Turgay Batuhan, Özmen Batuhan, Kılıçkıran Harun, Şükür Yavuz Emre, Sönmezer Murat, Berker Bülent, Atabekoğlu Cem Somer, Aytaç Ruşen
Department of Obstetrics and Gynecology, Reproductive Endocrinology, School of Medicine, Ankara University, Ankara, Türkiye.
Hatay Dörtyol State Hospital Department of Obstetrics and Gynecology, Hatay, Türkiye.
Front Endocrinol (Lausanne). 2025 Jul 30;16:1624717. doi: 10.3389/fendo.2025.1624717. eCollection 2025.
In this study, we aimed to investigate whether serum NGAL, MMP-9 and the MMP-9/NGAL ratio, which are inflammatory markers used for the diagnosis and follow-up of some diseases, can be used as diagnostic and follow-up markers for the diagnosis of endometriomas in infertile patients.
Forty-five patients with unexplained infertility and 45 infertile patients with endometriomas were included in the study. Patients with endometriomas of at least 3 cm in size were included in the study. NGAL and MMP-9 levels in venous blood samples and the MMP-9/NGAL ratios of the unexplained infertility and endometrioma groups and the preoperative and postoperative results of the endometrioma group were compared.
The mean blood NGAL and MMP-9 levels in the endometrioma and unexplained groups were 22.0 ± 4.0 ng/ml and 25.4 ± 4.9 ng/ml and 43.7 ± 8.0 ng/ml and 39.3 ± 10.7 ng/ml, respectively, and all the results were statistically significant (p=0.001; p=0.012). The mean blood levels of NGAL and MMP-9 in endometriomas and the same patients at three months after surgery were 24.9 ± 4.9 ng/ml and 27.0 ± 4.9 ng/ml and 43.9 ± 7.3 ng/ml and 36.7 ± 8.7 ng/ml, respectively (p=0.179; p=0.006). The mean ratios of MMP-9/NGAL in the endometrioma, unexplained and postoperative groups were 2.0 ± 0.2, 1.5 ± 0.2 and 1.4 ± 0.2, respectively. All these results were significantly different between the endometrioma-unexplained group and the endometrioma-postoperative group (p=0.001; p=0.001). When we performed a ROC curve analysis for the presence of endometrioma, an MMP-9/NGAL ratio greater than 1.75 had 86.1% sensitivity and 84% specificity in indicating the presence of endometrioma (AUC=0.898). There was a positive correlation between the VAS score and the MMP-9/NGAL ratio.
Interestingly, the NGAL blood NGAL level was lower in the endometrioma group than in the control group. The MMP-9/NGAL ratio can be useful in the diagnosis of endometrioma, and this ratio reflects the clinical findings of the disease.
在本研究中，我们旨在调查血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、基质金属蛋白酶-9（MMP-9）以及MMP-9/NGAL比值（这些是用于某些疾病诊断和随访的炎症标志物）是否可作为诊断和随访不育患者子宫内膜异位囊肿的标志物。
本研究纳入了45例不明原因不育患者和45例患有子宫内膜异位囊肿的不育患者。纳入研究的患者其子宫内膜异位囊肿大小至少为3厘米。比较不明原因不育组和子宫内膜异位囊肿组静脉血样本中的NGAL和MMP-9水平以及MMP-9/NGAL比值，以及子宫内膜异位囊肿组术前和术后的结果。
子宫内膜异位囊肿组和不明原因组的平均血NGAL水平分别为22.0±4.0 ng/ml和25.4±4.9 ng/ml，MMP-9水平分别为43.7±8.0 ng/ml和39.3±10.7 ng/ml，所有结果均具有统计学意义（p = 0.001；p = 0.012）。子宫内膜异位囊肿患者及其术后三个月时的平均血NGAL和MMP-9水平分别为24.9±4.9 ng/ml和27.0±4.9 ng/ml以及43.9±7.3 ng/ml和36.7±8.7 ng/ml（p = 0.179；p = 0.006）。子宫内膜异位囊肿组、不明原因组和术后组的MMP-9/NGAL平均比值分别为2.0±0.2、1.5±0.2和1.4±0.2。子宫内膜异位囊肿-不明原因组与子宫内膜异位囊肿-术后组之间所有这些结果均存在显著差异（p = 0.001；p = 0.001）。当我们对子宫内膜异位囊肿的存在进行ROC曲线分析时，MMP-9/NGAL比值大于1.75在提示子宫内膜异位囊肿存在方面具有86.1%的敏感性和84%的特异性（AUC = 0.898）。视觉模拟评分（VAS）与MMP-9/NGAL比值之间存在正相关。
有趣的是，子宫内膜异位囊肿组的血NGAL水平低于对照组。MMP-9/NGAL比值可用于子宫内膜异位囊肿的诊断，且该比值反映了疾病的临床情况。
