子宫内膜异位症患者血清中HMGB1、RBP4和CA125的水平及诊断价值
|
摘要
背景和目的
子宫内膜异位症(endometriosis, EMs)简称内异症,是指有功能的子宫内膜(腺体和间质)异位在子宫腔以外的身体其他部位,主要发生于生殖器、膀胱、腹膜和直肠等处,属于性质良性而行为却类似恶性肿瘤的常见妇科疾病。该病多见于育龄妇女,发病率约10%-15%。近年来内异症发病率有明显升高的趋势,严重影响妇女的身体健康及生活质量。内异症发病机制至今尚不明确,研究证实内异症患者体内的免疫系统调节功能异常,大量细胞因子分泌失调(包括数量及活性的改变),它们相互之间形成了正反馈,使体内的无菌性炎症反应大大增加,导致内异症的发生及发展。因此,可以把内异症看作是一种免疫缺陷导致的炎症相关性疾病,尤其是腹腔局部微环境的炎症反应对异位内膜细胞的增殖、生长影响较大。
高迁移率组蛋白B1(high mobility group protein B1，HMGB1)属于非组蛋白,它含量丰富且高度保守,广泛存在于真核生物的细胞核内。近年来研究显示,HMGB1可调节炎症反应过程,对内异症的发展也有重要的影响。目前国内外关于HMGB1与内异症的报道较少,尚未被考虑应用于临床诊断。
视黄醇结合蛋白4(retinol binding protein4, RBP4)属于一种脂肪因子,主要由肝脏分泌。近年来大量的研究发现RBP4也属于一种蛋白质,由脂肪细胞分泌,它有多种生物学活性。在基因方面,RBP4与炎症标记物相关。有研究显示,内异症患者腹腔液中RBP4的含量随内异症期别的升高而升高,说明腹腔微环境中RBP4基因的表达可能与异位内膜及间质细胞增生相关。目前关于RBP4在内异症血清中的表达情况研究较少。
癌抗原125(cancer antigen125, CA125)是目前研究最多的肿瘤标志物,对内异症的诊断有一定的价值,但它不是内异症的标记性抗原,对内异症的诊断灵敏度和特异度均较低,因此联合其他指标检测可大大提高对内异症的诊断价值。。
关于联合检测HMGB1、RBP4及CA125三因子在子宫内膜异位症患者血清中的水平目前国内外尚未见报道。本实验通过检测子宫内膜异位症患者血清中HMGB1、RBP4及CA125的水平,分析三者相关性,探讨三者在内异症发生、发展中的关系,并分析三者对内异症的诊断价值,以期对子宫内膜异位症临床上无创性诊断起到一定指导作用。
材料与方法
1实验分组
1.1病例组：随机抽取2011年11月至2012年10月在我院妇科住院行手术治疗,根据术中腹腔镜诊断的60例内异症患者,根据美国生育协会于1985年修订的(the revised classification of the American Fertility Society,r-AFS)分期,I-II期30例,III-IV期30例。患者年龄20-47岁,平均年龄31.3岁。
1.2对照组：取同期行腹腔镜手术的非内异症患者55例(包括20例卵巢成熟性畸胎瘤,15例输卵管性不孕,20例卵巢浆液性囊腺瘤),患者年龄19-49岁,平均年龄34.7岁。
1.3纳入标准：(1)育龄期妇女,无恶性肿瘤(妇科)病史；(2)术前月经周期较正常,且至少3个月内没有用过激素类药；(3)无严重的其他系统疾病(免疫系统疾病、心、肝、肾疾病、糖尿病及恶性肿瘤)；(4)无妇科急性炎症及其他的盆腔改变。
2实验方法
抽取患者清晨空腹肘静脉血,采用酶联免疫吸附法(enzyme linked immuno-sorbent assay, ELISA)检测样本血清中HMGB1、RBP4及CA125的水平,采用统计软件SPSS17.0分析处理,P<0.05为差异有统计学意义。
结果
1.内异症组和对照组血清中HMGB1、RBP4及CA125的含量
(1)内异症组血清中HMGB1、RBP4及CA125的水平明显高于对照组(P<0.05)
(2)Ⅲ-Ⅳ期患者血清中HMGB1、RBP4及CA125的水平明显高于Ⅰ-Ⅱ期(P<0.05)
2.检测血清中HMGB1、RBP4及CA125对内异症的诊断价值
单独检测患者血清中HMGB1、RBP4及CA125的表达水平,在诊断内异症中的灵敏度及特异度依次为：83.34%,65.45%；86.67%,78.18%；56.67%,81.82%。联合检测患者血清中HMGB1、RBP4及CA125的表达水平,采取并联试验时：HMGB1+RBP4+CA125的灵敏度为92.78%,特异度为60.61%;采取串联试验时：HMGB1+RBP4+CA125的灵敏度为47.78%,特异度为96.97%。
3.内异症组血清中HMGB1、RBP4及CA125的相关性分析
内异症组血清中HMGB1和RBP4的水平呈正相关(r=0.801,P<0.05)；内异症组血清中HMGB1和RBP4的水平与CA125的水平均无相关性(r=0.102,P>0.05；r=0.130,P>0.05)。
结论
1. HMGB1、RBP4及CA125可能参与内异症的发生发展过程,且与疾病的严重程度相关联。
2.单独检测血清中HMGB1、RBP4及CA125的水平对内异症的诊断价值有限；联合检测血清中三者的水平时,采取三者串联实验判断内异症时的特异性最高,可尝试作为诊断内异症的血清学标志物。
3.HMGB1与RBP4在内异症的发生发展过程中可能有协同作用。
Background and Objective
Endometriosis (EMs) is a general disease of gynaecology which nature of the benign and the behavior is similar to malignant tumor. EMs refers to the functional endometrial (glands and stroma) growth in other parts of the body outside the uterine cavity, mainly in the place such as genital, bladder, rectum and peritoneum. It is more common in women of childbearing age and the incidence is about10%～15%. The incidence of EMs has obvious rising trend in recent years, seriously impacting on women's health and quality of life. The pathogenesis of EMs remains unclear, studies confirm that immune function in EMs patients with dysfunction and various cytokines, including a large number of inflammatory cytokine changes in number and activity which form a positive feedback to expand non-bacterial inflammatory response and promot the development of EMs. Therefore, EMs as an immune deficiency leading to inflammation-related diseases, especially the inflammation of abdominal cavity microenvironment had a greater influence on the growth and proliferation of ectopic endometrial cells.
High mobility group protein B1(HMGB1) is a content-rich, highly conservative non-histone, widely found in nucleus of eukaryotic organisms. In recent years, studies have shown that HMGB1may adjust the inflammation process, also have an important impact on the development of EMs. Reports of HMGB1to EMs are less at home and abroad, so HMGB1has not yet been considered applied to clinical diagnosis of EMs.
Retinol binding protein4(RBP4) is an adipocytokines mainly secreted by the liver. In recent years it has been found that RBP4is a protein secreted by fat cell with variety of biological activities. In terms of gene, RBP4is associated with inflammatory markers. Studies have shown that RBP4content increased in response to elevated levels in peritoneal fluid of EMs patients. At present, the research about RBP4level in serum of EMs patients are very little.
Cancer antigen125(CA125) is one of the most studied tumor markers by far with certain value to the diagnosis of EMs, but it is not the markup antigen of EMs, the diagnosis sensitivity and speciality degree is low, so we need to combine other indicators to improve the diagnosis of EMs.
