Objective: To explore the relationship between T lymphocyte subsets and clinical staging of patients with endometriosis(EMs) based on propensity score matching. Methods: The medical records of 170 patients with EMs who were admitted into hospital from June 2018 to June 2021 were analyzed retrospectively. All patients were divided into late group(90 cases with stage Ⅲ-Ⅳ) and early group(80 cases with stageⅠ-Ⅱ) according to the Revised AFS Classification of Endometriosis(r-AFS). The baseline data such as age, menstrual cycle and graviditas were analyzed by propensity score matching, and the nearest neighbor method was used for 1:1 matching, and the late group was matched with the early group. After propensity score matching, the cases were finally included in the late group and the early group. The T lymphocyte subsets in the two groups were detected on the day after admission, and the relationship between T lymphocyte subsets and clinical staging of EMs patients was analyzed. Results: There were significant differences in age, menstrual cycle, graviditas, menarche time, the degree of dysmenorrhea and the EMs lesion location between the late group and the early group before propensity score matching(P<0.05). After propensity score matching, they were finally included in the late group and the early group, with 50 cases in each group. There were no significant differences between the late group and the early group in age, menstrual cycle, graviditas, menarche time, the degree of dysmenorrhea and EMs lesion location(P>0.05). After matching, the levels of CD3+, CD4+ and the ratio of CD4+/CD8+ in the late group were lower than those in the early group, while the level of CD8+ was higher than that in the early group, with statistically significant differences(P<0.05). There were no significant differences in HE4 and CA125 levels between the two groups(P>0.05). Multivariate Logistic regression analysis showed that the high levels of CD3+, CD4+ and the ratio of CD4+/CD8+ were the protective factors for the high clinical stage of EMs patients(OR<1, P<0.05); the high level of CD8+ was a risk factor for the high clinical stage of EMs(OR>1, P<0.05). Receiver operating characteristic curve was drawn. The results showed that the AUC of CD3+, CD4+, CD8+ and CD4+/CD8+ ratio of EMs patients with high clinical stage risk were all>0.70 on the day after admission, with the ideal evaluation value. Conclusion: There is a correlation between T lymphocyte subsets and clinical staging of EMs patients. |
[1] CHAPRON C, MARCELLIN L, BORGHESE B, et al.Rethinking mechanisms, diagnosis and management of endometriosis[J].Nat Rev Endocrinol, 2019, 15(11):666-682.
[2] 王平, 朱新群.子宫内膜异位症患者血清中Syndecan-1的表达及意义[J].广东医学, 2015, 36(2):259-260.
[3] GUO M, BAFLIGIL C, TAPMEIER T, et al.Mass cytometry analysis reveals a distinct immune environment in peritoneal fluid in endometriosis:a characterisation study[J].BMC Med, 2020, 18(1):3.
[4] LI K, RAN R Y, JIANG Z C, et al.Changes in T-lymphocyte subsets and risk factors in human immunodeficiency virus-negative patients with active tuberculosis[J].Infection, 2020, 48(4):585-595.
[5] JERMAN L F, ANDERSON L, MARKHAM R, et al.The lymphatic system in endometriosis:a pilot study of endometrial-like cells and immune cell populations in lymph nodes associated with deep infiltrating bowel lesions[J].Reprod Sci, 2020, 27(4):977-987.
[6] 谢幸, 孔北华, 段涛.妇产科学[M].9版.北京:人民卫生出版社, 2018:261-267.
[7] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志, 2015, 40(3):161-169.
[8] 梁月凤, 黄秀敏, 温兰玲, 等.血清脑源性神经营养因子与子宫内膜异位症临床分期及痛经的相关性[J].中华医学杂志, 2020, 100(10):771-774.
[9] 王希波, 刘艳.异位子宫内膜组织中黏附斑激酶表达及其与临床分期的关系[J].山东医药, 2017, 57(18):90-91.
[10] LAGANÀ A S, GARZON S, GÖTTE M, et al.The pathogenesis of endometriosis:molecular and cell biology insights[J].Int J Mol Sci, 2019, 20(22):5615.
[11] SYMONS L K, MILLER J E, KAY V R, et al.The Immunopathophysiology of Endometriosis[J].Trends Mol Med, 2018, 24(9):748-762.
[12] YANG X X, WANG L Z, LI L H, et al.The imbalance of lymphocyte subsets and cytokines:potential immunologic insights into the pathogenesis of chronic dacryocystitis[J].Invest Ophthalmol Vis Sci, 2018, 59(5):1802-1809.
[13] WATAD A, ROWE H, RUSSELL T, et al.Normal human enthesis harbours conventional CD4+ and CD8+ T cells with regulatory features and inducible IL-17A and TNF expression[J].Ann Rheum Dis, 2020, 79(8):1044-1054.
[14] 靳丽杰, 杜丹丽, 张燕, 等.子宫内膜异位症患者腹腔液T淋巴细胞亚群的改变及临床意义[J].实用医学杂志, 2012, 28(5):739-741.
[15] 翟志伟, 王振军, 张坤宁, 等.外周血T淋巴细胞亚群变化与直肠癌患者新辅助放化疗效果的关系[J].中华普通外科杂志, 2020, 35(5):397-400.
[16] 俞超芹.子宫内膜异位症免疫微环境形成机制及中药干预作用[J].中国中西医结合杂志, 2019, 39(5):6-9.
[17] ZHANG T, CAROLIS C D, MAN G C W, et al.The link between immunity, autoimmunity and endometriosis:a literature update[J].Autoimmun Rev, 2018, 17(10):945-955.
[18] KRÁLÍKOVÁ M, FIALA L, LOSAN P, et al.Altered immunity in endometriosis:what came first?[J].Immunol Invest, 2018, 47(6):569-582.
[19] BI J L, WANG D D, CUI L Y, et al.RNA sequencing-based long non-coding RNA analysis and immunoassay in ovarian endometriosis[J].Am J Reprod Immunol, 2021, 85(3):e13359.
[20] 王国云.子宫内膜异位症发病机制研究进展[J].山东大学学报(医学版), 2019, 57(6):33-39. |