The Role And Clinical Significance Of Coagulation And Inflammatory Factors In Moderate And Severe Endometriosis

BackgroundEndometriosis was a common and incurable benign disease of gynecology with chronic pelvic pain and infertility as the main symptoms,it was not only a hereditary disease or immune disease,but also a kind of inflammatory disease or hemorrhagic disease.Clinical studies in recent years had found that neutrophil/lymphocyte ratio(NLR)and platelet count/lymphocyte ratio(PLR)were significantly elevated in patients with endometriosis,and could be as an adjunct to serum CA125 for the diagnosis of endometriosis.Meanwhile,the shortened activated partial prothrombin time(APTT)could predict a potential hypercoagulable state in women with endometriosis.It was suggested that the abnormalities of inflammatory reaction and coagulation system may be related to the pathogenesis of endometriosis.As the bidirectional relation between inflammation and coagulation was an important part of the body's defense mechanism,the detection of coagulation and inflammatory factors may be not only has important clinical significance for the diagnosis of endometriosis,but also provides laboratory data for further study of the pathogenesis of endometriosis.ObjectiveTo determine the levels of coagulation indicators,inflammatory factors and serum CA125 in women with moderate and severe endometriosis so as to investigate the possible role of coagulation and inflammatory factors in the pathogenesis,diagnosis and treatment of this disease.MethodsBetween June 2015 and June 2017,clinical data of 366 patients with pathologically diagnosed moderate and severe ovarian endometriosis(case group)and 244 patients with pathologically diagnosed benign ovarian cysts(control group)in the affiliated Women's Hospital of Zhejiang University School of Medicine were retrospectively analyzed.Compared the differences of coagulation indicators,inflammatory factors and serum CA125 levels between the two groups of patients,and analyzed their correlation with the clinical parameters.ResultsThe levels of plasma prothrombin time(PT)and thrombin time(TT)in patients with ovarian endometriosis[Median:12.8 seconds(12.4-13.2 seconds)and 15.5 seconds(15.1-15.9 seconds),respectively]were significantly shorter than those with benign ovarian cysts[median:13.0 seconds(12.5-13.4 seconds)and 15.7 seconds(15.3-16.1 seconds),respectively;P<0.01].The expression levels of plasma fibrinogen(FIB)and D-dimers(D-D)[median:3.1 g/L(2.8-3.5 g/L)and 0.9 mg/L(0.6-2.1 mg/L),respectively]in patients with ovarian endometriosis were significantly higher than those with benign ovarian cysts[median:2.8 g/L(2.6-3.2 g/L)and 0.6 mg/L(0.4-1.2 mg/L),respectively;P=0.000],Moreover,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)[median:2.3(1.8-3.1)and 144(113-179),respectively]in patients with ovarian endometriosis were significantly higher than those with benign ovarian cysts[median:2.1(1.6-2.8)and 128(104-165),respectively;P<0.01].Furthermore,in patients with ovarian endometriosis,the levels of PT were significantly shorter in stage IV endometriosis than that in stage ? endometriosis(P<0.01).The levels of FIB and PLR were significantly higher in patients with stage ?endometriosis than those in patients with stage ? endometriosis(P<0.01).The cut-off value of CA125 was 27.2 kU/L with a sensitivity of 83.6%,the cut-off value of FIB was 3.1 g/L,while the sensitivity of combination index(FIB × CA125)was 84.9%.In patients with endometriosis who had no history of peritoneal surgery,the median level of platelet count(PLT)and FIB(240 × 109/L and 3.2 g/L,respectively)in patients compact with pelvic adhesions were higher than those without pelvic adhesions(208 ×109/L and 2.8g/L respectively),while the median level of PLT and FIB(257 × 109/L and 3.4g/L,respectively)in the patients with cul-de-sac completely obliterated were higher than those without obliterated(225 × 109/L and 3.1g/L,respectively),and the difference were significantly(P<0.05).;Moreover,there was a positive correlation between PLT and FIB with the pelvic adhesion scores in endometriosis.ConclusionThe abnormality of coagulation and inflammatory factors may be involved in the pathogenesis of moderate and severe endometriosis,and the detection of coagulation and inflammatory factors may have important clinical significance for the diagnosis and treatment of moderate and severe endometriosis.The coagulation parameters platelet count and fibrinogen could assist in judging the severity of pelvic adhesion in endometriosis.