It has not been reported about the joint detection of HMGB1, RBP4and CA125in the serum levels of EMs patients domestic and overseas. In this experiment,the HMGB1, RBP4and CA125in the serum levels of EMs patients are detected and correlation analysis in them, aiming to discusses the relations of them in the development and progression of EMs and analyze the diagnostic value of them, in order to obtain guidance in the clinically non-invasive diagnosis in EMs.
Materials and methods
1. Experimental groups
1.1Experimental group:In our hospital,60patients were chosen from November2011to October2012. All of them, aged from20to47, were diagnosed for EMs after laparoscopic surgery, with average age31.3. According to the staging standard of r-AFS in1985, Ⅰ-Ⅱ30cases, and III-IV30cases.
1.2Control group:Selected55cases in patients given laparoscopic surgery (including15cases of tubal infertility,20cases of ovarian mature teratoma and20 cases of ovarian serous cystadenoma) in the same period. All of the patients, aged from19to49, and the average age was34.7.
1.3Inclusion criteria:(1) Women of childbearing age, without a history of gynecologic malignant tumors;(2) Preoperative menstrual cycle is normal, at least3months did not use hormonal drugs;(3) No other serious diseases (autoimmune diseases, cardiovascular disease, liver disease, kidney disease, diabetes and cancer);(4) No acute pelvic inflammation and other pelvic changes.
2. Experimental methods
Their fasting elbow venous blood was taken in the early morning. The concentration of HMGB1, RBP4and CA125were detected by ELISA and analyzed by SPSS17.0. There was statistically significant difference (P<0.05).
Results
1. The serum levels of HMGB1, RBP4and CA125in EMs patients
(1) The serum levels of HMGB1, RBP4and CA125in EMs patients were significantly higher than control group (P<0.05)
(2) The serum levels of HMGB1, RBP4and CA125in stage Ⅲ-Ⅳ of EMs patients were significantly higher than stage Ⅰ-Ⅱ (P<0.05)
2. The diagnostic value of HMGB1, RBP4and CA125of serum in EMs patients
When separate detecting of the serum levels of HMGB1, RBP4or CA125was used to diagnose EMs, the sensitivity and the specificity was83.34%,65.45%;86.67%,78.18%;56.67%,81.82%. If the joint test of HMGB1, RBP4and CA125in the serum of EMs patients was used, the parallel experiments of the sensitivity and specificity were92.78%and60.61%and the series experiments were47.78%and96.97%.
3. The correlations of HMGB1, RBP4and CA125of serum in EMs patients
The serum levels of HMGB1were positive correlation with that of RBP4in EMs patients (r=0.801, P<0.05); The serum levels of HMGB1and RBP4had no correlation with that of CA125in EMs patients (r=0.102, P>0.05; r=0.130, P>0.05).
Conclusion
1. HMGB1, RBP4and CA125maybe involve in the EMs progression. Besides, they also have relevance with the EMs severity.
2. The diagnostic value of separate detecting the serum levels of HMGB1, RBP4or CA125is limited; When joint detecting the serum levels of HMGB1, RBP4and CA125, the specificity in series were the highest, so we can try to use this as a serological markers of EMs diagnosis.
3. HMGB1and RBP4may take synergetic effect in the development process of EMs.
子宫内膜异位症(endometriosis, EMs)简称内异症,是指有功能的子宫内膜(腺体和间质)异位在子宫腔以外的身体其他部位,主要发生于生殖器、膀胱、腹膜和直肠等处,属于性质良性而行为却类似恶性肿瘤的常见妇科疾病。该病多见于育龄妇女,发病率约10%-15%。近年来内异症发病率有明显升高的趋势,严重影响妇女的身体健康及生活质量。内异症发病机制至今尚不明确,研究证实内异症患者体内的免疫系统调节功能异常,大量细胞因子分泌失调(包括数量及活性的改变),它们相互之间形成了正反馈,使体内的无菌性炎症反应大大增加,导致内异症的发生及发展。因此,可以把内异症看作是一种免疫缺陷导致的炎症相关性疾病,尤其是腹腔局部微环境的炎症反应对异位内膜细胞的增殖、生长影响较大。
高迁移率组蛋白B1(high mobility group protein B1，HMGB1)属于非组蛋白,它含量丰富且高度保守,广泛存在于真核生物的细胞核内。近年来研究显示,HMGB1可调节炎症反应过程,对内异症的发展也有重要的影响。目前国内外关于HMGB1与内异症的报道较少,尚未被考虑应用于临床诊断。
视黄醇结合蛋白4(retinol binding protein4, RBP4)属于一种脂肪因子,主要由肝脏分泌。近年来大量的研究发现RBP4也属于一种蛋白质,由脂肪细胞分泌,它有多种生物学活性。在基因方面,RBP4与炎症标记物相关。有研究显示,内异症患者腹腔液中RBP4的含量随内异症期别的升高而升高,说明腹腔微环境中RBP4基因的表达可能与异位内膜及间质细胞增生相关。目前关于RBP4在内异症血清中的表达情况研究较少。
癌抗原125(cancer antigen125, CA125)是目前研究最多的肿瘤标志物,对内异症的诊断有一定的价值,但它不是内异症的标记性抗原,对内异症的诊断灵敏度和特异度均较低,因此联合其他指标检测可大大提高对内异症的诊断价值。。
关于联合检测HMGB1、RBP4及CA125三因子在子宫内膜异位症患者血清中的水平目前国内外尚未见报道。本实验通过检测子宫内膜异位症患者血清中HMGB1、RBP4及CA125的水平,分析三者相关性,探讨三者在内异症发生、发展中的关系,并分析三者对内异症的诊断价值,以期对子宫内膜异位症临床上无创性诊断起到一定指导作用。
材料与方法
1实验分组
1.1病例组：随机抽取2011年11月至2012年10月在我院妇科住院行手术治疗,根据术中腹腔镜诊断的60例内异症患者,根据美国生育协会于1985年修订的(the revised classification of the American Fertility Society,r-AFS)分期,I-II期30例,III-IV期30例。患者年龄20-47岁,平均年龄31.3岁。
1.2对照组：取同期行腹腔镜手术的非内异症患者55例(包括20例卵巢成熟性畸胎瘤,15例输卵管性不孕,20例卵巢浆液性囊腺瘤),患者年龄19-49岁,平均年龄34.7岁。
1.3纳入标准：(1)育龄期妇女,无恶性肿瘤(妇科)病史；(2)术前月经周期较正常,且至少3个月内没有用过激素类药；(3)无严重的其他系统疾病(免疫系统疾病、心、肝、肾疾病、糖尿病及恶性肿瘤)；(4)无妇科急性炎症及其他的盆腔改变。
2实验方法
抽取患者清晨空腹肘静脉血,采用酶联免疫吸附法(enzyme linked immuno-sorbent assay, ELISA)检测样本血清中HMGB1、RBP4及CA125的水平,采用统计软件SPSS17.0分析处理,P<0.05为差异有统计学意义。
结果
1.内异症组和对照组血清中HMGB1、RBP4及CA125的含量
(1)内异症组血清中HMGB1、RBP4及CA125的水平明显高于对照组(P<0.05)
(2)Ⅲ-Ⅳ期患者血清中HMGB1、RBP4及CA125的水平明显高于Ⅰ-Ⅱ期(P<0.05)
2.检测血清中HMGB1、RBP4及CA125对内异症的诊断价值
单独检测患者血清中HMGB1、RBP4及CA125的表达水平,在诊断内异症中的灵敏度及特异度依次为：83.34%,65.45%；86.67%,78.18%；56.67%,81.82%。联合检测患者血清中HMGB1、RBP4及CA125的表达水平,采取并联试验时：HMGB1+RBP4+CA125的灵敏度为92.78%,特异度为60.61%;采取串联试验时：HMGB1+RBP4+CA125的灵敏度为47.78%,特异度为96.97%。
3.内异症组血清中HMGB1、RBP4及CA125的相关性分析
内异症组血清中HMGB1和RBP4的水平呈正相关(r=0.801,P<0.05)；内异症组血清中HMGB1和RBP4的水平与CA125的水平均无相关性(r=0.102,P>0.05；r=0.130,P>0.05)。
结论
1. HMGB1、RBP4及CA125可能参与内异症的发生发展过程,且与疾病的严重程度相关联。
2.单独检测血清中HMGB1、RBP4及CA125的水平对内异症的诊断价值有限；联合检测血清中三者的水平时,采取三者串联实验判断内异症时的特异性最高,可尝试作为诊断内异症的血清学标志物。
3.HMGB1与RBP4在内异症的发生发展过程中可能有协同作用。
Background and Objective
