背景:子宫内膜异位症是育龄妇女常见的致残性疼痛,经常显示家族聚类。然而,关于家族性倾向是否会影响其严重程度或表现,人们知之甚少。在这项研究中,我们调查有子宫内膜异位症家族史(FH)或偏头痛合并症的子宫内膜异位症患者的疾病特征,抑郁症和早期更年期(EMP)。
方法:我们进行了一项观察性病例对照研究,在三级研究中心招募了经组织学证实的子宫内膜异位症妇女。根据手术结果,患者记录和电话采访,我们检查了子宫内膜异位症的FH之间的关系,偏头痛,抑郁症或EMP和子宫内膜异位的体征和症状,例如对激素避孕药(CHC)和镇痛药的反应,疾病定位,入渗深度,Enzian和rASRM分数。
结果:子宫内膜异位症FH阳性,偏头痛,抑郁症或EMP报告为10.2%,33.4%,344例患者的32.6%和9.9%。子宫内膜异位症FH阳性与高rASRM评分的风险增加相关(rASRM3+4:OR2.74(95%CI1.16-6.49),p=0.017)和子宫内膜瘤的存在(OR2.70(1.22-5.95),p=0.011)。偏头痛的FH阳性与子宫内膜异位症症状对CHC的反应较少相关(OR0.469(0.27-0.82)p=0.025)。家庭中的抑郁症与较不严重的rASRM评分有关(rASRM34:OR0.63(0.39-0.99),p=0.046)和较少的子宫内膜瘤(OR0.58(0.67-0.92),p=0.02),但同时增加了偏头痛的风险(OR1.66(1.01-2.73),p=0.043)和抑郁(OR3.04(1.89-4.89),p<0.001),同时显示对CHC的更好反应(OR2.0(1.15-3.48,p<0.001)。家庭中EMP患者目前报告了更多的子宫内膜异位症症状(OR3.72(1.67-8.30),p=0.001),更多痛经(OR2.13(1.04-4.35),p=0.037),更频繁的严重痛经(OR2.32(1.14-4.74),p=0.019),并且明显更经常遭受>5天的非循环性疼痛(OR3.58(1.72-7.44),p<0.001)。
结论:约30%的人报告偏头痛或抑郁症的FH阳性。子宫内膜异位症FH阳性的患者,偏头痛,与对照组相比,抑郁症或EMP的症状和手术结果不同。虽然子宫内膜异位症的FH与更高的rASRM评分和更多的子宫内膜瘤相关,患有抑郁症FH的女性rASRM评分较低,子宫内膜瘤较少,但对CHC反应较好.相比之下,患有偏头痛FH的女性对CHC的反应较少。
BACKGROUND: Endometriosis is a common disabling pain condition in women of childbearing age, frequently showing familial clustering. Nevertheless, little is known about whether familial predispositions influence its severity or presentation. In this study, we investigate disease characteristics in endometriosis patients with a family history (FH) for endometriosis or the comorbidities migraine, depression and early
menopause (EMP).
METHODS: We performed an observational
case-control study enrolling women with histologically confirmed endometriosis in a tertiary center. Based on surgical findings, patient records and phone interviews, we examined the relations between a FH for endometriosis, migraine, depression or EMP and endometriotic signs and symptoms, such as response to combined hormonal contraceptives (CHC) and analgesics, disease localization, infiltration depth, Enzian- and rASRM-scores.
RESULTS: A positive FH for endometriosis, migraine, depression or EMP was reported by 10.2 %, 33.4 %, 32.6 % and 9.9 % of the 344 patients. A positive FH of endometriosis was associated with an increased risk for high rASRM-scores (rASRM 3 + 4: OR 2.74 (95 % CI 1.16-6.49), p = 0.017) and the presence of endometriomas (OR 2.70 (1.22-5.95), p = 0.011). A positive FH for migraine was associated with less response of endometriosis symptoms to CHC (OR 0.469 (0.27-0.82) p = 0.025). Depression in the family was linked to less severe rASRM-scores (rASRM 3 + 4: OR 0.63 (0.39-0.99), p = 0.046) and less endometriomas (OR 0.58 (0.67-0.92), p = 0.02), but increased the risk of both migraine (OR 1.66 (1.01-2.73), p = 0.043) and depression (OR 3.04 (1.89-4.89), p < 0.001) while showing a better response to CHC (OR 2.0 (1.15-3.48, p < 0.001). Patients with EMP in their family reported more current endometriosis symptoms at present (OR 3.72 (1.67-8.30), p = 0.001), more dysmenorrhea (OR 2.13 (1.04-4.35), p = 0.037), more frequent severe dysmenorrhea (OR 2.32 (1.14-4.74), p = 0.019) and suffered significantly more often > 5 days of non-cyclic pain (OR 3.58 (1.72-7.44), p < 0.001).
CONCLUSIONS: Around 30% reported a positive FH for migraine or depression. Patients with a positive FH for endometriosis, migraine, depression or EMP differ in symptoms and surgical findings when compared to controls. While a FH for endometriosis is associated with higher rASRM scores and more endometriomas, women with a FH for depression had lower rASRM scores and less endometriomas while responding better to CHC. In contrast, women with a FH for migraine showed less response to CHC.