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雌孕激素受体表达与卵巢型子宫内膜异位患者术后复发风险的相关性分析

Correlation between estrogen receptor expression and risk of postoperative recurrence in patients with ovarian endometriosis

    摘要
  • 摘要:
    目的 探讨雌激素受体（estrogen receptor, ER）和孕激素受体（progesterone receptor, PR）表达与卵巢型子宫内膜异位症（endometriosis, EMT）患者术后复发风险的相关性。
    方法 前瞻性选取2019年4月— 2020年4月河南南阳张仲景医院妇产科收治的卵巢EMT患者185例作为研究对象, 均接受手术治疗, 术后随访观察24个月, 根据疾病有无复发分为复发组和未复发组。对比两组一般资料, 采用免疫组织化学方法检测异位组织中ER、PR的表达情况；采用多因素logistic回归分析EMT复发的影响因素, 采用限制性立方样条拟合ER、PR表达与卵巢EMT患者术后复发风险的相关性。
    结果 随访观察24个月, 因各种原因失访4例, 最终纳入181例, 其中41例（22.65%）复发归为复发组, 其余140例（77.35%）未复发归为未复发组。两组患者术前痛经占比、美国生殖医学协会子宫内膜异位症分期（re-vised classification of American Fertility Society, r-AFS）评分、ER和PR表达水平比较差异均有统计学意义（均P < 0.05）。多因素logistic回归分析显示, 痛经（OR = 2.637, 95% CI：1.085 ~ 6.408）、高r-AFS评分（OR = 1.040, 95% CI：1.001 ~ 1.080）、高ER表达水平（OR = 1.073, 95% CI：1.029 ~ 1.118）为卵巢EMT患者术后复发风险的危险因素（P < 0.05）；高PR表达水平（OR = 0.920, 95% CI：0.880 ~ 0.962）则为卵巢EMT患者术后复发风险的保护因素（P < 0.05）。限制性立方样条显示, ER、PR表达水平与卵巢EMT患者术后复发风险呈非线性关系（P < 0.05）。
    结论 ER、PR表达水平与卵巢EMT患者术后复发风险有关, ER高表达、PR低表达可增加术后卵巢EMT的复发风险。

     

    Abstract:
    Objective To explore the correlation between estrogen receptor (ER) and progesterone receptor (PR) expression and the risk of postoperative recurrence in patients with ovarian endometriosis (EMT).
    Methods Totally 185 ovarian EMT patients admitted to the obstetrics and gynecology department of Nanyang Zhang Zhongjing Hospital from April 2019 to April 2020 were recruited as research subjects. They all received surgical treatment, and were followed up for 24 months prospectively. They were divided into relapse group and non-relapse group based on their disease status. The general information of the 2 groups were compared, and immunohistochemistry was used to detect the expression of ER and PR in ectopic tissue. Multivariate Logistic regression was used to analyze the factors associated with recurrence, and restricted cubic spline was used to fit the correlation between the expression of ER and PR and the risk of postoperative recurrence in patients with ovarian EMT.
    Results After 24 months of follow up, 4 cases were lost to follow-up due to various reasons, and 181 cases were finally included. 41 cases (22.65%) relapsed were classified as relapse group, and the other 140 cases (77.35%) without relapse were classified as non-relapse group. There were significant differences between 2 groups in terms of the percentage of preoperative dysmenorrhea, score of revised classification of American Fertility Society (r-AFS), expression levels of ER and PR(all P < 0.05). Multivariate Logistic regression analysis showed that dysmenorrhea(OR = 2.637, 95% CI: 1.085 - 6.408), high r-AFS score(OR = 1.040, 95% CI: 1.001 - 1.080), high ER expression level(OR = 1.073, 95% CI: 1.029 -1.118)were risk factors (P < 0.05), while high PR expression level (OR = 0.920, 95% CI: 0.880 - 0.962) was a protective factor for postoperative recurrence in patients with ovarian EMT (P < 0.05). The restricted cubic spline showed that ER and PR expression level were not linear correlated with the risk of postoperative recurrence in ovarian EMT patients (P < 0.05).
    Conclusion The expression levels of ER and PR are associated with the risk of postoperative recurrence in ovarian EMT patients. High ER expression and low PR expression can increase the risk of postoperative recurrence of ovarian EMT.

     

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