Expression Of Vascular Endothelial Growth Factor And Endostatin In Women With Endometriosis

BackgroundEndometriosis, the growth of ectopic endometrial tissue, is a chronic recurrent disease affecting 10% of the female population causing infertility, dysmenorrhea, dyspareunia and pelvic pain. The diagnosis of endometriosis can only be definitively by laparoscopy or laprotomy. So far there are still no effective and specific chemical markers. Suppression of ovarian activity by hormonal therapy or operation are the main therapeutic interventions with severe adverse effects and a high relapse rate. No clear understanding of its pathogenesis is the principal cause that restricts the clinical and basic studies of endometriosis. Hence, investigating its pathogenesis has been becoming a ugent task of gynaecologist and other medical scientists. Recent study revealed that angiogenesisis plays a major role in the development and maintenance of endometriosis. Among A lot of angiogenic factors, vascular endothelial growth factor(VEGF), the most potent and specific stimulator of angiogenic factor, and endostatin, the most potent and specific inhibitor, are getting to be emphasized for their role in the angiogenesis in recent years. Now some studies revealed that both of them regulates the angiogenesis of malignant tumor, but their role in the pathogenesis of endometriosis are not clear yet.ObjectiveTo investigate that whether both of them contribute to the pathogenesis of endometriosis and its feasibility of VEGF and endostatin regarded as serum diagnosis markers.Methods and Results1. we detected mRNA expression of VEGF and endostatin with reverse transcription polymerase chain reaction technique. The levels of VEGF and endostatin in ectopic and eutopic endomtrial tissues of patients with endometriosis are all significantly higher than those in endometrium of control women. Among different ectopic endometriotic lesions, level of VEGF in peritoneal red lesion is the highest while that of uterosacral ligament nod is the lowest. However, level of endostatin has no significantly difference. In women with endometriosis, the level of VEGF in eutopic endometium during secretory phase is significantly higher than that during proliferative phase, but there is no significant diffirence in control womens. Compared the level of VEGF and endostatin in euctopic endometrium frompatients of advanced stages with those from paients of earlier stages, there was no significant difference.2. The concentrations of VEGF and endostatin in serum and peritoneal fluid of the patients with endometriosis were determinated with enzyme linked immunoabsorbant assay (ELISA). Serum or peritoneal fluid VEGF and endostatin concentrations in endometriosis were all significantly higher than the mean in controls. The VEGF and endostatin levels in advanced patients were both higher than those in early stages. But, there was no significantly difference between follicular phase and luteal phase. When the optimal cut-off value of serum VEGF and endostatin in diagnosis of endometriosis were 175 pg/ml, 90 ng/ml, respectively, the sensitivity, specificity, youden index, positive predictive value and negative predictive value of serum VEGF were 0.92, 0.84, 0.75, 0.82 and 0.90, respectively; those of enedostatin were 0.91, 0.82, 0.73, 0.87 and 0.93, respectively. When both factors were used concomitantly, they were 0.98, 0.77, 0.75, 0.80 and 0.98, respectively. The areas under ROC were 0.867, 0.801, respectively.ConclusionBoth VEGF and endostatin mightbe be involved in the process of angiogenesis and the balance between them maybe the critical cause of angiogenesis. The development and progression of endometriosis maybe associated with increasing activity of endometrium during secretory phase. Both serum VEGF and serum endostatin could be regarded as one of useful diagnosis markers for endometriosis.