Abstract
BackgroundEndometriosis is a long-standing progressive disease that affects women of reproductive age. Macrophage migration inhibitory factor (MIF) is one of non-invasive blood biomarker that was detected in sera of endometriotic patients. The present study aimed to determine the accuracy of serum MIF in diagnosing endometriosis in women with infertility and chronic pelvic pain, and correlate its level to the stage of the disease.MethodsObservational case-control study conducted at Fayoum University hospital from March 2016 till September 2018. Three hundred women candidate for diagnostic laparoscopy for either infertility or gynecologic chronic pelvic pain were included. The study group included patients with symptoms suggestive of endometriosis or chocolate cyst by ultrasound and proved by laparoscopy and histopathology. The control group included other causes of infertility or pelvic pain. All patients undergone either diagnostic or operative laparoscopy, and before laparoscopy blood sampling for quantitative measurement of macrophage migration inhibitory factor (MIF) protein in serum by ELISA technique.ResultsThe level of serum MIF was significantly higher in endometriosis group compared to control group (1.75 ± 1.48 pg/ml and 0.51 ± 0.45 pg/ ml, respectively, P = < 0.001), with a progressive increase with advancing stage (stage I, 1.3 ± 1.03 pg/ml, stage II, 1.7 ± 1.57 pg/ml, stage III, 2.1 ± 1.19 pg/ml and in stage IV, 3.2 ± 2.6 pg/ml). Moreover, in patients presented with pain and infertile patients showed significantly higher levels of serum MIF (1.92 ± 1.13 vs 1.21 ± 1.17 and 1.82 ± 1.13 vs 1.32 ± 0.91 respectively with p-value < 0.001). ROC curve of serum MIF with a cut off value of 0.85 pg/ml or more achieves a sensitivity of 80.6%, specificity of 83.3%, positive predictive value of 82.9% and negative predictive value of 81.2%.ConclusionSerum MIF might be a promising marker not only for noninvasive diagnosis of endometriosis but as a target for detecting severity as well.
Highlights
Endometriosis is a long-standing progressive disease that affects women of reproductive age
In 2017 Lagana et al in their study based on understanding of genetic, epigenetic and biological mechanisms that regulate the development and differentiation of the urogenital tract during intrauterine life, proposed a theory that harmonized the pathogenesis of endometriosis
The present study aimed to evaluate the value of serum macrophage migration inhibitory factor in diagnosing endometriosis in women with infertility and chronic pelvic pain and correlate its level with the stage of the disease
Summary
Endometriosis is a long-standing progressive disease that affects women of reproductive age. In 2017 Lagana et al in their study based on understanding of genetic, epigenetic and biological mechanisms that regulate the development and differentiation of the urogenital tract during intrauterine life, proposed a theory that harmonized the pathogenesis of endometriosis. They hypothesized that, alternation and uncontrol within the mesoderm due to a deregulation of genes leads abnormal placing of stem cells with endometrial phenotype during organogenesis and keep them in an inactive slots. What triggers such alterations was not clear, that’s why in their later review, they concluded that a single etiopathogenetic model is not sufficient to explain its complex pathobiology [6, 7]
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