Objective To assess the efficacy and safety of Chinese medicinal herbs for treating endometriosis. Methods We searched Cochrane Library, MEDLINE, EMBASE, CBM (from establishment to 2003). Randomized controlled trials (RCTs) and quasi-randomized controlled trials of patients with endometriosis were included. The quality of included studies such as randomization, blinding, allocation concealment and loss of follow up were evaluated and meta-analysis was performed by RevMan 4.3 software. Results Ten RCTs or quasi-RCTs involving 1 120 patients were included. Because of different therapies in the treatment and control groups, the results of outcome were described separately. Most of included studies suggested that the effects of traditional Chinese medicine (TCM) on general effect, pregnancy rate improvement and alleviating dysmenorrhoea were similar to Danazol or Tamoxifen, only a few studies showed better effects. There was no evidence to support that TCM was more effective than western medicine in reducing the size of endometriotic cysts. Only one study mentioned the recurrence rate and showed that TCM enema had lower recurrence rate than oral Tamoxifen with OR 0.17, 95%CI 0.04 to 0.67. Five studies mentioned adverse reactions and showed TCM had fewer adverse effects than western medicine. Conclusions Chinese medicinal herbs are effective in treating endometriosis with fewer adverse effects. The evidence is not b enough because of low quality of the included studies. Therefore, more high quality randomized controlled trials are required.
ObjectiveTo systematically review the efficacy and safety of dienogest in the treatment of endometriosis. MethodsThe PubMed, Embase, Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of dienogest for the treatment of endometriosis from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 20 RCTs, involving 2 826 patients were included. Meta-analysis showed that compared with gonadotropin-releasing hormone agonist (GnRH-a), dienogest had similar efficacy. Compared with placebo, dienogest was more effective in reducing endometriosis-related pelvic pain. Compared with oral contraceptives, dienogest performed better in relieving endometriosis-related pelvic pain and improving recurrence and pregnancy rates. Compared with other drugs (such as non-steroidal anti-inflammatory drugs, dydrogesterone, etc.), dienogest could gradually reduce the pain. In terms of safety, dienogest could reduce bone density damage and hot flashes in patients with endometriosis compared with those in the control group. ConclusionCurrent evidence shows that dienogest is effective and safely tolerated in the treatment of endometriosis. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.
ObjectiveTo evaluate the association between tumor necrosis factor alpha (TNF-α) gene -308G/A polymorphism and the risk of endometriosis (EM). MethodsDatabases including PubMed, EMbase, CBM, CNKI, VIP, and WanFang Data were searched to collect case-control studies about the association between TNF-α gene -308G/A polymorphism and the risk of EM from inception to October 2014. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then Meta-analysis was performed by using Stata 12.0 software. ResultsA total of seven case-control studies were included, which involved 687 patients and 877 controls. The results of meta-analysis showed that, AA genotype carriers presented 2.06-fold (OR=2.06, 95%CI 1.10 to 3.83, P=0.02) and 1.94-fold (OR=1.94, 95%CI 1.18 to 3.18, P<0.01) higher risk of EM than GG genotype carriers and AG+GG genotype carriers, respectively; but sensitivity analysis showed that the robustness of these results was unstable. No statistical significance was found in the allele model, co-dominant model, and dominant model (A vs. G: OR=1.37, 95%CI 0.87 to 2.17, P=0.18; AG vs. GG: OR=1.09, 95%CI 0.77 to 1.53, P=0.63; AA+AG vs. GG: OR=1.29, 95%CI 0.95 to 1.77, P=0.11). While excluding studies that controls were not in HWE, no significant association was observed in these five genetic models; and no significant association was found in the results of subgroup analysis by ethnicity. ConclusionThe AA genotype of TNF-α gene -308G/A polymorphism might contribute to the risk of EM, but the association between other genotypes and EM susceptibility is unclear. In addition, due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the effectiveness and safety of laparoscopy with postoperative gonadotropin releasing hormone agonist (GnRH-a) versus laparoscopy alone for endometriosis. MethodsRandomized controlled trials (RCTs) on laparoscopy with postopertative GnRH-a versus laparoscopy alone in treatment of endometriosis were retrieved in the following databases:the Cochrane Library (Issue 3, 2013), PubMed, EMbase, WanFang Data, CNKI, and CBM from inception to February, 2013. According to the inclusion and exclusion criteria, the literature were screened, the data was extracted and the methodological quality of the included studies was also assessed by two reviewers independently. Then, meta-analysis was performed using RevMan 5.1.7 software. ResultsA total of 15 RCTs involving 1 761 patients were included. There were statistically significant differences between the laparoscopy with postoperative GnRH-a group and the laparoscopy alone group in the following 4 aspects:the symptom relief rate (RR=1.24, 95%CI 1.16 to 1.33, P < 0.000 01), the recurrence of lesion (RR=0.35, 95%CI 0.24 to 0.51, P < 0.000 01), the recurrence of pain (RR=0.70, 95%CI 0.53 to 0.92, P=0.01), and the pregnancy rate (RR=1.43, 95%CI 1.25 to 1.65, P < 0.000 01). ConclusionLaparoscopy postoperative GnRH-a for endometriosis can enhance the symptom relief rate, reduce the recurrence of lesion and the recurrence of pain, and increase the pregnancy rate. But because of the limitation of the quality of the included studies and publication bias, the above conclusion should be verified by conducting more high quality RCTs.