Endometriosis (EMs) is a general disease of gynaecology which nature of the benign and the behavior is similar to malignant tumor. EMs refers to the functional endometrial (glands and stroma) growth in other parts of the body outside the uterine cavity, mainly in the place such as genital, bladder, rectum and peritoneum. It is more common in women of childbearing age and the incidence is about10%～15%. The incidence of EMs has obvious rising trend in recent years, seriously impacting on women's health and quality of life. The pathogenesis of EMs remains unclear, studies confirm that immune function in EMs patients with dysfunction and various cytokines, including a large number of inflammatory cytokine changes in number and activity which form a positive feedback to expand non-bacterial inflammatory response and promot the development of EMs. Therefore, EMs as an immune deficiency leading to inflammation-related diseases, especially the inflammation of abdominal cavity microenvironment had a greater influence on the growth and proliferation of ectopic endometrial cells.
High mobility group protein B1(HMGB1) is a content-rich, highly conservative non-histone, widely found in nucleus of eukaryotic organisms. In recent years, studies have shown that HMGB1may adjust the inflammation process, also have an important impact on the development of EMs. Reports of HMGB1to EMs are less at home and abroad, so HMGB1has not yet been considered applied to clinical diagnosis of EMs.
Retinol binding protein4(RBP4) is an adipocytokines mainly secreted by the liver. In recent years it has been found that RBP4is a protein secreted by fat cell with variety of biological activities. In terms of gene, RBP4is associated with inflammatory markers. Studies have shown that RBP4content increased in response to elevated levels in peritoneal fluid of EMs patients. At present, the research about RBP4level in serum of EMs patients are very little.
Cancer antigen125(CA125) is one of the most studied tumor markers by far with certain value to the diagnosis of EMs, but it is not the markup antigen of EMs, the diagnosis sensitivity and speciality degree is low, so we need to combine other indicators to improve the diagnosis of EMs.
It has not been reported about the joint detection of HMGB1, RBP4and CA125in the serum levels of EMs patients domestic and overseas. In this experiment,the HMGB1, RBP4and CA125in the serum levels of EMs patients are detected and correlation analysis in them, aiming to discusses the relations of them in the development and progression of EMs and analyze the diagnostic value of them, in order to obtain guidance in the clinically non-invasive diagnosis in EMs.
Materials and methods
1. Experimental groups
1.1Experimental group:In our hospital,60patients were chosen from November2011to October2012. All of them, aged from20to47, were diagnosed for EMs after laparoscopic surgery, with average age31.3. According to the staging standard of r-AFS in1985, Ⅰ-Ⅱ30cases, and III-IV30cases.
1.2Control group:Selected55cases in patients given laparoscopic surgery (including15cases of tubal infertility,20cases of ovarian mature teratoma and20 cases of ovarian serous cystadenoma) in the same period. All of the patients, aged from19to49, and the average age was34.7.
1.3Inclusion criteria:(1) Women of childbearing age, without a history of gynecologic malignant tumors;(2) Preoperative menstrual cycle is normal, at least3months did not use hormonal drugs;(3) No other serious diseases (autoimmune diseases, cardiovascular disease, liver disease, kidney disease, diabetes and cancer);(4) No acute pelvic inflammation and other pelvic changes.
2. Experimental methods
Their fasting elbow venous blood was taken in the early morning. The concentration of HMGB1, RBP4and CA125were detected by ELISA and analyzed by SPSS17.0. There was statistically significant difference (P<0.05).
Results
1. The serum levels of HMGB1, RBP4and CA125in EMs patients
(1) The serum levels of HMGB1, RBP4and CA125in EMs patients were significantly higher than control group (P<0.05)
(2) The serum levels of HMGB1, RBP4and CA125in stage Ⅲ-Ⅳ of EMs patients were significantly higher than stage Ⅰ-Ⅱ (P<0.05)
2. The diagnostic value of HMGB1, RBP4and CA125of serum in EMs patients
When separate detecting of the serum levels of HMGB1, RBP4or CA125was used to diagnose EMs, the sensitivity and the specificity was83.34%,65.45%;86.67%,78.18%;56.67%,81.82%. If the joint test of HMGB1, RBP4and CA125in the serum of EMs patients was used, the parallel experiments of the sensitivity and specificity were92.78%and60.61%and the series experiments were47.78%and96.97%.
3. The correlations of HMGB1, RBP4and CA125of serum in EMs patients
The serum levels of HMGB1were positive correlation with that of RBP4in EMs patients (r=0.801, P<0.05); The serum levels of HMGB1and RBP4had no correlation with that of CA125in EMs patients (r=0.102, P>0.05; r=0.130, P>0.05).
Conclusion
1. HMGB1, RBP4and CA125maybe involve in the EMs progression. Besides, they also have relevance with the EMs severity.
2. The diagnostic value of separate detecting the serum levels of HMGB1, RBP4or CA125is limited; When joint detecting the serum levels of HMGB1, RBP4and CA125, the specificity in series were the highest, so we can try to use this as a serological markers of EMs diagnosis.
3. HMGB1and RBP4may take synergetic effect in the development process of EMs.
引文
[1]Omwandho CO, Konrad L, Halis G, et al. Role of TGF-betas in normal humanendometrium and endometriosis[J]. Hum Reprod,2010,25(1):101-109.
[2]Veeraswamy A, Lewis M, Mann A, et al. Extragenital endometriosis[J]. Clin Obstet Gynecol, 2010,53(2):449-466.
[3]Cakmak H, Guzeloglu-Kayisli O, Kayisli UA, et al. Immune-endocrine interactions in endometriosis[J]. Front Biosci(Elite Ed),2009,19(1):429-443.
[4]赵敏,陆江阳,吕艺,等.高迁移率族蛋白B1的生物学效应及在几种疾病发病中的作用[J].军事医学科学院院刊,2005,29(1)：91-95.
