Features of serum Ki-67 and APRIL level alterations in women with endometrial hyperplasia combined with arterial hypertension

Abstract

Aim. To assess serum levels of the proliferation markers Ki-67 and APRIL in women with endometrial hyperplasia (EH) combined with arterial hypertension (AH), and their correlation with clinical, medical history, and morphofunctional parameters of the endometrium.

Materials and methods. The study included 75 women with EH and simple or complex endometrial hyperplasia without atypia who received treatment at the Gynecology Department of Municipal Non-Commercial Enterprise “City Hospital No. 7” of Zaporizhzhia City Council. Patients were divided into two groups based on the presence of AH: 44 women with AH (mean age 36.40 ± 1.56 years) and 31 women without AH (mean age 34.20 ± 1.34 years). The groups were comparable by age and morphological characteristics of hyperplasia. The control group included 20 apparently healthy women who had no reproductive of extragenital pathology. All patients underwent ultrasound examination (MyLab50, Esaote, Italy) and video hysteroscopy (Karl Storz, Germany). Serum levels of Ki-67 and APRIL were determined by ELISA (Elabscience, USA). Blood pressure was measured according to ESC (2024) guidelines. Statistical analysis was performed using Statistica for Windows 13; differences were considered significant at p < 0.05.

Results. Among women with EH and concomitant AH, grade I hypertension was found in 47.7 %, grade II – in 40.9 %, and grade III – in 11.4 %. Serum Ki-67 levels were significantly higher in both EH groups, with and without AH, compared to controls (p < 0.05), with the highest levels observed in patients with EH and AH (p < 0.05). Serum APRIL levels were also significantly elevated in both EH groups compared to controls (p < 0.05), with no significant difference between hypertensive and normotensive EH patients. Correlation analysis revealed a significant positive association between serum Ki-67 levels and disease duration (+0.41; p < 0.05), endometrial thickness (M-echo) (+0.52; p < 0.05), and systolic blood pressure (+0.56; p < 0.05). Serum APRIL levels correlated positively with patient age (+0.42; p < 0.05) and disease duration (+0.44; p < 0.05).

Conclusions. APRIL levels are elevated in endometrial hyperplasia irrespective of the presence of arterial hypertension. The highest Ki-67 levels were observed in patients with endometrial hyperplasia and concomitant arterial hypertension. The Ki-67 levels were significantly correlated with M-mode endometrial thickness, systolic blood pressure, and disease history duration; the APRIL levels were correlated with age and the hyperplastic processes duration.