【摘要】目的探讨骨桥蛋白(OPN)联合血清CA125和CA199水平对子宫内膜异位症的诊断价值。方法2005年1月2008年12月采集45例子宫内膜异位症患者及45名健康妇女自愿捐赠的血清样品,分别采用ELISA法及化学发光法检测OPN、CA125、CA199水平。结果与健康妇女相比,子宫内膜异位症患者血清OPN和CA125、CA199含量明显升高(Plt;001)。重度组(美国生育学会分期Ⅲ、Ⅴ期)子宫内膜异位症患者OPN和CA125、CA199明显高于轻度组(Ⅰ、Ⅱ期)(Plt;001)。结论OPN、CA199可作为子宫内膜异位症诊断及病情监测的临床指标,联合CA125检测可提高其临床应用价值。
Objective To systematically evaluate the correlation between endometriosis (EM) in Chinese women and Xba I polymorphism in intron-1 of estrogen receptor α (ER-α) gene. Methods Such databases as PubMed, MEDLINE, The Cochrane Library (Issue 3, 2012), VIP, CBM, WanFang Data and CNKI were searched to collect case-control studies about the correlation between EM and Xba I polymorphism in intron-1 of ER-α gene. The retrieval time was from 1980 to 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 and Stata 12.0 software. Results A total of 7 studies involving 676 EM patients and 688 healthy volunteers were included. The results of meta-analyses showed that Chinese women with X/X genotype had similar risk of EM compared to those with x/x genotype (OR=0.95, 95%CI 0.58 to 1.54, P=0.82) or X/x genotype (OR=0.73, 95%CI 0.44 to 1.20, P=0.22). The allele X also showed similar risk of EM compared to the allele x (OR=1.11, 95%CI 0.93 to 1.33, P=0.25). Conclusion At present, it has not yet been found that the incidence of EM in Chinese women is related to the Xba I polymorphism in intron-1 of ER-α gene as well as the allele X. For the quantity and quality limitation of the included studies, this conclusion has to be proved by more studies.
ObjectiveTo discuss the clinical characteristics, treatment and prevention of abdominal wall endometriosis (AWE). MethodsA retrospective analysis of 295 cases of AWE from February 2007 to August 2011 in our hospital was performed. ResultsAll of the patients had abdominal operations before and 99% of them had a history of caesarean section. The mean age of the patients was (31.55±4.52) years old. The average size of the mass was (2.66±1.12) cm, significantly larger than the estimation of ultrasonography before operation which was (1.91±0.83) cm (P<0.001). No relapse was discovered five months to three years after the operation. ConclusionIt is easy to diagnose abdominal wall endometriosis through medical history, clinical characteristics, physical signs and ultrasonic assessment. The prevention of AWE is very important. Operation is still the best treatment for AWE.
