摘要
目的探讨巨噬细胞移动抑制因子(MIF)和人类白细胞DR抗原(HLA-DR)表达在自身免疫性卵巢早衰(APOF)患者的表达及其临床意义。方法选择深圳市宝安区人民医院2016年1月至2018年1月诊治的60例卵巢早衰患者,年龄21~39岁,平均年龄32.58岁。根据病因分为:观察组30例,诊断为APOF;对照组30例,诊断为非APOF。另选取30例健康绝经妇女作为绝经组(年龄59~67岁,平均年龄63.26岁)。检测并比较3组外周血抗卵巢抗体(AOAb)、抗透明带抗体、抗核抗体(ANA)、MIF和淋巴细胞HLA-DR表达水平。采用Pearson相关分析评估血清MIF与HLA-DR间的相关性。根据年龄(> 30岁组和≤30岁组)和病程(> 3年组和≤3年组)进行分组,比较血清MIF与HLA-DR水平的差异。应用多元Logistic回归分析上述各临床指标与APOF发病的相关性。绘制受试者工作特征曲线(ROC)评估血清MIF与HLA-DR水平对APOF患者的临床诊断价值。结果观察组与对照组患者的AOAb、抗透明带抗体、ANA水平差异无统计学意义(P> 0.05),但均高于绝经组(P <0.05);观察组血清MIF和HLA-DR水平最高,对照组次之,绝经组最低(P <0.05)。观察组中年龄> 30岁组MIF水平明显高于年龄≤30岁组(P <0.05);但在年龄亚组中HLA-DR水平未见差异(P> 0.05)。病程> 3年组MIF和HLA-DR水平明显高于病程≤3年组(P <0.05)。Pearson相关分析显示APOF患者血清MIF与HLA-DR呈负相关(P <0.05)。多元Logistic回归分析显示,血清MIF、HLA-DR+CD3、HLA-DR+CD19为APOF的危险因素(OR=2.135,P=0.030;OR=2.867,P=0.024;OR=2.779,P=0.036)。血清MIF及HLA-DR联合,诊断APOF的AUC最大为0.878,P值为0.028,其灵敏度84.5%,特异度86.7%。结论 APOF患者外周血存在MIF和HLA-DR高水平,在一定程度上反映卵巢早衰患者存在免疫紊乱,可作为临床早期诊断的主要参考指标。
Objective To explore the expression and clinical significance of macrophage migration inhibitory factor(MIF) and human leukocyte DR antigen(HLA-DR) antigen in patients with autoimmune premature ovarian failure(APOF). Methods From January 2016 to January 2018, a total of 60 premature ovarian failure patients were enrolled, which aged 21-39 years old with mean age of 32.58 years old. All of the patients were divided into observation group(n = 30, with APOF) and control group(n = 30, with non-APOF). Another 30 contemporaneous healthy postmenopausal females(aged 59-67 years old with mean age of 63.26 years old) were enrolled as postmenopausal group. The serum levels of antiovarian antibody( AOAb), anti-zone pellucida antibody(AZPA), antinuclear antibody(ANA), MIF and HLA-DR were detected and compared in 3 groups. The correlations of MIF and HLA-DR were confirmed by Pearson linear correlation analysis. The patients were divided into sub-group according to age(> 30-year-old group and ≤ 30-year-old group) and duration(> 3 years group and ≤ 3 years group). The serum levels of MIF and HLR-DR were compared between sub-groups. The risk factors of APOF were confirmed by multivariate Logistic analysis. The receiver operation characteristic(ROC) curve was drawn to evaluate the clinical diagnostic value of MIF and HLA-DR levels in APOF patients. Results The levels of AOAb, AZPA and ANA were not different between observation group and control group(P > 0.05), but were higher than those of postmenopausal group(P < 0.05). The MIF and HLADR levels in observation group were the highest, and that of control group were middle and postmenopausal group was the lowest(P < 0.05). The MIF level in > 30-year-old group was significantly higher than that in ≤ 30-year-old group(P < 0.05),while there was no difference in HLA-DR level between different age groups(P > 0.05). The MIF and HLA-DR levels in duration > 3 years group were significantly higher than those in ≤ 3 years group(P < 0.05). The Pearson analysis results showed the negative correlation between serum MIF and HLA-DR in APOF patients( P < 0.05). The multivariate logistic regression analysis results showed that serum MIF, HLA-DR + CD3, and HLA-DR + CD19 were risk factors for APOF(OR = 2.135,P = 0.030;OR = 2.867, P = 0.024;OR = 2.779, P = 0.036). The MIF combined HLA-DR in diagnosis of APOF, the area under curve(AUC) was 0.878, P was 0.028 and sensitivity was 84.5 %, specificity was 86.7 %. Conclusion It is demonstrated that peripheral blood of APOF showed high levels of MIF and HLA-DR, which reflect immune disorder in patients with premature ovarian failure in some degree, and could be used as the major reference indicator for early clinical diagnosis.
作者
陈云霞
白巍
杨步琴
李大志
王丽
CHEN Yun-xia;BAI Wei;YANG Bu-qin;LI Da-zhi;WANG Li(Department of Gynecology and Obstetrics,People’s Hospital of Baoan District,Shenzhen 518101,Guangdong,China)
出处
《生物医学工程与临床》
CAS
2019年第6期714-718,共5页
Biomedical Engineering and Clinical Medicine
作者简介
陈云霞(1982-),女,广东深圳市人,本科,主治医师,主要从事妇科肿瘤方面研究工作。电话:0755-27788311。E-mail:47644086@qq.com。
