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Hum Reprod Update:激素抑制疗法在预防子宫内膜异位症术后复发中的效果如何?

2021-02-20 MedSci原创 MedSci原创

研究人员设计了一种使用智能手机来衡量食物消耗的方法,这也为预测身体健康提供了新方法。

子宫内膜异位症是育龄期妇女的常见疾病,常表现为盆腔疼痛和不孕。除了显著影响女性的生活质量外,子宫内膜异位症的治疗也带来了相当大的经济负担。手术有助于缓解症状、恢复解剖结构和改善生育。然而,术后子宫内膜异位症复发率很高,患者仍有需要再次干预的风险。据报道,保留卵巢的子宫内膜异位症手术后的再手术率为27%至58%

术后激素抑制被认为是减少子宫内膜异位症手术后再次干预的一种手段。2004年发表的Cochrane综述(2011年更新)综合了随机对照试验(RCT)的结果,比较了药物治疗预防子宫内膜异位症术后复发和改善疼痛症状的效果。与单纯手术相比,这篇综述没有发现术后激素抑制的优势证据;目前对子宫内膜异位症的认识表明,术后短期的抑制性治疗可能不会带来长期的益处。病人需要长时间的激素抑制以防止疾病复发,因为当病人停止服药时就会复发。

为此,有研究对接受了保守性子宫内膜异位症手术的女性的相关前瞻性观察研究和随机对照试验进行了系统回顾和荟萃分析,以评估术后接受激素抑制治疗的患者与接受安慰剂/预期治疗的患者的疾病复发风险。该研究结果近日发表在Human Reproduction Update杂志上。

利用电子数据库的综合检索策略,定位从建立到2020年3月18日发表的相关研究数据,包括MEDLINE、Embase、Cochrane CENTRAL和Web of Science。检索词用于识别子宫内膜异位症患者并接受医疗管理

主要结果是术后子宫内膜异位症复发,无论是影像学上的还是临床上的。子宫内膜异位症复发的影像学证据包括超声(US)或MRI上出现新的子宫内膜瘤、子宫内膜异位症斑块和结节。复发的临床定义包括新发或加重的盆腔疼痛症状、体检时触诊新的子宫内膜异位症结节、开始子宫内膜异位症治疗的额外治疗以及第二次手术的发现(如有)。次要转归在子宫内膜异位症相关疼痛中发生改变。由于研究中疼痛的报告不一致(即骨盆疼痛、性交困难、痛经、非周期性骨盆疼痛),研究者在评估多个疼痛参数时选择痛经变化作为主要疼痛终点。当痛经没有明确报告时,盆腔疼痛被替代为结果。

研究最后纳入了17项研究(13项随机对照试验和4项队列研究),包含2137名患者(1189名接受术后抑制治疗,948名对照),评估了各种药物:激素联合避孕药CHC(6项研究,n 869)、孕激素(3项研究,n 183)、左炔诺孕酮宫内释放系统LNG-IUS(2项研究,n 94)和GnRH激动剂(9项研究,n 1237)。纳入研究的平均随访时间为12-36个月,评估结果的中位数为18个月。与预期治疗/安慰剂相比,接受术后激素抑制治疗的患者子宫内膜异位症复发的风险显著降低(相对风险(RR)0.41,95%CI:0.26至0.65),14项研究,1766名患者,I 2 68%,随机效应模型)。对接受CHC和LNG-IUS治疗的患者进行亚组分析,以及仅限于RCT和高质量研究的敏感性分析均显示子宫内膜异位症复发的风险持续降低。此外,与对照组相比,接受术后激素抑制治疗的患者疼痛评分显著降低(SMD 0.49,95%CI:0.91至0.07,7项研究,652名患者,I268%)。

与预期治疗相比,术后激素抑制治疗的疼痛评分变化

总之,当激素抑制(CHC、孕激素、LNG-IUS、GnRH激动剂)在子宫内膜异位症手术后6周内开始使用时,术后1年内子宫内膜异位症复发率和疼痛评分显著降低,手术后无怀孕需求的患者应考虑激素抑制治疗。由于各种激素制剂已被证明是有效的,治应根据每个妇女的需要进行个性化选择。

参考文献:Andrew Zakhari, Emily Delpero, Sandra McKeown, George Tomlinson, Olga Bougie, Ally Murji. Human Reproduction Update, Volume 27, Issue 1, January-February 2021, Pages 96–107, https://doi.org/10.1093/humupd/dmaa033

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    2022-02-23 屋顶瞄爱赏月

    学习了

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  5. 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  6. 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  7. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602342, encodeId=15c41602342aa, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Feb 22 08:13:37 CST 2021, time=2021-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926167, encodeId=5bd892616e5f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5dda5461794, createdName=ms2000002025855177, createdTime=Sun Feb 21 17:06:39 CST 2021, time=2021-02-21, status=1, 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  8. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602342, encodeId=15c41602342aa, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Feb 22 08:13:37 CST 2021, time=2021-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926167, encodeId=5bd892616e5f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5dda5461794, createdName=ms2000002025855177, createdTime=Sun Feb 21 17:06:39 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047283, encodeId=0a63104e28364, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sat Feb 20 20:13:37 CST 2021, time=2021-02-20, status=1, ipAttribution=)]
    2021-02-22 sunylz
  9. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602342, encodeId=15c41602342aa, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Feb 22 08:13:37 CST 2021, time=2021-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926167, encodeId=5bd892616e5f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5dda5461794, createdName=ms2000002025855177, createdTime=Sun Feb 21 17:06:39 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047283, encodeId=0a63104e28364, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sat Feb 20 20:13:37 CST 2021, time=2021-02-20, status=1, ipAttribution=)]
    2021-02-21 ms2000002025855177

    学习

    0

  10. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602342, encodeId=15c41602342aa, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Feb 22 08:13:37 CST 2021, time=2021-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926167, encodeId=5bd892616e5f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5dda5461794, createdName=ms2000002025855177, createdTime=Sun Feb 21 17:06:39 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047283, encodeId=0a63104e28364, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sat Feb 20 20:13:37 CST 2021, time=2021-02-20, status=1, ipAttribution=)]
    2021-02-20 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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