[5]Liu H, Yao YM, Yu Y, et al. Role of Janus kinase/signal transducer and activator of transcription pathway in regulation of expression and inflammation-promoting activity of high mobility group box protein 1 in rat peritoneal macrophages [J]. Shock,2007,27(1): 55-60.
[6]Perseghin G, Lattuada G, De Cobelli F, et al. Serum retinol-binding protein-4,leptin, and adiponectin concentrations are related to ectopic fat accumulation [J]. J Clin Endocrinol Metab,2007,92(12):4883-4888.
[7]Yao-Borengasser A, Varma V, Bodles AM, et al. Retinol binding protein 4 expression in humans:relationship to insulin resistance, inflammation,and response to pioglitazone[J]. J Clin Endocrinol Metab,2007,92(7):2590-2597.
[8]Park BJ, Kim TE, Kim YW. Massive peritoneal fluid and markedly elevated serum CA125 and CA19-9 levels associated with an ovarian endometrioma[J]. J Obstet Gynaecol Res, 2009,35(5):935-939.
[9]Kurdoglu Z, Gursoy R, Kurdoglu M, et al. Comparison of the clinical value of CA19-9 versus CA125 for the diagnosis of endometriosis[J]. Fertil Steril,2009,92(5):1761-1763.
[10]Fiegler P, Kaminski K,Wegrzyn P. Serum CA125 variability-new aspects of clinical usefulness [J]. Ginekol Pol,2003,74(5):412-418.
[11]Harada T, Kubota T, Aso T. Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis[J]. Fertil Steril,2002,78 (4):733-739.
[12]Van Gorp T, Amant F, Neven P, et al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature[J]. Best Pract Res Clin Obstet Gynaecol,2004, 18(2):349-371.
[13]朱兰,郎景和.子宫内膜异位症的免疫学研究进展[J].国外医学妇产科分册,2002,29(5)：281-282.
[14]晏红.缩宫素受体、环氧化酶-2在子宫内膜异位症、子宫腺肌病的表达及与疼痛关系的研究[D].北京：军医进修学院,2008：31.
[15]Yanai H, Ban T, Wang Z, et al. HMGB proteins function as universal sentinels for nucleic-acid-mediated innate immune responses[J]. Nature 2009,462(7269):99-103.
[16]Muller S, Ronfani L, Bianchi ME. Regulated expression and subcelluar localization of HMGB1, a chromatin protein with a cytokine function[J]. J Int-ern Med,2004,255(3):332-343.
[17]Bonaldi T, Talamo F, Scaffidi P, et al. Monocytic cells hyperacetylate chromatin protein HMGBlto redirect it towards secretion[J]. EMBO J,2003,22(20):5551-5560.
[18]Sarac S, Ayhan A, Hosal AS, et al. Prognostic significance of PCNA expression in laryngeal cancer [J]. Arch Otolaryngol Head Neck Surg,1998,124(12):1321-1324.
[19]Messmer D, Yang H, Telusma G, et al. High mobility group box protein 1:an endogenous signal for dendritic cell maturation and Thl polarization[J]. J Immunol,2004,173(1):307-313.
[20]Wang H, Bloom O, ZhangM, et al. HMG-1 as a late mediator of endotoxin lethality in mice[J]. Science,1999,285 (5425):248-251.
[21]刘旺华,李花,肖献忠.高迁移率族蛋白B-1与炎症关系的研究进展[J].中国病理生理杂志,2008,24(8)：1656-1660.
[22]Taguchi A, Blood DC, del Toro G, et al. Blockade of RAGE-amphoterin signalling suppresses tumour growth and metastases[J]. Nature,2000,405(6784):354-360.
[23]Johnson MC, Torres M, Alves A, et al. Augmented cell survival in eutopic endometrium from women with endometriosis:expression of c-mye,TGF-beta 1 and bax genes[J]. Reprod Biol Endocrinol,2005,3:45.
[24]Tamatani M, Mitsuda N, Matsuzaki H, et al. A pathway of neuronal apoptosis induced by hypoxia/reoxygenation:roles of nuclear factor-kappaB and Bcl-2[J]. J Neurochem,2000, 75(2):683-693.
[25]赵龙军.子宫内膜异位症患者血清及组织中高迁移率组蛋白B1的表达及其作用机制的研究[D].泰安：泰山医学院,2009：23.
[26]丁云川.视黄醇结合蛋白4研究进展[J].右江医学,2011,39(3)：373-375.
[27]Noy N. Retinoid-binding proteins:mediators of retinoid action[J]. Biochem J,2000, 348(3):481-495.
[28]Quadro L, Hamberger L, Colantuoni V, et al. Understanding the physiological role of retinol-binding protein in vitamin A metabolism using transgenic and knockout mouse models[J]. Mol Aspects Med,2003,24 (6):421-430.
[29]Vanitallie TB. Frailty in the elderly:contributions of sarcopenia and visceral protein depletion[J]. Metabolism,2003,52(10 Suppl 2):22-26.
[30]秦志琳. RBP4、Leptin与2型糖尿病及炎症的相关研究[D].广西：广西医科大学,2007：14.
[31]Farjo KM, Farjo RA, Halsey S, et al. Retinol-binding protein 4 induces inflammation in human endothelial cells by an NADPH oxidase-and nuclear factor kappa B-dependent and retinol-independent mechanism[J]. Mol Cell Biol,2012,32(24):5103-5115.
[32]张文敏,赵艳丽,班开斌,等.子宫内膜异位症患者RBP4与ENA-78的含量变化[J].中华全科医学,2012,10(3)：384-385.
[33]Durdevic'S, Stojanovic'S, Marijana BN, et al. Rational application of tumor marker CA125 in gynecological oncology[J]. Med Pregl,2010,63(3-4):195-199.
[34]Daoud E,Bodor G. CA-125 concentrations in malignant and nonmalignant disease[J]. Clin Chem,1991,37(11):1968-1974.
[35]Aggarwal P, Kehoe S. Serum tumour makers in gynaecological cancers[J]. Maturitas,2010, 67(1):46-53.
[36]朱小凤,蒋凤艳.血清CA125、EmAb与子宫内膜异位症痛经的关系[J].西部医学,2007,19(5)：873-874.
[37]Kafali H, Artuc H, Demir N. Use of CA125 fluctuation during the menstrual cycle as a tool in the clinical diagnosis of endometriosis；a preliminary report [J]. Eur J Obstet Gynecol Reprod Biol,2004,116(1):85-88.
[38]McBean JH, Brumsted JR. In vitro CA-125 secretion by endometrium from women with advanced endometriosis[J]. Fertil Steril,1993,59(1):89-92.
[39]樊冬梅,陈志敏,史惠蓉.子宫内膜异位症患者血清CA125水平测定[J].郑州大学学报(医学版),2006,41(2)：347-348.
[40]Maiorana A, Cicerone C, Niceta M, et al. Evaluation of serum CA125 levels in patients with pelvic pain related to endometriosis[J]. Int J BiolMarkers,2007,22(3):200-202.
[41]李云霞,徐琳,苏玉林.血清和腹腔液中IL-6、TNF-α及CA125与子宫内膜异位症关系探讨[J].昆明医学院学报,2009,30(9)：73-78.
[42]屈王蕾,吕杰强,董剑达.血清和腹腔液CA125对子宫内膜异位症和子宫腺肌症的诊断价值[J].中国妇幼保健,2007,22(16)：2252-2254.
