組織蛋白酶B及其抑制劑胱蛋白C與骨盆腔炎症之相關性探討

骨盆腔炎症包括了子宮內膜炎、骨盆腔腹膜炎、輸卵管卵巢囊腫、輸卵管炎、輸卵管卵巢炎等，在定義上泛指女性的急性骨盆腔逆行性感染。在現今社會中由於不孕症夫婦的比例增加，造成了育齡婦女的生育率有逐年下降的趨勢，而骨盆腔炎症就是造成女性不孕症的最主要原因。骨盆腔炎症的症狀與許多骨盆相關疾病相似，所以很難經由一般的實驗室檢查來診斷，因此針對骨盆腔炎症較具專一性、特異性且快速的檢查在臨床診斷上就顯得很重要。先前的研究顯示，cathepsin B及cystatin C的濃度變化可以反應一些發炎疾病的發展情形，因此我們分別收集了骨盆腔炎症患者及健康婦女的血液檢體，以全自動血球分析儀、血清蛋白分析儀及ELISA的方法進行neutrophils、CRP、cathepsin B與cystatin C的檢測。實驗結果發現骨盆腔炎症患者其neutrophils、CRP、cathepsin B及cathepsin B/cystatin C ratio的數值比健康婦女皆有較高的表現，而cystatin C卻是明顯的偏低。另外，我們再進一步比較骨盆腔炎症患者其治療前與治療後的數值，結果也有相同的表現。最後我們統計分析neutrophils、CRP、 cathepsin B與cystatin C的數值之間的相關性，統計結果顯示neutrophils、CRP的數值與cathepsin B、cathepsin B/cystatin C ratio的數值呈現良好的相關性。因此我們提出骨盆腔炎症患者血清中cathepsin B與cystatin C的濃度表現能夠專一的顯示骨盆腔炎症發展進行的概括狀況的看法，且檢測血清中cathepsin B與cystatin C的濃度是一個較為便利、快速且安全的方法。所以我們認為檢測血清中cathepsin B與cystatin C的濃度及分析cathepsin B/cystatin C ratio可以做為臨床上診斷骨盆腔炎症時的一個有效的輔助工具。

Pelvic inflammatory disease (PID) is caused by micro-organisms which colonize in the endocervix and ascend to the endometrium and fallopian tubes and become manifestations such as endometritis, pelvic peritonitis, tubal abscess, and salpingitis in the fallopian tube. We speculate that the regulation of cathepsin B and cystatin C is involved the inflammatory process and is related to the progression of PID. Thus, in this study, we sought to determine whether serum cathepsin B and cystatin C were efficient serum markers compared with WBC, neutrophils, and CRP in PID patients. In this study, ELISA analysis was employed to measure the serum levels of cathepsin B and cystatin C before and after routine protocol treatments in PID patients. A significantly increased expression of cathepsin B but decreased expression of cystatin C and significant correlations between neutrophils and cathepsin B, as well as between CRP and cathepsin B, were found in PID patients. Consistently, the ratio of cathepsin B to cystatin C correlated significantly with neutrophils and with CRP in PID patients. Increased expression of cathepsin B but a decreased level of cystatin C and an imbalance between cathepsin B and cystatin C may contribute to the progression of PID. Detection of cathepsin B and cystatin C can provide useful clinical information for PID.