Circulating Redox and Extracellular Matrix Biomarkers by Pelvic Organ Prolapse Severity in Vulvar Leukoplakia: a Propensity Score-Matched Study.

This study aimed to investigate the biochemical expression characteristics of circulating oxidative stress markers, antioxidant defense indicators, and extracellular matrix (ECM) degradation products in patients with vulvar leukoplakia complicated by different degrees of pelvic organ prolapse (POP). Patients with vulvar leukoplakia admitted between May 2024 and January 2026 were retrospectively included. After propensity score matching (PSM), they were divided according to pelvic organ prolapse quantification (POP-Q) stage into four groups: no POP, mild POP, moderate POP, and severe POP, with 57 patients in each group. Oxidative damage products, antioxidant defense-related indicators, ECM degradation and remodeling indicators were compared among the groups, and differences in the clinical phenotype of vulvar leukoplakia and POP-Q anatomical indicators were also analyzed. The results showed that, as POP severity increased, oxidative damage indicators, including MDA, 8-OHdG, 8-iso-PGF2α, AOPP, protein carbonyl, lipid hydroperoxide, and AGEs, tended to increase overall. By contrast, SOD, GSH-Px, CAT, T-AOC, GSH, and the GSH/GSSG ratio showed downward trends, suggesting that the redox balance of these patients may shift toward an oxidative state. Meanwhile, MMP-2, MMP-9, the MMP-9/TIMP-1 ratio, CTX-I/ICTP, PIIINP, and desmosine/isodesmosine were higher in the higher recorded severity categories, whereas TIMP-1 and TIMP-2 were lower. These findings indicate associations between the recorded POP severity categories and circulating redox and ECM-related biomarker profiles; they do not establish the tissue source of the markers, local pelvic floor remodeling, or a causal relationship between vulvar disease and POP.