[43]Broseens J, Timmerman D, Starzinski-Powitz A, et al. Noninvasive diagnosis of endometriosis:the role of imaging and markers[J]. Obstet Gynecol Clin North Am,2003, 30(1):95-114.
[44]刘爱民.血.清CA125和CA19-9水平对子宫内膜异位症诊断价值的探讨[J].放射免疫学杂志,2008,21(1)：11-13.
[l]冷金花,郎景和,等.盆腔子宫内膜异位症病灶分布特点及其腹腔镜诊断标准性的评价[J].中华妇产科杂志,2006,41(2)：111-113.
[2]Wu WC, Hsiao MW,Ye JC,et al. Malignant transformation of extragonadal endometriosis:a case report[J]. Eur J Gynaecol Oncol,2009,30(5):563-565.
[3]赵昀,李亚里.子宫内膜异位症病因学基础与临床研究[J].中国实用妇科与产科杂志,2001,17(8)：499-503.
[4]Oehmke F, Weyand J, Hackethal A, et al. Impact of endometriosis on quality of life:a pilot study[J]. Gynecol Endocrinol,2009,25(11):722-725.
[5]Harkki P,TiitinenA, Ylikorkala O. Endometriosis and assisted reproduction techniques[J]. Ann N Y Acad Sci,2010,1205:207-213.
[6]乐杰.妇产科学[M].第六版.北京：人民卫生出版社,2005：354-355.
[7]Seli E, Berkkanoglu M, Arici A. Pathogenesis of endometriosis[J]. Obstet Gynecol Clin North Am,2003,30 (1):41-61.
[8]仝佳丽,郎景和.子宫内膜异位症的在位内膜病变研究进展[J].现代妇产科进展,2010,19(6)：465-467.
[9]郎景和.子宫内膜异位症研究的新里程[J].中华妇产科杂志,2005,40(1)：3-4.
[10]郎景和,冷金花,周应芳,等.子宫内膜异位症[J].现代妇产科学进展,2006,15(3)：161-172.
[11]Meola J, Rosa e Silva JC, Dentillo DB, et al. Differentially expressed genes in eutopic and ectopic endometrium of women with endometriosis[J]. Fertil Steril,2010,93(6):1750-1773.
[12]Sha G, Wu D, Zhang L, et al. Differentially expressed genes in human endometrial endothelial cells derived from eutopic endometrium of patients with endometriosis compared with those from patients without endometriosis [J]. Hum Reprod,2007,22 (12):3159-3169.
[13]Zheng W, Li N, Wang J, et al. Initial endometriosis showing direct morphologic evidence of metaplasia in the pathogenesis of ovarian endometriosis[J]. Int J Gynecol Pathol,2005,24 (2):164-172.
[14]蒋红清,李亚里.子宫内膜异位症免疫学研究进展[J].国外医学妇产科分册,2006,33(2)：79-82.
[15]李华军,郎景和,刘珠凤,等.子宫内膜异位症患者在位内膜细胞的异常生物学特性[J].中日友好医学学报,2007,21(6)：323-326.
[16]周礼兰,林婉君.子宫内膜异位症发病机制研究进展[J].国际妇产科学杂志,2012,39(4)：395-398.
[17]Tsuchiya M, Nakao H, Katoh T, et al. Association between endometriosis and genetic polymorphisms of the estradiol-synthesizing enzyme genes HSD 17B1 and CYP 19[J]. Hum Reprod,2005,20 (4):974-978.
[18]王志红,申爱荣.子宫内膜异位症患者血清和腹腔液中CA125和抗转铁蛋白抗体的表达及诊断价值[D].郑州：郑州大学,2011,28.
[19]纪巍,宋晖,陈必良.子宫内膜异位症的发病机制研究[J].国外医学妇幼保健分册,2000,11(4)：145-147.
[20]刘颂平,温坚.子宫内膜异位症发病机制研究新进展[J].医学综述,2013,19(2)：291-294.
[21]Osuga Y, Koga K, Tsutsumi O, et al. Stem cell factor(SCF) concentrations in peritoneal fluid of women with or without endometriosis[J]. Am J Reprod Immunol,2000,44 (4):231-235.
[22]Gargett CE, Schwab KE, Zillwood RM, et al. Isolation and culture of epithelial progenitors and mesenchymal stem cells from human endometrium[J]. Biol Reprod,2009,80(6):1136-1145.
[23]杨红,朱琰,周华,等.子宫内膜异位症与干细胞学说[J].国际妇产科学杂志,2012,39(3)：217-238.
[24]洪湘兰.在子宫内膜异位症的病因和发病机制[J].中国现代应用药学杂志,2008,25(8)：769-771.
[25]焦丽,曹保利.子宫内膜异位症发病机制的研究进展[J].医学综述,2010,16(12)：1856-1858.
[26]Oral E, Arici A. Pathogenesis of endometriosis[J]. Obstet Gynecol Clin North Am,1997,24 (2):219-233.
[27]Kennedy S. Is there a genetic basis to endometriosis?[J]. Semin Reprod Endocrinol,1997, 15(3):309-318.
[28]安晓汾,陈必良,苏明权,等.CYP1A1基因多态性在子宫内膜异位症中的表达[J].肿瘤防治研究,2003,30(1)：18-20.
[29]Rier SE, Martin DC, Bowman RE, et al. Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin[J]. Fundam Appl Toxicol,1993,21(4):433-441.
[30]李大金.环境与内分泌因素在子宫内膜异位症发病中的作用[A]；全国中西医结合生殖健康学术研讨会论文及摘要集[C]；2000年.
[31]Muzii L, Marana R, Pedulla S, et al. Correlation between endometriosis-associated dysmen-orrhea and the presence of typical of atypical lesions [J]. Fertil Steril,1997,68(1):19-22.
[32]郎景和,冷金花,周应芳,等.子宫内膜异位症[J].现代妇产科进展,2006,15(3)：161-172.
[33]郑兆秋.子宫内膜异位症的临床表现特点及其相关因素[J].中国中医药现代远程教育,2010,8(19)：76.
[34]Chatterjee S, Chakravarti S. Screening of endometriosis at an early stage:a simple clinical approach[J]. J Indian Med Assoc,2000,98(7):387-393.
[35]Scurry J, Whitehead J, Healey M. Classification of ovarian endometriotic cysts [J]. Int J Gynecol Pathol,2001,20(2):147-154.
[36]Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis:surgical implications and proposition for a classification[J]. Hum Reprod, 2003,18(1):157-161.
[37]Hilaris GE, Payne CK, Osias J, et al. Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis [J]. J Societ Laparoe Surg,2005,9(1):78-82.
[38]Marana R, Paparella R, Ferrari S, et al. Laparoscopic diagnosis of peritoneal endometriosis [J]. Minerva Ginecol,2008,60(6):552-554.
[39]Malik E, Berg C, Meyhofer-Malik A, et al. Fluorescence diagnosis of endometriosis using 5-aminolevulinic acid[J]. Hum Reprod,2000,14(5):452-455.
[40]任真珍.盆腔子宫内膜异位症的超声诊断及动态观察[J].现代诊断与治疗,2006,17(3)：185.
[41]苗丽萍.尿中可溶性血管内皮生长因子受体-1在子宫内膜异位症中的表达及意义[D].大连：大连医科大学,2010：5.
