Tuesday, September 12, 2017

Peripheral Biomarkers as Predictive Indicators of Endometriosis: A Prospective Case Control Study

Sujata Deo1*, SP Jaiswar1, PL Shankhwar1, Bushra Iqbal2, Manisha Jhirwar1
1Department of Obs & Gyn, King George Medical University, Lucknow, India
2Department of Physiology, King George Medical University, Lucknow, India
 *Address for Correspondence: Dr. Sujata Deo, Professor, Department of Obs & Gyn, King George Medical University, Lucknow, India

Background: Endometriosis is associated with chronic, benign, oestrogen-dependent inflammatory disease that affects approximately 10% of reproductive age women and 35-50% of women with pelvic pain and infertility. It can be a weakening disease with dysmenorrhoea, dyspareunia, and chronic pelvic pain symptoms.
Objective: To evaluate the role of serum marker (IL-6, IL-8, TNF-α) as non-invasive tool to diagnose endometriosis in reproductive age group.
Methods: A case control study was conducted in Department of Obstetrics and Gynecology, KGMU, Lucknow for a period of one year. Total numbers of women enrolled in study were 100. Out of 100 women, 75 women of reproductive age group with clinical suspicion and USG findings were taken as cases. Out of 75 cases, 12 cases lost the follow up and 26 cases kept on conservative management and they responded well. Finally 37 cases of endometriosis with strong clinical suspicions (Dysmenorrhea, Heavy or irregular bleeding, Pelvic pain, Lower abdominal or back pain, Dyspareunia, Dyschezia) and USG finding of endometriosis were recruited as cases and they underwent laparoscopy/ laparotomy.  Control group comprises of 25 women undergoing for laparoscopic tubal ligation. After taking informed consent, all the women were subjected to the detailed menstrual, gynaecological, medical history and general, systemic and gynaecological examination. Patient was investigated for haemoglobin, ultrasound abdomen and pelvis and serum markers (IL-6, IL-8, TNF-α). Blood sample (5ml of blood) was collected in vecutainer tube for serum analysis. The blood was centrifuged to separate the serum and stored at -70ºC till examined. Finally 37 cases of endometriosis underwent laparotomy/laparoscopy (gold standard to diagnose endometriosis) for proper diagnosis and treatment.
Results:  Serum IL-8 cut-off at 0.78% pg/ml afforded a sensitivity of 70.3% and specificity of 80% in the diagnosis of endometriosis and has good discriminant ability. TNF-α has average discriminant ability, 62.2% sensitivity and 56% specificity for endometriosis diagnosis. So that serum IL-8 and TNF-α can differentiate cases with or without endometriosis. By detecting these serum markers, we can diagnose endometriosis without undergoing laparoscopy or laparotomy.
Conclusion: The serum markers (IL-8, TNF-α) can be used as a non-invasive tool for diagnosis of endometriosis.
Key-words-Endometriosis, Interleukins, Tumour necrosis factor, Laparoscopy