子宫内膜异位症：主要慢性疾病的高危人群？
Endometriosis: a high-risk population for major chronic diseases?
作者信息
Kvaskoff Marina, Mu Fan, Terry Kathryn L, Harris Holly R, Poole Elizabeth M, Farland Leslie, Missmer Stacey A
机构信息
Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA 02115, USA Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), 'Nutrition, Hormones and Women's Health' Team, F-94805 Villejuif, France Univ. Paris Sud 11, UMRS 1018, F-94807 Villejuif, France Gustave Roussy, F-94805 Villejuif, France Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
出版信息
Hum Reprod Update. 2015 Jul-Aug;21(4):500-16. doi: 10.1093/humupd/dmv013. Epub 2015 Mar 11.
BACKGROUND
Despite an estimated prevalence of 10% in women, the etiology of endometriosis remains poorly understood. Over recent decades, endometriosis has been associated with risk of several chronic diseases, such as cancer, autoimmune diseases, asthma/atopic diseases and cardiovascular diseases. A deeper understanding of these associations is needed as they may provide new leads into the causes or consequences of endometriosis. This review summarizes the available epidemiological findings on the associations between endometriosis and other chronic diseases and discusses hypotheses for underlying mechanisms, potential sources of bias and methodological complexities.
METHODS
We performed a comprehensive search of the PubMed/Medline and ISI Web of Knowledge databases for all studies reporting on the associations between endometriosis and other diseases published in English through to May 2014, using numerous search terms. We additionally examined the reference lists of all identified papers to capture any additional articles that were not identified through computer searches.
RESULTS
We identified 21 studies on the associations between endometriosis and ovarian cancer, 14 for breast cancer, 8 for endometrial cancer, 4 for cervical cancer, 12 for cutaneous melanoma and 3 for non-Hodgkin's lymphoma, as well as 9 on the links between endometriosis and autoimmune diseases, 6 on the links with asthma and atopic diseases, and 4 on the links with cardiovascular diseases. Endometriosis patients were reported to be at higher risk of ovarian and breast cancers, cutaneous melanoma, asthma, and some autoimmune, cardiovascular and atopic diseases, and at decreased risk of cervical cancer.
CONCLUSIONS
Increasing evidence suggests that endometriosis patients are at higher risk of several chronic diseases. Although the underlying mechanisms are not yet understood, the available data to date suggest that endometriosis is not harmless with respects to women's long-term health. If these relationships are confirmed, these findings may have important implications in screening practices and in the management and care of endometriosis patients.
背景
尽管估计女性子宫内膜异位症的患病率为10%，但其病因仍知之甚少。近几十年来，子宫内膜异位症与几种慢性疾病的风险相关，如癌症、自身免疫性疾病、哮喘/特应性疾病和心血管疾病。需要更深入地了解这些关联，因为它们可能为子宫内膜异位症的病因或后果提供新线索。本综述总结了关于子宫内膜异位症与其他慢性疾病之间关联的现有流行病学研究结果，并讨论了潜在机制的假设、潜在的偏倚来源和方法学复杂性。
方法
我们使用众多检索词，对PubMed/Medline和ISI Web of Knowledge数据库进行了全面检索，以查找截至2014年5月发表的所有用英文报道子宫内膜异位症与其他疾病之间关联的研究。我们还检查了所有已确定论文的参考文献列表，以获取通过计算机检索未发现的任何其他文章。
结果
我们确定了21项关于子宫内膜异位症与卵巢癌关联的研究、14项与乳腺癌关联的研究、8项与子宫内膜癌关联的研究、4项与宫颈癌关联的研究、12项与皮肤黑色素瘤关联的研究和3项与非霍奇金淋巴瘤关联的研究，以及9项关于子宫内膜异位症与自身免疫性疾病之间联系的研究、6项与哮喘和特应性疾病之间联系的研究和4项与心血管疾病之间联系的研究。据报道，子宫内膜异位症患者患卵巢癌、乳腺癌、皮肤黑色素瘤、哮喘以及一些自身免疫性、心血管和特应性疾病的风险较高，而患宫颈癌的风险降低。
结论
越来越多的证据表明，子宫内膜异位症患者患几种慢性疾病的风险较高。尽管潜在机制尚不清楚，但迄今为止的现有数据表明，就女性的长期健康而言，子宫内膜异位症并非无害。如果这些关系得到证实，这些发现可能对筛查实践以及子宫内膜异位症患者的管理和护理具有重要意义。
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