[42]Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endometriosis [J]. Obstet Gynecol,2002,99(3):375-380.
[43]Vigano P, Somigliana E, Di Blasio AM, et al. Suppression of natural killer cell function and production of soluble ICAM-1:endometrial stroma versus melanoma[J]. Am J Reprod Immunol,2001,46(5):342-348.
[44]Ametzazurra A, Matorras R, Garcia-Velasco JA, et al. Endometrial fluid is a specific and non-invasive biological sample for protein biomarker identification in endometriosis[J]. Hum Reprod,2009,24(4):954-965.
[45]Burney RO, Hamilton AE, Aghajanova L, et al. MicroRNA expression profiling of eutopic secretory endometrium in women with versus without endometriosis[J]. Mol Hum ReProd, 2009,15(10):625-631.
[46]Liu HY, Zheng YH, Zhang JZ, et al. Establishment of endometriosis diagnostic model using plasma protein profiling[J]. Zhonghua Fu Chan Ke Za Zhi,2009,44(8):601-604.
[47]刘亚南,昌晓红,崔恒.子宫内膜异位症生物标记物的研究进展[J].中国临床医师杂志,2010,14(10)：1901-1904.
[48]Vercellini P, Frontino G, De Giorgi O, et al. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen[J]. Fertil Steril,2003,80(3):560-563.
[49]Gomes MK, Rosa-e-Silva JC, Garcia SB, et al. Effects of the levonorgestrel-releasing intrau-terine system on cell proliferation, Fas expression and steroid receptors in endometriosis lesions and normal endometrium[J]. Hum Reprod,2009,24(11):2736-2745.
[50]刘渝红,廖静蜀.子宫内膜异位症诊断与治疗的基础研究进展[J].医学论坛杂志,2011,32(14)：203-206.
[51]郎景和.子宫内膜异位症研究的任务与展望(之二)[J].中华妇产科杂志,2006,41(10)：649-651.
[52]Kupker W, Felberbaum RE, Krapp M, et al. Use of CnRH antagonists in the treatment of endometriosis[J]. Reprod Biomed Online,2002,5(1):12-16.
[53]Bulun SE, Fang Z, Imir G, et al. Aromatase and endometriosis [J]. Semin Reprod Med,2004, 22(1):45-50.
[54]Cobellis L, Razzi S, De Simone S, et al. The treatment with a COX-2 specific inhibitor is effective in the management of pain related to endometriosis [J]. Eur J Obstet Gynecol Reprod Biol,2004,116 (1):100-102.
[55]邢玉霞.中药治疗子宫内膜异位症痛经58例[J].实用中医药杂志,2005,21(3)：154.
[56]刘秋红,黄凤英.子宫内膜异位症的诊断和治疗进展[J].医学与哲学(临床决策论坛版),2006,27(10)：63-66.
[57]Valle RF, Sciarra JJ. Endometriosis:treatment strategies [J]. Ann N Y Acad Sci,2003,997(3): 229-239.
[58]Scarselli G, Rizzello F, Cammilli F, et al. Diagnosis and treatment of endometriosis [J]. Minerva Ginecol,2005,57(1):55-78.
[59]do Amaral VF, Bydlowski SP, Peranovich TC, et al. Lipid peroxidation in the peritoneal fluid of infertile women with peritoneal endometriosis[J]. Eur J Ob-stet Gynecol Reprod Biol, 2005,119(1):72-75.
[2]Veeraswamy A, Lewis M, Mann A, et al. Extragenital endometriosis[J]. Clin Obstet Gynecol, 2010,53(2):449-466.
[3]Cakmak H, Guzeloglu-Kayisli O, Kayisli UA, et al. Immune-endocrine interactions in endometriosis[J]. Front Biosci(Elite Ed),2009,19(1):429-443.
[4]赵敏,陆江阳,吕艺,等.高迁移率族蛋白B1的生物学效应及在几种疾病发病中的作用[J].军事医学科学院院刊,2005,29(1)：91-95.
[5]Liu H, Yao YM, Yu Y, et al. Role of Janus kinase/signal transducer and activator of transcription pathway in regulation of expression and inflammation-promoting activity of high mobility group box protein 1 in rat peritoneal macrophages [J]. Shock,2007,27(1): 55-60.
[6]Perseghin G, Lattuada G, De Cobelli F, et al. Serum retinol-binding protein-4,leptin, and adiponectin concentrations are related to ectopic fat accumulation [J]. J Clin Endocrinol Metab,2007,92(12):4883-4888.
[7]Yao-Borengasser A, Varma V, Bodles AM, et al. Retinol binding protein 4 expression in humans:relationship to insulin resistance, inflammation,and response to pioglitazone[J]. J Clin Endocrinol Metab,2007,92(7):2590-2597.
[8]Park BJ, Kim TE, Kim YW. Massive peritoneal fluid and markedly elevated serum CA125 and CA19-9 levels associated with an ovarian endometrioma[J]. J Obstet Gynaecol Res, 2009,35(5):935-939.
[9]Kurdoglu Z, Gursoy R, Kurdoglu M, et al. Comparison of the clinical value of CA19-9 versus CA125 for the diagnosis of endometriosis[J]. Fertil Steril,2009,92(5):1761-1763.
[10]Fiegler P, Kaminski K,Wegrzyn P. Serum CA125 variability-new aspects of clinical usefulness [J]. Ginekol Pol,2003,74(5):412-418.
[11]Harada T, Kubota T, Aso T. Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis[J]. Fertil Steril,2002,78 (4):733-739.
[12]Van Gorp T, Amant F, Neven P, et al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature[J]. Best Pract Res Clin Obstet Gynaecol,2004, 18(2):349-371.
[13]朱兰,郎景和.子宫内膜异位症的免疫学研究进展[J].国外医学妇产科分册,2002,29(5)：281-282.
[14]晏红.缩宫素受体、环氧化酶-2在子宫内膜异位症、子宫腺肌病的表达及与疼痛关系的研究[D].北京：军医进修学院,2008：31.
[15]Yanai H, Ban T, Wang Z, et al. HMGB proteins function as universal sentinels for nucleic-acid-mediated innate immune responses[J]. Nature 2009,462(7269):99-103.
[16]Muller S, Ronfani L, Bianchi ME. Regulated expression and subcelluar localization of HMGB1, a chromatin protein with a cytokine function[J]. J Int-ern Med,2004,255(3):332-343.
[17]Bonaldi T, Talamo F, Scaffidi P, et al. Monocytic cells hyperacetylate chromatin protein HMGBlto redirect it towards secretion[J]. EMBO J,2003,22(20):5551-5560.
[18]Sarac S, Ayhan A, Hosal AS, et al. Prognostic significance of PCNA expression in laryngeal cancer [J]. Arch Otolaryngol Head Neck Surg,1998,124(12):1321-1324.
[19]Messmer D, Yang H, Telusma G, et al. High mobility group box protein 1:an endogenous signal for dendritic cell maturation and Thl polarization[J]. J Immunol,2004,173(1):307-313.
[20]Wang H, Bloom O, ZhangM, et al. HMG-1 as a late mediator of endotoxin lethality in mice[J]. Science,1999,285 (5425):248-251.
[21]刘旺华,李花,肖献忠.高迁移率族蛋白B-1与炎症关系的研究进展[J].中国病理生理杂志,2008,24(8)：1656-1660.
