To detect the serum expression of cathepsin B and cystatin C and the ratio of cathepsin B to cystatin C in patients with pelvic inflammatory disease (PID) and speculate whether those are helpful indicators for the diagnosis of PID.A random consecutive study.University hospital.Forty-four women who were diagnosed with PID.Collected blood specimens of patients before and after they received treatment.ELISA analysis was used to measure the serum levels of cathepsin B and cystatin C.A significantly increased expression of cathepsin B but decreased expression of cystatin C and significant correlations between neutrophils and cathepsin B, as well as between C-reactive protein (CRP) and cathepsin B, were found in patients with PID. Consistently, the ratio of cathepsin B to cystatin C correlated significantly with neutrophils and with CRP in patients with PID.Increased expression of cathepsin B but a decreased level of cystatin C and an imbalance between cathepsin B and cystatin C may contribute to the progression of PID. Detection of cathepsin B and cystatin C can provide useful clinical information for PID.