血清血管生成素样蛋白2、4及抗苗勒管激素对子宫内膜异位症相关不孕症的预测价值

Value of serum angiopoietin-like protein 2, protein 4 and anti-Mullerian hormone levels in predicting infertility in patients with endometriosis

摘要:

目的 探讨血清血管生成素样蛋白-2（Angptl-2）、血管生成素样蛋白-4（Angptl-4）及抗苗勒管激素（AMH）对子宫内膜异位症（EMT）患者不孕症的预测价值。方法 回顾性分析2022年5月—2025年5月暨南大学附属广州红十字会医院收治的206例EMT患者的临床资料。患者入院后均接受血清学检查。依据EMT患者是否合并不孕症分为不孕组（74例）与可孕组（132例）。比较两组患者的临床资料及血清Angptl-2、Angptl-4、AMH水平。采用多因素一般Logistic回归模型分析EMT患者发生不孕症的独立危险因素。绘制受试者工作特征（ROC）曲线评估各指标单独及联合检测对EMT患者不孕症的预测价值。结果 不孕组r-AFS分期Ⅲ、Ⅳ期占比及血清Angptl-2、Angptl-4水平均高于可孕组（P 0.05），AMH水平低于可孕组（P 0.05）。多因素一般Logistic回归分析结果显示，r-AFS分期Ⅲ、Ⅳ期［O^R =3.054（95% CI：1.051，8.870）］、Angptl-2水平高［O^R =2.067（95% CI：1.565，2.730）］、Angptl-4水平高［O^R =1.234（95% CI：1.112，1.369）］及AMH水平低［O^R =0.632（95% CI：0.496，0.806）］均为EMT患者不孕的危险因素（P 0.05）。ROC曲线分析结果显示，Angptl-2、Angptl-4、AMH单独及联合检测对EMT患者不孕症发生预测的曲线下面积分别为0.806（95% CI：0.745，0.858）、0.793（95% CI：0.731，0.846）、0.791（95% CI：0.729，0.845）、0.885（95% CI：0.834，0.925）；敏感性分别为72.97%（95% CI：0.612，0.823）、70.27%（95% CI：0.584，0.801）、71.62%（95% CI：0.598，0.812）、74.32%（95% CI：0.626，0.835）；特异性分别为72.73%（95% CI：0.642，0.799）、74.24%（95% CI：0.658，0.813）、73.48%（95% CI：0.650，0.806）、87.88%（95% CI：0.808，0.927）。结论 血清Angptl-2、Angptl-4、AMH联合检测对EMT患者不孕症发生的预测效能较高，可为临床早期识别不孕症高风险患者提供参考。

Abstract:

Objective To explore the predictive value of serum angiopoietin-like protein-2 (Angptl-2), angiopoietin-like protein-4 (Angptl-4) and anti-Mullerian hormone (AMH) levels on infertility in patients with endometriosis (EMT).Methods The clinical data of 206 patients with EMT admitted to Guangzhou Red Cross Hospital from May 2022 to May 2025 were analyzed retrospectively, and all patients received serological examination after admission. EMT patients were divided into infertility group (n = 74) and fertile group (n = 132) according to whether they were complicated with infertility. The clinical data, serum levels of Angptls and AMH were compared between the two groups. Logistic regression analysis was used to screen the independent risk factors of infertility in EMT patients, and the receiver operating characteristic (ROC) curve of subjects was drawn to evaluate the predictive value of each index and joint detection for infertility in EMT patients.Results The proportion of patients with r-AFS stage III or IV, and the levels of serum Angptl-2 and Angptl-4 were higher in the infertility group than in the fertile group, while the AMH level was lower (P 0.05). The results of the Logistic multivariate analysis showed that r-AFS stage Ⅲ, Ⅳ [O^R = 3.054 (95% CI: 1.051, 8.870) ], high Angptl-2 levels [O^R = 2.067 (95% CI: 1.565, 2.730) ], high Angptl-4 levels [O^R = 1.234 (95% CI: 1.112, 1.369) ], and low AMH levels [O^R = 0.632 (95% CI: 0.496, 0.806) ] were all risk factors for infertility in EMT patients (P 0.05). The AUCs for Angptl-2, Angptl-4, AMH alone and their combination were 0.806 (95% CI: 0.745, 0.858), 0.793 (95% CI: 0.731, 0.846), 0.791 (95% CI: 0.729, 0.845), and 0.885 (95% CI: 0.834, 0.925), respectively; the sensitivities were 72.97% (95% CI: 0.612, 0.823), 70.27% (95% CI: 0.584, 0.801), 71.62% (95% CI: 0.598, 0.812), and 74.32% (95% CI: 0.626, 0.835), respectively; the specificities were 72.73% (95% CI: 0.642, 0.799), 74.24% (95% CI: 0.658, 0.813), 73.48% (95% CI: 0.650, 0.806), and 87.88% (95% CI: 0.808, 0.927), respectively.Conclusion The combined detection of serum Angptl-2, Angptl-4 and AMH has a high predictive efficiency for infertility in EMT patients, which can provide reference for early clinical identification of patients with high risk of infertility.