| Objective: Through studying the main influencing factors of plasma cortisol concentration,perceived pressure level and quality of life in women with endometriosis,the effects of chronic stress state on the development of the disease were preliminarily discussed,which may provide guidance for clinical treatment.Methods: 44 cases of endometriosis patients(EMs group)and 43 cases of mature teratoma patients(control group)were recruited from Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University as the experimental group and the control group respectively.All patients have completed 3 questionnaires,including Numerical Rating Scale(NRS)(0 =no pain;10 =severe pain)used to indicate their average pain symptoms,the perceived stress scale defining the stress level,and the short form determination of quality of life used to evaluate quality of life within 4 weeks before operation.Plasma cortisol concentrations test was also conducted by electrochemical luminescence method.1.The basic data of the patients were collected(onset time,lesion site,mass size,past history,menstrual history,marriage and childbearing history,educational level,income).Comparisons between two groups were performed for the basic data,the plasma cortisol concentrations,the perceived stress score,as well as the quality of life including four aspects,i.e.the physiological field,psychological field,social relations field,and the environment field.2.According to the degree of pain,the patients with endometriosis were divided into two groups:15 cases(≤ 3 scores)with no or mild pain,29 cases(>3 scores)with moderate or severe pain level.The plasma cortisol concentration,perceived pressureand quality of life of the two groups were compared by two sample T-test.The relationship between plasma cortisol concentrations and pain scores was analyzed by Pearson correlation.3.According to the childbearing condition,the EMs group was divided into two groups,23 cases of Fertility group and 21 cases of non fertility group.The EMs group were graded according to the total score criterion of endometriosis fertility index(EFI).Between-group comparison of the plasma cortisol concentrations,perceived pressure and quality of life was conducted using two-sample T-test.The correlation between plasma cortisol concentration and the scores of EFI was analyzed by Spearman correlation.4.According to ASRM’s modified staging of endometriosis(1996),the patients with endometriosis were divided into two groups,I/II stage of EMs in 11 cases,and III/IV stage of EMs in 33 cases.Comparison of plasma cortisol concentration,perceived pressure and quality of life between groups were tested by two-sample t-test.Results:1.The average cortisol concentration in the EMs group was lower than that in the control group(257.01±121.46 VS 335.24±134.63nmol/l,P<0.05),and the score of perceived stress level was higher than that in the control group(28.7±4.22 VS26.7±4.45,P<0.05).The quality of life in physiological and psychological domains was significantly higher than that in the control group(62.69±12.32 VS69.68±14.48,62.31±15.69 VS 71.51±13.08,P<0.05).There is no significant difference in the quality of life between EMs group and control group in the field of social relations and the environment.In addition,there was a negative correlation between plasma cortisol and perceived pressure in EMs group(r=-0.606,P<0.05).2.In EMs group,plasma cortisol levels in moderate and severe pain patients were higher than those in mild pain patients(287.30 ±113 VS 198.43±117nmol/L,P<0.05).No significant correlation between plasma cortisol concentration and pain score was found(r=0.178,P > 0.05).3.In EMs group,plasma cortisol levels in infertile patients were lower than those in fertile patients(209.37±96.06 VS 292.06±136.69nmol/l,P < 0.05);theperceived stress level was higher than that in fertile patients(30.13±3.77 VS27.33±4.25,P < 0.05).The psychological quality of life was lower than that in fertile patients(57.53 ±14.99 VS 66.98 ±15.49,P<0.05).The cortisol levels in patients with endometriosis were found positively correlated with the scores of endometriosis fertility index(r=0.340,P < 0.05).Neither stress level nor quality of life aspects was significantly correlated with the scores of EFI.4.The plasma cortisol concentration in the III/IV group was lower than that in the I/II group(251.79±141.94 VS 372.64±127.51nmol/l,P < 0.05).There was no significant difference between III/IV group and I/II group in perceived stress level,as well as the quality of life in physical and psychological fields.Conclusion: 1.The patients with endometriosis were in the chronic stress state,accompanied with objective performance of decreased concentration of plasma cortisol and subjective performance of increased perceived stress and decreased quality of life in the physiological and psychological fields.2.Perceived pressure levels,pain,reproductive status,and exacerbation of disease are related to the change of plasma cortisol in patients with endometriosis.Chronic stress leads to a decline in HPA axis regulation and may promote disease progression.3.The stress level of infertile patients is higher and the influence on the quality of life in the psychological field is greater than that in the physiological field.It is suggested that the infertile patients with endometriosis should be given psychological guidance in addition to the physiological treatment. |
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