[22]Taguchi A, Blood DC, del Toro G, et al. Blockade of RAGE-amphoterin signalling suppresses tumour growth and metastases[J]. Nature,2000,405(6784):354-360.
[23]Johnson MC, Torres M, Alves A, et al. Augmented cell survival in eutopic endometrium from women with endometriosis:expression of c-mye,TGF-beta 1 and bax genes[J]. Reprod Biol Endocrinol,2005,3:45.
[24]Tamatani M, Mitsuda N, Matsuzaki H, et al. A pathway of neuronal apoptosis induced by hypoxia/reoxygenation:roles of nuclear factor-kappaB and Bcl-2[J]. J Neurochem,2000, 75(2):683-693.
[25]赵龙军.子宫内膜异位症患者血清及组织中高迁移率组蛋白B1的表达及其作用机制的研究[D].泰安：泰山医学院,2009：23.
[26]丁云川.视黄醇结合蛋白4研究进展[J].右江医学,2011,39(3)：373-375.
[27]Noy N. Retinoid-binding proteins:mediators of retinoid action[J]. Biochem J,2000, 348(3):481-495.
[28]Quadro L, Hamberger L, Colantuoni V, et al. Understanding the physiological role of retinol-binding protein in vitamin A metabolism using transgenic and knockout mouse models[J]. Mol Aspects Med,2003,24 (6):421-430.
[29]Vanitallie TB. Frailty in the elderly:contributions of sarcopenia and visceral protein depletion[J]. Metabolism,2003,52(10 Suppl 2):22-26.
[30]秦志琳. RBP4、Leptin与2型糖尿病及炎症的相关研究[D].广西：广西医科大学,2007：14.
[31]Farjo KM, Farjo RA, Halsey S, et al. Retinol-binding protein 4 induces inflammation in human endothelial cells by an NADPH oxidase-and nuclear factor kappa B-dependent and retinol-independent mechanism[J]. Mol Cell Biol,2012,32(24):5103-5115.
[32]张文敏,赵艳丽,班开斌,等.子宫内膜异位症患者RBP4与ENA-78的含量变化[J].中华全科医学,2012,10(3)：384-385.
[33]Durdevic'S, Stojanovic'S, Marijana BN, et al. Rational application of tumor marker CA125 in gynecological oncology[J]. Med Pregl,2010,63(3-4):195-199.
[34]Daoud E,Bodor G. CA-125 concentrations in malignant and nonmalignant disease[J]. Clin Chem,1991,37(11):1968-1974.
[35]Aggarwal P, Kehoe S. Serum tumour makers in gynaecological cancers[J]. Maturitas,2010, 67(1):46-53.
[36]朱小凤,蒋凤艳.血清CA125、EmAb与子宫内膜异位症痛经的关系[J].西部医学,2007,19(5)：873-874.
[37]Kafali H, Artuc H, Demir N. Use of CA125 fluctuation during the menstrual cycle as a tool in the clinical diagnosis of endometriosis；a preliminary report [J]. Eur J Obstet Gynecol Reprod Biol,2004,116(1):85-88.
[38]McBean JH, Brumsted JR. In vitro CA-125 secretion by endometrium from women with advanced endometriosis[J]. Fertil Steril,1993,59(1):89-92.
[39]樊冬梅,陈志敏,史惠蓉.子宫内膜异位症患者血清CA125水平测定[J].郑州大学学报(医学版),2006,41(2)：347-348.
[40]Maiorana A, Cicerone C, Niceta M, et al. Evaluation of serum CA125 levels in patients with pelvic pain related to endometriosis[J]. Int J BiolMarkers,2007,22(3):200-202.
[41]李云霞,徐琳,苏玉林.血清和腹腔液中IL-6、TNF-α及CA125与子宫内膜异位症关系探讨[J].昆明医学院学报,2009,30(9)：73-78.
[42]屈王蕾,吕杰强,董剑达.血清和腹腔液CA125对子宫内膜异位症和子宫腺肌症的诊断价值[J].中国妇幼保健,2007,22(16)：2252-2254.
[43]Broseens J, Timmerman D, Starzinski-Powitz A, et al. Noninvasive diagnosis of endometriosis:the role of imaging and markers[J]. Obstet Gynecol Clin North Am,2003, 30(1):95-114.
[44]刘爱民.血.清CA125和CA19-9水平对子宫内膜异位症诊断价值的探讨[J].放射免疫学杂志,2008,21(1)：11-13.
[l]冷金花,郎景和,等.盆腔子宫内膜异位症病灶分布特点及其腹腔镜诊断标准性的评价[J].中华妇产科杂志,2006,41(2)：111-113.
[2]Wu WC, Hsiao MW,Ye JC,et al. Malignant transformation of extragonadal endometriosis:a case report[J]. Eur J Gynaecol Oncol,2009,30(5):563-565.
[3]赵昀,李亚里.子宫内膜异位症病因学基础与临床研究[J].中国实用妇科与产科杂志,2001,17(8)：499-503.
[4]Oehmke F, Weyand J, Hackethal A, et al. Impact of endometriosis on quality of life:a pilot study[J]. Gynecol Endocrinol,2009,25(11):722-725.
[5]Harkki P,TiitinenA, Ylikorkala O. Endometriosis and assisted reproduction techniques[J]. Ann N Y Acad Sci,2010,1205:207-213.
[6]乐杰.妇产科学[M].第六版.北京：人民卫生出版社,2005：354-355.
[7]Seli E, Berkkanoglu M, Arici A. Pathogenesis of endometriosis[J]. Obstet Gynecol Clin North Am,2003,30 (1):41-61.
[8]仝佳丽,郎景和.子宫内膜异位症的在位内膜病变研究进展[J].现代妇产科进展,2010,19(6)：465-467.
[9]郎景和.子宫内膜异位症研究的新里程[J].中华妇产科杂志,2005,40(1)：3-4.
[10]郎景和,冷金花,周应芳,等.子宫内膜异位症[J].现代妇产科学进展,2006,15(3)：161-172.
[11]Meola J, Rosa e Silva JC, Dentillo DB, et al. Differentially expressed genes in eutopic and ectopic endometrium of women with endometriosis[J]. Fertil Steril,2010,93(6):1750-1773.
[12]Sha G, Wu D, Zhang L, et al. Differentially expressed genes in human endometrial endothelial cells derived from eutopic endometrium of patients with endometriosis compared with those from patients without endometriosis [J]. Hum Reprod,2007,22 (12):3159-3169.
[13]Zheng W, Li N, Wang J, et al. Initial endometriosis showing direct morphologic evidence of metaplasia in the pathogenesis of ovarian endometriosis[J]. Int J Gynecol Pathol,2005,24 (2):164-172.
[14]蒋红清,李亚里.子宫内膜异位症免疫学研究进展[J].国外医学妇产科分册,2006,33(2)：79-82.
[15]李华军,郎景和,刘珠凤,等.子宫内膜异位症患者在位内膜细胞的异常生物学特性[J].中日友好医学学报,2007,21(6)：323-326.
[16]周礼兰,林婉君.子宫内膜异位症发病机制研究进展[J].国际妇产科学杂志,2012,39(4)：395-398.
[17]Tsuchiya M, Nakao H, Katoh T, et al. Association between endometriosis and genetic polymorphisms of the estradiol-synthesizing enzyme genes HSD 17B1 and CYP 19[J]. Hum Reprod,2005,20 (4):974-978.
