COMPARATIVE ANALYSIS OF CA125, HE4 INDICATORS AND MESOTHELIN LEVEL AS DIAGNOSTICS FOR ENDOMETRIOSIS ASSOCIATED WITH INFERTILITY

Introduction. The use of CA-125 (cancer antigen) as a blood biomarker in endometriosis has been widely studied. However, CA-125 is not specific for endometriosis, as it is a tumor marker elevated in ovarian cancer. In addition to this lack of specificity, the sensitivity to detect all stages of endometriosis is low. Therefore, we decided to determine and compare CA-125, HE4 and mesothelin levels in peripheral blood in patients with endometriosis in order to identify a non-invasive diagnostic marker.The aim of the study. To investigate and conduct a comparative analysis of CA-125, HE4 and mesothelin levels in peripheral blood and peritoneal fluid in patients with endometriosis in order to identify a non-invasive diagnostic marker.Material and methods. Oncomarkers CA-125, HE4 and mesothelin was determined in patients with endometriosis associated with infertility in blood serum and peritoneal fluid. The main group consisted of women with endometriosis associated with infertility in the number of 455 people. Oncomarkers CA-125, HE-4 were determined in this group of patients in blood serum.We determined the level of mesothelin in blood serum and peritoneal fluid in 29 patients. Msln Human ELISA kits for humans (SunRedBio, Shanghai, China, number 201-12-1089) with a sensitivity of 0,135 ng/L and an assay range of 0,3-40 ng/L were used.Research results. Stage I and III endometriosis was more often detected in women of the main group (37%). IV stage endometriosis was found only in 11% of cases. Stage II endometriosis was detected in 14% of cases. Among the women of the main group, primary infertility prevailed reliably (82%). Endometrial ovarian cysts were found in 59% of women with endometriosis associated with infertility. The level of mesothelin in the blood plasma of women of the main group with primary infertility was significantly higher compared to women of the main group with secondary infertility (0,86±0,001 ng/ml vs. 0,69±0,001 ng/ml), (p<0,01). In 48% of patients with stage I endometriosis, the average value of the tumor marker CA-125 is 28,8 Units/ml, in 23% of women with stage II endometriosis – 33,6 Units/ml. An increase in CA-125 indicators above the norm was observed in 25% of women with stage III endometriosis, which is 60,5% U/ml. And only 4% of women with IV stage have CA-125 at the level of 58,6 Units/ml. The average value of the tumor marker HE4 in patients with stage I endometriosis (46%) is 37,2 pmol/l, with stage II endometriosis – 48,6 pmol/l (20%), in women with stage III endometriosis – 56,3 pmol/ l (25%) and only 9% of women with stage IV endometriosis have an HE-4 indicator of 52,2 pmol/l.Conclusions. 1. In the blood of women of the main group, a reliable increase in the level of mesothelin was established, depending on the stages of endometriosis: dependence is directly proportional to the progression of the disease. 2. An increase in the level of mesothelin is noted in patients with stage I endometriosis who do not yet have clinical symptoms, which indicates a non-invasive marker of preclinical diagnosis of endometriosis. 3. The level of mesothelin in the blood plasma of women of the main group with primary infertility was significantly higher compared to women of the main group with secondary infertility (0,86±0,001 ng/ml and 0,69±0,001 ng/ml) (p<0.01 ). A significantly higher level of mesothelin in peritoneal fluid was noted in women of the main group with primary infertility compared to secondary infertility (0,67±0,001 ng/ml and 0,42±0,001 ng/ml) (p<0,001).4. An increase in the level of the tumor marker CA-125 is observed in women with stage III endometriosis, where pronounced clinical symptoms are noted, therefore, the tumor marker CA-125 cannot be considered a non-invasive marker for early diagnosis of endometriosis.5. The level of the tumor marker HE-4 remains within the reference values in women with stage I-IV endometriosis, which also indicates its impracticality as a marker for the diagnosis of endometriosis.