| BackgroundAdenomyosis(AM)refers to benign infiltration and diffuse growth of the endometrium in the myometrium.It is characterized by ectopic endometrium and glands in the myometrium accompanied by hypertrophy and hyperplasia of surrounding myometrium cells.Common symptoms such as dysmenorrhea and excessive menstrual flow often have a serious impact on the patient’s quality of life.On the other hand,adenomyosis is believed to lead to poor pregnancy and infertility.Due to its poor conservative treatment effect and relatively easy to relapse,some patients need to receive surgical treatment.In recent years,adenomyosis has gradually become a hotspot in the field of gynecology.The pathogenesis of adenomyosis is complex,and the mechanism of ectopic implantation and growth of endometrium and glands is still unclear,which may be related to immune escape.Human leukocyte antigen G(HLA-G)is the class I molecule of the non-classical major histocompatibility complex(MHC I).HLA-G can mediate the immune tolerance and immune escape of the body and plays an important role in the immune escape,invasion,and metastasis of tumor and ectoplasmic cells.Previous studies have shown that HLA-G may play an important role in immune escape during the occurrence and development of adenomyosis lesions.The purpose of this study was to preliminarily explore the correlation between sHLA-G and the onset and progression of adenomyosis by detecting the expression level of HLA-G in the serum of patients with adenomyosis.We hope to explore the possibility of sHLA-G as a serological biomarker associated with adenomyosis through this study.MethodsIn this study,34 patients with adenomyosis and 31 patients with uterine fibroids who received surgical treatment in Shandong Provincial Hospital from February to October 2019 were enrolled.Clinical data of enrolled patients were collected,including age,BMI,pathological type,surgical method and other information.Serum specimens were collected and preserved before,2 days and 1 month after the operation.1.Enzyme-linked immunosorbent assay(ELISA)was used to detect the HLA-G expression level in retained serum of patients with adenomyosis and fibroids,and the serum HLA-G level in the control group and the experimental group before surgery,2 days and 1 month after surgery.Statistical analysis comparing the expression level of serum HLA-G of experimental group and control group.Comparing the expression level of HLA-G of patients with adenomyosis in pre-operation,2 days after operation and 1 month after operation.Compare the differences between myoma patients and patients with adenomyosis,and analyze the relationship between the level of HLA-G and the clinical characteristics of adenomyosis patients including age,operation method,pathological type,degree of dysmenorrhea and size of the uterus.2.Serum CA125 level was detected by chemiluminescence method in patients with adenomyosis and fibroids,and the difference was compared between patients with fibroids and adenomyosis.The relationship between CA125 level and clinical characteristics of patients was analyzed.3.Evaluating the clinical diagnostic value of HLA-G in patients with adenomyosis.The receiver operating characteristic curve(ROC)was applied to compare the diagnostic value of HLA-G and serum CA125 in adenomyosis and their combined diagnostic value,so as to explore the application value of HLA-g in the diagnosis of adenomyosis.Result1.The preoperative CA125 level of the experimental group was significantly different from that of the control group(18.59 ±1.673 U/ml vs 134.8± 30.41 U/ml;P<0.001);There were also significant differences in serum HLA-G between the control group and the experimental group(18.53 ± 1.435 ng/ml vs 28.05 ± 2.466 ng/ml;P<0.005).2.In adenomyosis group,serum HLA-g levels in pre-operation,2 days after operation and lmouth after operation were 28.05± 14.38 ng/ml,18.41± 8.34 ng/ml and 14.45±5.77 ng/ml,showing a decreasing trend.There were significant differences in preoperative HLA-G levels compared with that 2 days after surgery(P<0.0001).However,there was no statistical significance in serum HLA-G level in 2 days after surgery compared with that in 1 month after surgery(P>0.05).3.Correlation analysis was conducted between serum CA125 and serum HLA-G levels and dysmenorrhea in patients with adenomyosis before operation showed no significant correlation(liner trend,P>0.05).There was a positive correlation between preoperative serum CA125 level and preoperative uterine volume in patients with adenomyosis(P<0.05,r2=0.26),while there was no significant correlation between serum HLA-G level and uterine volume(P>0.05)4.Comparison of different surgical methods.There was no significant difference in HLA-G level between patients who underwent total hysterectomy and those who underwent partial hysterectomy(28.85±16.38 ng/ml VS 26.89±11.40 ng/ml).In two days after the operation,the HLA-G level of the patients with total resection(16.04±4.27 ng/ml)was statistically lower compared with that of the patients with partial resection(21.79±11.35 ng/ml)(P<0.05).In one month after the operation,the HLA-G level of the patients with total resection(14.22±4.73 ng/ml)was not significantly different from that of the patients with partial resection(14.78±7.20 ng/ml)(P>0.05).HLA-G level(16.04±4.27 ng/ml)in 2 days after total resection was significantly lower than that before operation(28.85±16.38 ng/ml).There was no significant difference between the level of HLA-G before partial resection(26.89±11.40 ng/ml)and that in 2 days after operation(21.79±11.35 ng/ml).5.ROC analysis results showed that the AUC under serum HLA-G curve was 0.697.When the positive cut-off value of HLA-G was 27.27ng/ml,the sensitivity and specificity were 50%and 87.1%.Combined detection has the largest area under the curve and is more sensitive than CA125 or HLA-G detection alone.Conclusion1.The expression level of serum HLA-G in patients with adenomyosis was significantly higher than that in patients with uterine fibroids.It suggests that serum HLA-G,as one of the important molecules mediating immune tolerance,may play an important role in ectopic implantation of adenomyosis.2.The preoperative and postoperative changes of serum HLA-G level were correlated with the surgical intervention and surgical mode in patients with adenomyosis,suggesting that HLA-G may be a potential marker for prognosis evaluation and disease monitoring in patients with adenomyosis.3.Serum HLA-G has a certain value in differential diagnosis of adenomyosis,and compared with the detection and diagnosis of serum CA125 alone,serum HLA-G combined with CA125 can improve the diagnostic efficiency of adenomyosis to a certain extent. |
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