血漿中嗜中性白血球明膠酶表現相關載脂蛋白與骨盆腔炎症之相關性探討

藉由檢測盆腔炎(Pelvic Inflammatory Disease; PID)患者的血漿嗜中性白血球明膠酶表現相關載脂蛋白(neutrophil gelatinase associated lipocalin; NGAL)及其複合的基質金屬蛋白-9 (matrix metalloproteinase-9; MMP-9)的表現。骨盆腔炎症(Pelvic Inflammatory Disease; PID)大部分是因性行為的感染造成，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，骨盆腔炎患者的分泌物中含有大量的白血球，而這些白血球會吞噬精子、而使精子的活動力降低、甚至縮短精子的生命力，導致受孕機率降低。由於骨盆腔炎症狀上的表現變異性相當大，從下腹痛到排尿困難都有可能，而目前實驗室對診斷PID的檢查，特異性並不高，因此實驗室可以在骨盆腔炎症有較具專一性、特異性的檢查，在臨床診斷上就顯得很重要。我們知道NGAL是一種急性蛋白，會加強調節在人上皮細胞引發的不同的發炎性疾病；而MMP-9主要在發炎細胞中所分泌，但在之前並無研究指出骨盆腔炎患者血漿中NGAL與NGAL/MMP-9 complex的表現，因此我們想要研究這兩者與PID的相關性。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、ELISA的方法進行WBC (White blood cells)、neutrophils、CRP (C-reactive protein)、NGAL與NGAL/MMP-9 complex的檢測，結果發現骨盆腔炎症患者其NGAL與NGAL/MMP-9 complex的數值比健康婦女或是PID治療後的患者皆有較高的表現。我們觀察在PID患者治療前NGAL與白血球及嗜中性白血球有明顯的相關性：在PID患者其NGAL/MMP-9 complex與NGAL、MMP-9呈現正相關性；對在預測是否為PID，其NGAL及NGAL/MMP-9 complex的敏感性分別為76.6％和78.1％，而陰性預測率為分別為72.7％和74.5％。因此我們發現檢測血清中NGAL及NGAL/MMP-9 complex可以當為確認PID的輔助診斷工具。在PID的患者中，約有80%的PID其血漿中NGAL及NGAL/MMP-9 complex的濃度分別高於10.04 ng/ml及2.33 ng/ml。

To detect the expression of plasma neutrophil gelatinase associated lipocalin (NGAL) and its complex with matrix metalloproteinase-9 (MMP-9) in patients with pelvic inflammatory disease (PID). Enzyme-linked immunosorbent assay was used to measure the plasma NGAL and NGAL/MMP-9 complex levels. Results: The plasma NGAL or NGAL/MMP-9 complex levels were elevated in PID patients compared with normal controls subjects and decreased significantly after treatment. Pre-treatment plasma level of NGAL was significantly correlated with WBC and neutrophil counts. In PID patients, NGAL/MMP-9 complex plasma level was correlated significantly with NGAL or MMP-9 plasma level. In predicting PID, the sensitivities of NGAL and NGAL/MMP-9 complex were 76.6% and 78.1%, respectively and the negative predictive values were 72.7% and 74.5%, respectively. Conclusions: Plasma NGAL and NGAL/MMP-9 complex may act as diagnostic adjuvant biomarkers for PID. About 80% of PID patients have NGAL or NGAL/MMP-9 complex plasma levels higher than 10.04 ng/ml or 2.33 ng/ml, respectively