骨髓過氧化酶及前發炎因子與骨盆腔炎症之相關性探討

Study of plasma myeloperoxidase and proinflammatory cytokines in patients with pelvic inflammatory disease

李順安(Shun-An Lee)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/博士(2009年)

https://doi.org/10.6834/CSMU.2009.00084

摘要

骨盆腔炎症包括了子宮內膜炎、骨盆腔腹膜炎、輸卵管卵巢膿腫、輸卵管炎、輸卵管炎等，在定義上泛指女性的急性骨盆腔逆行性感染。在現今社會中不孕症夫婦的比例有逐年增加的趨勢，而骨盆腔炎症就是造成女性不孕症的原因之ㄧ。骨盆腔炎症的症狀與許多骨盆相關疾病相似，所以很難經由一般的實驗室檢查來診斷，因此針對骨盆腔炎症較具專一性、特異性的檢查在臨床診斷上就顯得很重要。而骨髓過氧化酶及一些前發炎因子如IL-1β、IL-6、IL-8及TNF-α等細胞激素與骨盆腔炎症的相關性並不清楚。因此，我們分別收集了骨盆腔炎症患者及健康婦女的血液檢體，以全自動血球分析儀、血清蛋白分析儀及ELISA的方法進行WBC、neutrophils、CRP、骨髓過氧化酶、IL-1β、IL-6、IL-8與TNF-α的檢測。實驗結果發現利用抗生素治療前的骨盆腔炎症患者其血漿中的WBC、neutrophils、CRP、骨髓過氧化酶、IL-1β、IL-6、IL-8及TNF-α的數值比治療後的數值皆有較高的表現。另外，我們再進一步比較骨盆腔炎症患者其治療前與健康婦女的血漿中的數值，結果發現除了IL-8沒有統計學上的差異之外，其他皆有較高的數值表現。而我們更進一步分析這些前發炎因子與WBC、neutrophils及CRP之間的相關性，結果發現IL-6與WBC、neutrophils、CRP的數值皆呈現相關性。因此我們發現患者血清中這些前發炎因子的表現能夠專一的顯示骨盆腔炎症發展進行的概括狀況。因此我們發現檢測血清中骨髓過氧化酶、IL-1β、IL-6、IL-8及TNF-α的濃度可以在臨床上診斷骨盆腔炎症時提供一個輔助的診斷工具。

關鍵字

骨盆腔炎症 ； 前發炎因子 ； 骨髓過氧化酶

並列摘要

Pelvic inflammatory disease (PID) is caused by micro-organisms which colonize in the endocervix and ascend to the endometrium and fallopian tubes and become manifestations such as endometritis, pelvic peritonitis, tubal abscess, and salpingitis in the fallopian tube. However, the role of myeloperoxidases and proinflammatory cytokines in PID is unclear. We therefore determine whether plasma myeloperoxidases and proinflammatory cytokines, interleukin 1beta (IL-1beta), IL-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha) were useful plasma markers in PID patients. ELISA and PCR-RFLP were respectively used to measure the plasma levels and genetic polymorphism of myeloperoxidase. Furthermore, Multiplex bead array analysis was used to measure the plasma levels of proinflammatory cytokines in healthy controls as well as in PID patients before and after routine protocol treatments. We discussed the plasma level of myeloperoxidase was elevated in PID patients compared to that in normal controls and decreased significantly compared to that in the same patients after they received treatment. IL-1beta, IL-6, IL-8, and TNF-alpha were statistically elevated in PID patients before they received antibiotic treatment than after they did. However IL-8 was not significantly difference between healthy controls and PID patients. The relatively increased ratio of IL-6 was correlated with the count of WBC (r=0.448, P=0.003), neutrophil (r=0.472, P=0.002), and the level of CRP (r=0.412, P=0.008). We concluded that IL-1beta, IL-6, IL-8, and TNF-alpha may play important roles in the pathogenesis of PID. These biomarkers, particular IL-6, could be useful adjuncts for the clinical diagnosis of PID. Furthermore, elevated expression of myeloperoxidase may be involved in the pathogenesis of PID and could be useful for the diagnosis of PID.

並列關鍵字

Pelvic inflammatory disease ； proinflammatory cytokines ； myeloperoxidases

參考文獻

[1] Dayan L. Pelvic inflammatory disease. Aust Fam Physician 2006;35:858-62.

[2] Quentin R, Lansac J. Pelvic inflammatory disease: medical treatment. Eur J Obstet Gynecol Reprod Biol 2000;92:189-92.

[3] Manavi K. A review on infection with Chlamydia trachomatis. Best Pract Res Clin Obstet Gynaecol 2006;20:941-51.

[4] Gray-Swain MR, Peipert JF. Pelvic inflammatory disease in adolescents. Curr Opin Obstet Gynecol 2006;18:503-10.

[5] Ross J. Pelvic inflammatory disease. BMJ 2001;322:658-9.