Abstract：
OBJECTIVE: Endometriosis diagnostic delays are still encountered due to the lack of a reliable, noninvasive diagnostic test. Besides, menstrual blood is a relatively untapped field for diagnostics, yet it provides a readily accessible source for investigating common gynecological conditions. In the present study, we aim to evaluate the expression levels of menstrual blood aromatase, SF-1, and HSD17B2 from women with and without endometriosis and their diagnostic performance.
METHODS: A total of 40 subjects participated in this study, including 20 patients from each endometriosis and non-endometriosis group. The endometriosis group comprised patients with proven endometriosis confirmed by pathological diagnosis and pelvic ultrasound examination, then requiring endometrial biopsy determined by the clinicians. The non-endometriosis group consisted of women who had primary and secondary infertility and underwent endometrial examination without any visible endometriosis lesion. The menstrual blood and eutopic endometrial tissue of enrolled subjects were collected, and the relative expression of the genes was performed by quantitative real-time polymerase chain reaction (qPCR). ROC curve was used to evaluate the diagnostic efficacy of aromatase, SF-1, and HSD17B2.
RESULTS: We found significantly higher expressions of aromatase, SF-1, and HSD17B2 in the menstrual blood of the endometriosis group compared to non-endometriosis (P < 0.05). In contrast, examination of eutopic endometrial tissue of both groups only found significant in HSD17B2 (P < 0.05), while aromatase and SF-1 showed no statistically significant variance. The Area Under Curve (AUC) of aromatase, SF-1, and HSD17B2 in the menstrual blood was 0.977, 0.862, and 0.807, respectively. The optimal cutoff value was determined to be >1.63 (sensitivity = 95 % and specificity = 90 %) for aromatase, >1.71 (sensitivity = 90 % and specificity = 80 %) for SF-1, and >1.83 (sensitivity = 80 % and specificity = 75 %) for HSD17B2.
CONCLUSIONS: Our study showed that aromatase, SF-1, and HSD17B2 in the menstrual blood solidly discriminate between endometriosis and non-endometriosis patients with high diagnostic accuracy. However, further confirmation in larger cohorts is required to validate the reliability of these biomarkers to endometriosis.
METHODS: A total of 40 subjects participated in this study, including 20 patients from each endometriosis and non-endometriosis group. The endometriosis group comprised patients with proven endometriosis confirmed by pathological diagnosis and pelvic ultrasound examination, then requiring endometrial biopsy determined by the clinicians. The non-endometriosis group consisted of women who had primary and secondary infertility and underwent endometrial examination without any visible endometriosis lesion. The menstrual blood and eutopic endometrial tissue of enrolled subjects were collected, and the relative expression of the genes was performed by quantitative real-time polymerase chain reaction (qPCR). ROC curve was used to evaluate the diagnostic efficacy of aromatase, SF-1, and HSD17B2.
RESULTS: We found significantly higher expressions of aromatase, SF-1, and HSD17B2 in the menstrual blood of the endometriosis group compared to non-endometriosis (P < 0.05). In contrast, examination of eutopic endometrial tissue of both groups only found significant in HSD17B2 (P < 0.05), while aromatase and SF-1 showed no statistically significant variance. The Area Under Curve (AUC) of aromatase, SF-1, and HSD17B2 in the menstrual blood was 0.977, 0.862, and 0.807, respectively. The optimal cutoff value was determined to be >1.63 (sensitivity = 95 % and specificity = 90 %) for aromatase, >1.71 (sensitivity = 90 % and specificity = 80 %) for SF-1, and >1.83 (sensitivity = 80 % and specificity = 75 %) for HSD17B2.
CONCLUSIONS: Our study showed that aromatase, SF-1, and HSD17B2 in the menstrual blood solidly discriminate between endometriosis and non-endometriosis patients with high diagnostic accuracy. However, further confirmation in larger cohorts is required to validate the reliability of these biomarkers to endometriosis.
摘要：
目的：由于缺乏可靠的子宫内膜异位症诊断延迟，非侵入性诊断测试。此外,经血是一个相对未开发的诊断领域，然而，它为调查常见的妇科疾病提供了一个容易获得的来源。在本研究中,我们旨在评估经血芳香化酶的表达水平，患有和不患有子宫内膜异位症的女性的SF-1和HSD17B2及其诊断性能。
方法：共有40名受试者参加了这项研究，包括子宫内膜异位症和非子宫内膜异位症组的20例患者。子宫内膜异位症组包括经病理诊断和盆腔超声检查证实的子宫内膜异位症患者，然后需要由临床医生确定的子宫内膜活检。非子宫内膜异位症组由患有原发性和继发性不孕的妇女组成，并接受了子宫内膜检查，没有任何可见的子宫内膜异位症病变。收集入组受试者的经血和在位子宫内膜组织，并通过定量实时聚合酶链反应（qPCR）进行基因的相对表达。用ROC曲线评价芳香化酶的诊断效能,SF-1和HSD17B2。
结果：我们发现芳香化酶的表达明显升高，子宫内膜异位症组的经血中SF-1和HSD17B2与非子宫内膜异位症组相比（P<0.05）。相比之下,两组在位子宫内膜组织检查仅发现HSD17B2有统计学意义(P<0.05),而芳香化酶和SF-1无统计学差异。芳香化酶的曲线下面积(AUC),经血中SF-1和HSD17B2分别为0.977、0.862和0.807。确定芳香酶的最佳截断值>1.63（灵敏度=95％，特异性=90％），SF-1>1.71（敏感性=90%，特异性=80%），HSD17B2>1.83（敏感性=80%，特异性=75%）。
结论：我们的研究表明，芳香化酶，经血中的SF-1和HSD17B2能可靠地辨别子宫内膜异位症和非子宫内膜异位症患者，诊断准确率高。然而,需要在更大的队列中进一步确认,以验证这些生物标志物对子宫内膜异位症的可靠性.
方法：共有40名受试者参加了这项研究，包括子宫内膜异位症和非子宫内膜异位症组的20例患者。子宫内膜异位症组包括经病理诊断和盆腔超声检查证实的子宫内膜异位症患者，然后需要由临床医生确定的子宫内膜活检。非子宫内膜异位症组由患有原发性和继发性不孕的妇女组成，并接受了子宫内膜检查，没有任何可见的子宫内膜异位症病变。收集入组受试者的经血和在位子宫内膜组织，并通过定量实时聚合酶链反应（qPCR）进行基因的相对表达。用ROC曲线评价芳香化酶的诊断效能,SF-1和HSD17B2。
结果：我们发现芳香化酶的表达明显升高，子宫内膜异位症组的经血中SF-1和HSD17B2与非子宫内膜异位症组相比（P<0.05）。相比之下,两组在位子宫内膜组织检查仅发现HSD17B2有统计学意义(P<0.05),而芳香化酶和SF-1无统计学差异。芳香化酶的曲线下面积(AUC),经血中SF-1和HSD17B2分别为0.977、0.862和0.807。确定芳香酶的最佳截断值>1.63（灵敏度=95％，特异性=90％），SF-1>1.71（敏感性=90%，特异性=80%），HSD17B2>1.83（敏感性=80%，特异性=75%）。
结论：我们的研究表明，芳香化酶，经血中的SF-1和HSD17B2能可靠地辨别子宫内膜异位症和非子宫内膜异位症患者，诊断准确率高。然而,需要在更大的队列中进一步确认,以验证这些生物标志物对子宫内膜异位症的可靠性.
