,Liu X,Duan J,et al.Platelets are an unindicted culprit in the development of endometriosis:clinical and experimental evidence[J].Hum Reprod,2015,30(4):812-832.
[5]Leyendecker G,Wildt L,Mall G.The pathophysiology of endometriosis and adenomyosis:tissue injury and repair[J].Arch Gynecol Obstet,2009,280(4):529-538.
[6]Capobianco A,Cottone L,Monno A,et al.The peritoneum:healing,immunity and diseases[J].J Pathol,2017,243(2):137-147.
[7]Revised American Society for Reproductive Medicine classification of endometriosis:1996[J].Fertil Steril,1997,67(5):817-821.
[8]Yun BH,Jeon YE,Chon SJ,et al.The prognostic value of individual adhesion scores from the revised American Fertility Society classification system for recurrent endometriosis[J].Yonsei Med J,2015,56(4):1079-1086.
[9]Shaw TJ,Martin P.Wound repair at a glance[J].J Cell Sci,2009,122(18):3209-3213.
[10]Ohtsuka N.Study on pathogenesis of adhesions in endometriosis[J].Acta Obstet Gynaecol Jpn,1980,11:1758-1766.
[11]Tennent GA,Brennan SO,Stangou AJ,et al.Human plasma fibrinogen is synthesized in the liver[J].Blood,2007,109(5):1971-1974.
[12]Fassbender A,Waelkens E,Verbeeck N,et al.Proteomics analysis of plasma for early diagnosis of endometriosis[J].Obstet Gynecol,2012,119(1):276-285.
[13]Zhao Y,Liu YN,Li Y,et al.Identification of Biomarkers for Endometriosis Using Clinical Proteomics[J].Chin Med J(Engl),2015,128(4):520-527.
[14]Wu Q,Ding D,Liu X,et al.Evidence for a Hypercoagulable State in Women With Ovarian Endometriomas[J].Reprod Sci,2015,22(9):1107.
[15]Chmaj-Wierzchowska K,Kampioni M,Wilczak M,et al.Novel markers in the diagnostics of endometriomas:Urocortin,ghrelin,and leptin or leukocytes,fibrinogen,and CA-125?[J].Taiwan J Obstet Gynecol,2015,54(2):126-130.
[16]Nothnick WB,Graham A,Holbert J,et al.miR-451 Deficiency Is Associated with Altered Endometrial Fibrinogen Alpha Chain Expression and Reduced Endometriotic Implant Establishment in an Experimental Mouse Model[J].PLoS One,2014,9(6):e100336.
