多发性子宫肌瘤与血清维生素D水平及维生素D受体表达相关性研究

摘要

目的:探讨多发性子宫肌瘤患者子宫肌瘤组织中的VDR表达水平和血浆中维生素D水平情况,探讨多发性子宫肌瘤与VDR表达、维生素D水平是否具有相关性.方法:选取2015年4月至2017年4月期间入住海南省文昌市人民医院妇产科的多发子宫肌瘤患者40例(实验组),单发子宫肌瘤20例(对照组1),无子宫肌瘤患者20例(对照组2),采用液相色谱-串联质谱法检测血清维生素D水平,ELISA检测维生素D受体(VDR)蛋白的表达.结果:实验组患者血清维生素D水平(40.73±10.27) ng/ml低于对照组1(61.59±18.32) ng/ml和对照组2(92.51 ±25.18)ng/ml(P ＜0.05);实验组患者子宫肌瘤组织中VDR蛋白表达与对照组1和对照组2比较,其差异均具有统计学意义(均P＜0.05);实验组子宫肌瘤组织中VDR蛋白的表达水平与维生素D浓度呈正相关性(r =0.494,P＜0.05).多发性子宫肌瘤患者血清中维生素D绘制ROC曲线下面积(AUC)为0.914.筛选其最佳截断点:当维生素D为17.046 ng/ml时,敏感性为91.4％,特异性为85.3％.结论:维生素D的缺乏容易引起多发性子宫肌瘤,VDR蛋白的表达与血清中维生素D的浓度呈正相关,多发性子宫肌瘤的发病与维生素D呈负相关.%Objective:To investigate the expression of vitamin D receptor (VDR) and the levels of vitamin D in the myoma of uterus in patients with multiple uterine fibroids,in order to study the correlation between the expression of VDR and vitamin D levels and the incidence of multiple uterine fibroids.Methods:40 patients with multiple uterine fibroids admitted to Department of Obstetrics and Gynecology of Wenchang People's Hospital from April 2015 to April 2017 (case group) were selected.20 cases of single uterus myoma (control group 1) and 20 cases without myoma (control group 2) were also included.Serum vitamin D levels were determined by liquid chromatography tandem mass spectrometry,and the expression of vitamin D receptor (VDR) protein was detected by ELISA.Results:Serum vitamin D levels in case group (40.73 ± 10.27) ng/ml was lower than that of control group 1 (61.59 ±8.32ng/ml) and control group 2 (92.51 ±25.18) ng/ml (P ＜0.05).Compared with control group 1 and control group 2,the expression of VDR protein in the uterine leiomyoma tissue of the case group was significantly different (P ＜ 0.05).The expression level of VDR protein in uterine leiomyoma tissue was positively correlated with vitamin D concentration (r =0.494,P ＜ 0.05).The area under the ROC curve (AUC) was 0.914 in the serum of patients with multiple uterine fibroids.The best cutoff point was selected:when the level of vitamin D was 17.046 ng/ml,the sensitivity was 91.4％ and the specificity was 85.3％.Conclusions:Vitamin D deficiency can cause multiple uterine fibroids.The expression of VDR protein is positively correlated with the concentration of vitamin D in serum.The incidence of multiple uterine fibroids is negatively correlated with vitamin D.