【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。
【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。
Endometriosis (EM) is a common benign gynecological disease with complex pathogenesis and lack of unified understanding. In recent years, the theory of stem/progenitor cells has gradually been recognized by scholars. The presence of stem/progenitor cells in the endometrium and researchers’ understanding of stem/progenitor cell specific markers has been further developed, which is of great significance for sorting stem/progenitor cells and further elucidating their roles in the pathogenesis of EM. At present, more endometrial stem cell signaling pathways have been studied including Wnt, Hedgehog, Notch, phosphatidylinositol-3-kinase/protein kinase B, Smad/connective tissue growth factor, CXCL12/CXCR4, etc. These signaling pathways can regulate stem cell involvement in the pathogenesis of EM. Exploring how signaling pathways to regulate stem cell involvement in the pathogenesis of EM can help elucidate the specific pathogenesis of EM and provide new directions for its treatment. This paper will summarize them.
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.
①关于药物引起的卵巢抑制:1篇系统评价发现,使用卵巢抑制药治疗子宫内膜异位症与安慰剂或达那唑相比,妊娠率无明显差异.该评价还发现,卵巢抑制药引起的不良反应包括体重增加、潮热和骨质疏松症,达那唑可能引起剂量相关的体重增加和雄激素样作用. ②宫腔内人工授精+促性腺激素:1个RCT发现,宫腔内人工授精+促性腺激素治疗与不治疗相比,可明显提高活产率.第2个RCT发现,期待疗法与宫腔内人工授精+垂体降调节+促性腺激素治疗后的分娩率无明显差异.第3个RCT发现,宫腔内人工授精+促性腺激素治疗与单用宫腔内人工授精相比,仅明显提高妊娠率. ③体外受精:我们没有找到关于子宫内膜异位症引起不孕妇女接受受精体外治疗的RCT. ④手术治疗:两个比较腹腔镜手术与诊断性腹腔镜的RCT发现,在妊娠率和活产率方面结论不一.
【摘要】 目的 观察腹腔镜手术联合孕三烯酮治疗子宫内膜异位症合并不孕的疗效及不同评分系统对妊娠结局的预测价值。 方法 回顾性分析2004年1月-2006年12月收治的97例子宫内膜异位症合并不孕患者的临床病理资料，统计其术后妊娠率及活产率。 结果 术后1年内与1~2年的妊娠率与活产率比较，差异均无统计学意义（Pgt;0.05）。根据美国生育协会1985年修订的子宫内膜异位症分期标准（r-AFS）进行分期，各期患者术后妊娠率差异无统计学意义（Pgt;0.05）；但随着分期升高，活产率逐渐下降（Plt;0.05）。子宫内膜异位症生育指数（EFI）评分越高，其妊娠率和活产率也越高（Plt;0.05）。 结论 子宫内膜异位症患者腹腔镜手术后联用孕三烯酮可能会提高远期妊娠率。r-AFS分期对妊娠结局的预测有一定局限性，而EFI具有较好的预测性。【Abstract】 Objective To evaluate the therapeutic effectiveness of laparoscopic surgery combined with gestrinone treatment in the infertile women with endometriosis (EM), and the value of different score systems to predict gestational outcome. Methods We retrospectively analyzed the clinical data of 97 infertile women with EM who were treated in our hospital from January 2004 to December 2006, and collected their pregnancy rate (PR) and live birth rate (LBR) after operation. Results There was no significant difference of PR and LBR within the 1st year and between the 1st and the 2nd year (Pgt;0.05). There was no significant difference of PR among women of various stages of EM based on the 1985 edition of risk stratification for patients with EM put forward by American Fertility Society (r-AFS) (Pgt;0.05), but the LBR decreased with the raising of the stages (Plt;0.05). The endometriosis fertility index (EFI) was positively correlated with PR and LBR (Plt;0.05). Conclusion Laparoscopic surgery combined with gestrinone may increase the long-term pregnancy rate of women with EM. R-AFS classification is limited in predicting the gestational outcome of women with EM, while EFI achieves a better result.
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 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.
Objective To systematically assess the correlation between smoking and the risk of endometriosis, so as to offer scientific basis to health education and preventing decision. Methods A literature search was performed in The Cochrane Library, Pubmed, Embase, CBM, CNKI and Wanfang database to collect the case control studies on the correlation between smoking and endometriosis. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, extracted the data, assessed the quality, and then conducted Meta-analyses on the 13 included RCTs by using RevMan 5.0 software, with calculation of the OR value and 95%CI. Results A total of 13 case control studies involving 14260 cases were included, of which 1900 ones were endometriosis. The quality assessment indicated that 2 studies were in quality of Level A, 4 were Level B, 7 were Level C, totally meant low quality. Meta-analyses showed that compared with non-smokers, there was no increasing possibility of endometriosis in smokers (OR= 0.91, 95%CI 0.82 to 1.02). The geographical subgroup analyses showed there was no significant difference in the incidence of endometriosis between the non-smokers and smokers in North America (OR=0.96, 95%CI 0.84 to 1.08), but a significant difference was found between non-smokers and smokers in Europe (OR=0.72, 95%CI 0.54 to 0.97). Conclusion There is no causative relationship between smoking and incidence of endometriosis. However, more high-quality trials are expected for further study because of the heterogeneity and poor quality of the current included 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.