Expression And Significance Of Endometrial Placental Protein 14 (PP14) And CA125 In Serum And In Peritoneal Fluid Of Patients With Endometriosis (EM)

Objective: To evaluate the expression of placental protein 14 (PP14) in serum and peritoneal fluid (PF), and CA125 in serum of patients with endometriosis, and to investigate the role and significance of PP14 and CA125 on the diagnosis and pathogenesis of endometriosis.Methods: 50 cases of endometriosis patients were collected as the study group, who was admitted in the Third Affiliated Hospital of Suzhou University during October 2008 to March 2010. In the study group, 20 cases accepted laparoscopic operation, and 30 cases underwent laparotomy surgery. According to the revised American Fertility Society (AFS) staging criteria, Patients with endometriosis were grouped as follow: stageⅠ7 cases, stageⅡ1 3 cases, stageⅢ15 cases and stageⅣ15 cases. Phase I-II was classified as mild type, and phase III-IV was classified as severe type. In addition, according to menstruation days when the patients had blood tests , 5 to14 days of menstruation were in the proliferative phase, 15 to 30 days were in the secretory phase. As a result, the endometriosis patients could be divided into this new groups: mild type in secretory phase 10cases, severe type in secretory phase 10cases, mild type in proliferative phase 10cases, and severe type in proliferative phase 20cases. 30 patients who had normal physical examination were collected as the control group, which included 15 cases in proliferative phase and 15 cases in secretory phase . Enzyme-linked immunosorbent assay (ELISA) was used for the determination of PP14 level in the serum of both the endometriosis and the normal patients, and ELISA is also used to detect the serum PP14 levels in the control group. CA125 in serum in both the study and the control group were detected by chemiluminescence. Data was analyzed according to endometriosis stage and the different menstrual phase. Results: 1. As for the mild endometriosis group and normal control group, in proliferative phase, serum PP14 is higher in the anterior group than the posterior. In secretory phase, serum PP14 level is of no significance between the two groups. In proliferative phase, the results of the two groups were 2.28士0.67ng/ml,1.24士1.04 ng/ml (P<0.05); In secretory phase, the results were 3.24士0.69ng/ml ,2.24士1.43ng/ml (P>0.05).2. In both proliferative and secretory phase, serum PP14 was higher in severe endometriosis group than the control group. In Severe group of patients with endometriosis in proliferative secretory phase and normal control group in secretory phase, the serum pp14 were 5.56士2.88ng/ml,1.24士1.04ng/ml(P<0.05). In secretory phase, serum PP14 of the two groups were 8.04士3.88ng/ml,2.24士1.43ng/ml (P<0.05).3. Serum PP14 expression levels are higher in the severe type group than in the mild type group no matter the endometriosis patients were in the proliferative phase or secretory phase. Serum PP14 level in mild type in proliferative phase and severe type in proliferative phase were 2.28士0.67ng/ml and 5.56士2.88ng/ml respectively(P<0.05); Serum PP14 level in mild type in secretory phase and severe type in secretory phase were 3.24士0.69ng/ml and 8.04士3.88ng/ml respectively(P<0.05);4. As for the endometriosis patients in the proliferative phase, PP14 expression level of peritoneal fluid was of no difference between the severe and mild group(4.51士4.24ng/ml, 1.63士0.91ng/ml, P>0.05); In the secretory phase, the PP14 expression of peritoneal fluid in severe group is higher than mild group(5.62士2.38ng/ml, 1.79士1.08ng/ml, P<0.05).5. In both proliferative and secretory phase, serum CA125 was higher in severe endometriosis group than the control group. In Severe group of patients with endometriosis in proliferative phase and normal control group in secretory phase, the serum CA125 were 108.66±92.08U/ml and 16.73±6.55 U / ml (P <0.05). In secretory phase, serum CA125 of the two groups were 87.76士41.36U/ml, 17.78±9.90U/ml respectively (P<0.05). 6. As for the endometriosis patients in both proliferative and secretory phase, the serum CA125 expression in severe group is higher than mild group. In the proliferative phase, serum CA125 expression levels were 108.66士92.08U/ml , and 30.40士17.95U/ ml,( P<0.05). In the secretory phase, serum CA125 expression levels were 87.76士41.36U/ml, and 32.19士20.41U/ ml,(P<0.05).7. In Endometriosis patients, serum PP14 and PP14 level of peritoneal fluid was positively correlated (r = 0. 674, P <0.01).8. As for the sensitivity in diagnosis of proliferative endometriosis , serum PP14 is better than serum CA125. The sensitivity in diagnosis of proliferative endometriosis is 93.3%,and 63.3 % respectively(P<0.05).Conclusions: 1. Serum PP14 levels in severe endometriosis patients and the mild-proliferative group were significantly higher than the control group. In severe group the level were significantly higher than the mild group. And the PP14 levels in serum and peritoneal fluid was positively correlated. This suggests that endometrial placental protein PP14 play a role in the pathogenesis and development of endometriosis.2. CAl25 was significantly higher in severe endometriosis patients than the control group, and it was higher in severe group than mild, which indicated that CA125 is involved in the pathological process of endometriosis.3. As for the sensitivity in diagnosis of proliferative endometriosis , serum PP14 is better than serum CA125. However, there is no difference between PP14 and CA125 in the sensitivity in diagnosis of secretory endometriosis. Combinative detection of serum PP14 and CA125 may be more significant in the diagnosis of endometriosis.