目的 探讨不同剂量和不同疗程米非司酮对大鼠子宫异位内膜基质金属蛋白酶-9（MMP-9）及其组织特异性抑制物-1（TIMP-1）表达的影响。 方法 65只子宫内膜异位症大鼠随机分为低剂量组、高剂量组、对照组。各个剂量组分别灌胃20、30、40 d后取异位子宫内膜组织用免疫组织化学法检测MMP-9及TIMP-1的表达，并计算MMP-9/TIMP-1比值。 结果 低剂量组和高剂量组均能使异位内膜MMP-9表达下降（P＜0.05）,TIMP-1表达升高（P＜0.05）,高剂量组的作用更加明显，与低剂量组差异有统计学意义（P＜0.05）；用药30 d低剂量组TIMP-1表达最高，与用药20 d和40 d相比差异有统计学意义（P＜0.05）,同样高剂量组用药30d TIMP-1的表达也最高，与用药20 d和用药40 d比较差异有统计学意义（P＜0.05）。与用药20、40 d比较差异有统计学意义（P＜0.05）。 结论 米非司酮能够降低大鼠异位子宫内膜的侵袭能力，高剂量米非司酮抑制效果更明显；用药30 d米非司酮对大鼠异位内膜的侵袭能力抑制最强，延长用药时间不能使异位内膜侵袭能力继续下降。
Objective To systematically review the effectiveness and safety of different laparoscopic surgeries for ovarian endometrioma (OE). Methods Such databases as The Cochrane Library (Issue 3, 2011), MEDLINE (1966 to November 2011), EMbase (1980 to November 2011), CNKI (1980 to November 2011), CBM (1980 to November 2011) and WanFang Data (1978 to November 2011) were searched on computer, and the relevant references of the included literature were also retrieved manually to collect the randomized controlled trials (RCTs) about laparoscopic cystectomy vs. laparoscopic coagulation for OE. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs were included. The results of meta-analysis showed that, laparoscopic cystectomy for OE could reduce the reocurrence rates of dysmenorrhoea (RR=0.29, 95%CI 0.15 to 0.55, P=0.000 2), dyspareunia (RR=0.27, 95% CI 0.09 to 0.77, P=0.01) and non-menstrual pelvic pain (RR=0.19, 95% CI 0.05 to 0.76, P=0.02), decrease 1-year (RR=0.33, 95%CI 0.15 to 0.74, P=0.007) and 2-year (RR=0.49, 95%CI 0.26 to 0.95, P=0.03) postoperative reoccurence of OE, and lower the risk of short-term secondary operation (RR=0.25, 95%CI 0.07 to 0.85, P=0.03). However, it didn’t increase the 12-month (RR=2.82, 95%CI 1.44 to 5.50, P=0.002) and 24-month (RR=2.62, 95%CI 1.47 to 4.68, P=0.001) postoperative spontaneous pregnancy rates (SPR). In addition, although laparoscopic coagulation was superior to laparoscopic cystectomy in the 6-month postoperative ovarian reserve function (ORF), there was no significant difference in the 5-year postoperative ORF between the two groups (WMD=0.27, 95%CI −0.18 to 0.73, P=0.24). Conclusion Laparoscopic cystectomy for OE can reduce the reoccurence of dysmenorrhoea, dyspareunia, non-menstrual pelvic pain and endometriosis, decrease the risk of short-term secondary operation, and increase the postoperative SPR in women who had been diagnosed as infertility. Because of the quantity limitation of present clinical trials, this conclusion requires to be further proved by performing more high quality RCTs.
【摘要】目的探讨子宫内膜异位症患者子宫内膜组织中巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MMIF)表达的临床意义。方法2007年10月2008年10月应用免疫组化法检测MMIF在82例子宫内膜异位症患者的异位内膜组织、正常位置内膜组织和58例非子宫内膜异位症患者(对照组)正常位置子宫内膜组织的表达。结果①子宫内膜异位症患者在4个不同分期的异位内膜组织中MMIF的表达均明显高于其正常位置内膜组织(Plt;005);②子宫内膜异位症患者不同内膜组织中MMIF的表达较对照组明显增高;③随着分期的增加,MMIF在异位内膜组织中及其正常位置内膜组织中表达均逐渐上调,但只有Ⅳ期与Ⅰ期内膜组织的MMIF表达差异具有统计学意义(Plt;005)。结论MMIF与子宫内膜异位症的发生、发展密切相关。