[18]王志红,申爱荣.子宫内膜异位症患者血清和腹腔液中CA125和抗转铁蛋白抗体的表达及诊断价值[D].郑州：郑州大学,2011,28.
[19]纪巍,宋晖,陈必良.子宫内膜异位症的发病机制研究[J].国外医学妇幼保健分册,2000,11(4)：145-147.
[20]刘颂平,温坚.子宫内膜异位症发病机制研究新进展[J].医学综述,2013,19(2)：291-294.
[21]Osuga Y, Koga K, Tsutsumi O, et al. Stem cell factor(SCF) concentrations in peritoneal fluid of women with or without endometriosis[J]. Am J Reprod Immunol,2000,44 (4):231-235.
[22]Gargett CE, Schwab KE, Zillwood RM, et al. Isolation and culture of epithelial progenitors and mesenchymal stem cells from human endometrium[J]. Biol Reprod,2009,80(6):1136-1145.
[23]杨红,朱琰,周华,等.子宫内膜异位症与干细胞学说[J].国际妇产科学杂志,2012,39(3)：217-238.
[24]洪湘兰.在子宫内膜异位症的病因和发病机制[J].中国现代应用药学杂志,2008,25(8)：769-771.
[25]焦丽,曹保利.子宫内膜异位症发病机制的研究进展[J].医学综述,2010,16(12)：1856-1858.
[26]Oral E, Arici A. Pathogenesis of endometriosis[J]. Obstet Gynecol Clin North Am,1997,24 (2):219-233.
[27]Kennedy S. Is there a genetic basis to endometriosis?[J]. Semin Reprod Endocrinol,1997, 15(3):309-318.
[28]安晓汾,陈必良,苏明权,等.CYP1A1基因多态性在子宫内膜异位症中的表达[J].肿瘤防治研究,2003,30(1)：18-20.
[29]Rier SE, Martin DC, Bowman RE, et al. Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin[J]. Fundam Appl Toxicol,1993,21(4):433-441.
[30]李大金.环境与内分泌因素在子宫内膜异位症发病中的作用[A]；全国中西医结合生殖健康学术研讨会论文及摘要集[C]；2000年.
[31]Muzii L, Marana R, Pedulla S, et al. Correlation between endometriosis-associated dysmen-orrhea and the presence of typical of atypical lesions [J]. Fertil Steril,1997,68(1):19-22.
[32]郎景和,冷金花,周应芳,等.子宫内膜异位症[J].现代妇产科进展,2006,15(3)：161-172.
[33]郑兆秋.子宫内膜异位症的临床表现特点及其相关因素[J].中国中医药现代远程教育,2010,8(19)：76.
[34]Chatterjee S, Chakravarti S. Screening of endometriosis at an early stage:a simple clinical approach[J]. J Indian Med Assoc,2000,98(7):387-393.
[35]Scurry J, Whitehead J, Healey M. Classification of ovarian endometriotic cysts [J]. Int J Gynecol Pathol,2001,20(2):147-154.
[36]Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis:surgical implications and proposition for a classification[J]. Hum Reprod, 2003,18(1):157-161.
[37]Hilaris GE, Payne CK, Osias J, et al. Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis [J]. J Societ Laparoe Surg,2005,9(1):78-82.
[38]Marana R, Paparella R, Ferrari S, et al. Laparoscopic diagnosis of peritoneal endometriosis [J]. Minerva Ginecol,2008,60(6):552-554.
[39]Malik E, Berg C, Meyhofer-Malik A, et al. Fluorescence diagnosis of endometriosis using 5-aminolevulinic acid[J]. Hum Reprod,2000,14(5):452-455.
[40]任真珍.盆腔子宫内膜异位症的超声诊断及动态观察[J].现代诊断与治疗,2006,17(3)：185.
[41]苗丽萍.尿中可溶性血管内皮生长因子受体-1在子宫内膜异位症中的表达及意义[D].大连：大连医科大学,2010：5.
[42]Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endometriosis [J]. Obstet Gynecol,2002,99(3):375-380.
[43]Vigano P, Somigliana E, Di Blasio AM, et al. Suppression of natural killer cell function and production of soluble ICAM-1:endometrial stroma versus melanoma[J]. Am J Reprod Immunol,2001,46(5):342-348.
[44]Ametzazurra A, Matorras R, Garcia-Velasco JA, et al. Endometrial fluid is a specific and non-invasive biological sample for protein biomarker identification in endometriosis[J]. Hum Reprod,2009,24(4):954-965.
[45]Burney RO, Hamilton AE, Aghajanova L, et al. MicroRNA expression profiling of eutopic secretory endometrium in women with versus without endometriosis[J]. Mol Hum ReProd, 2009,15(10):625-631.
[46]Liu HY, Zheng YH, Zhang JZ, et al. Establishment of endometriosis diagnostic model using plasma protein profiling[J]. Zhonghua Fu Chan Ke Za Zhi,2009,44(8):601-604.
[47]刘亚南,昌晓红,崔恒.子宫内膜异位症生物标记物的研究进展[J].中国临床医师杂志,2010,14(10)：1901-1904.
[48]Vercellini P, Frontino G, De Giorgi O, et al. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen[J]. Fertil Steril,2003,80(3):560-563.
[49]Gomes MK, Rosa-e-Silva JC, Garcia SB, et al. Effects of the levonorgestrel-releasing intrau-terine system on cell proliferation, Fas expression and steroid receptors in endometriosis lesions and normal endometrium[J]. Hum Reprod,2009,24(11):2736-2745.
[50]刘渝红,廖静蜀.子宫内膜异位症诊断与治疗的基础研究进展[J].医学论坛杂志,2011,32(14)：203-206.
[51]郎景和.子宫内膜异位症研究的任务与展望(之二)[J].中华妇产科杂志,2006,41(10)：649-651.
[52]Kupker W, Felberbaum RE, Krapp M, et al. Use of CnRH antagonists in the treatment of endometriosis[J]. Reprod Biomed Online,2002,5(1):12-16.
[53]Bulun SE, Fang Z, Imir G, et al. Aromatase and endometriosis [J]. Semin Reprod Med,2004, 22(1):45-50.
[54]Cobellis L, Razzi S, De Simone S, et al. The treatment with a COX-2 specific inhibitor is effective in the management of pain related to endometriosis [J]. Eur J Obstet Gynecol Reprod Biol,2004,116 (1):100-102.
[55]邢玉霞.中药治疗子宫内膜异位症痛经58例[J].实用中医药杂志,2005,21(3)：154.
[56]刘秋红,黄凤英.子宫内膜异位症的诊断和治疗进展[J].医学与哲学(临床决策论坛版),2006,27(10)：63-66.
[57]Valle RF, Sciarra JJ. Endometriosis:treatment strategies [J]. Ann N Y Acad Sci,2003,997(3): 229-239.
[58]Scarselli G, Rizzello F, Cammilli F, et al. Diagnosis and treatment of endometriosis [J]. Minerva Ginecol,2005,57(1):55-78.
[59]do Amaral VF, Bydlowski SP, Peranovich TC, et al. Lipid peroxidation in the peritoneal fluid of infertile women with peritoneal endometriosis[J]. Eur J Ob-stet Gynecol Reprod Biol, 2005,119(1):72-75.