目标:以前,在子宫内膜异位症女性中注射的脂质纳米颗粒(LDE)显示集中在病变中.这里,对LDE携带甲氨蝶呤(MTX)治疗深部浸润型子宫内膜异位症的安全性和可行性进行了测试.
方法:前瞻性试点研究。
方法:PerolaByington医院妇女健康参考。
方法:11名志愿者(年龄30-47岁,BMI26.15±6.50kg/m2),子宫内膜异位症视觉模拟评分(VAS)>7,直肠乙状结肠病变纳入研究。
方法:3例患者接受LDE-MTX单次静脉25mg/m2剂量的MTX治疗,8例患者接受两次25mg/m2剂量的治疗,间隔1周。
方法:临床投诉,血细胞计数,在治疗前和LDE-MTX给药后第90、120和180天进行生化分析。在治疗前以及LDE-MTX给药后第30天和第180天,通过盆腔和经阴道超声(TVUS)评估子宫内膜异位症病变。
结果:患者未报告与LDE-MTX治疗相关的临床投诉,没有血液学,肾,或在实验室检查中观察到肝毒性。FSH,LH,TSH,游离T4,抗苗勒管激素,在观察期间,催乳素水平也在正常范围内。深度性交困难的评分(p<0.001),慢性盆腔疼痛(p=0.008),在180天的观察期内,病患(p=0.025)得到了改善。痛经的VAS评分降低趋势不显著。TVUS显示的肠道病变无变化。在治疗反应中没有观察到两种剂量水平之间的明显差异。
结论:结果支持LDE-MTX作为一种新的、有前景的治疗子宫内膜异位症的安全性和可行性。在未来的安慰剂对照研究中应该测试更长时间的治疗方案,旨在建立这种新型纳米医学方法的有用性。
Previously, lipid nanoparticles (LDE) injected in women with endometriosis were shown to concentrate in the lesions. Here, the safety and feasibility of LDE carrying methotrexate (MTX) to treat deep infiltrating endometriosis was tested.
Prospective pilot
study.
Perola Byington Hospital Reference for Women\'s Health.
Eleven volunteers (aged 30-47 years, BMI 26.15 ± 6.50 kg/m2) with endometriosis with visual analog scale pelvic pain scores (VAS) > 7 and rectosigmoid lesions were enrolled in the
study.
Three patients were treated with LDE-MTX at single intravenous 25 mg/m2 dose of MTX and eight patients with two 25 mg/m2 doses with 1-week interval.
Clinical complaints, blood count, and biochemistry were analyzed before treatment and on days 90, 120, and 180 after LDE-MTX administration. Endometriotic lesions were evaluated by pelvic and transvaginal ultrasound (TVUS) before treatment and on days 30 and 180 after LDE-MTX administration.
No clinical complaints related with LDE-MTX treatment were reported by the patients, and no hematologic, renal, or hepatic toxicities were observed in the laboratorial exams. FSH, LH, TSH, free T4, anti-Müllerian hormone, and prolactin levels were also within normal ranges during the observation period. Scores for deep dyspareunia (p < 0.001), chronic pelvic pain (p = 0.008), and dyschezia (p = 0.025) were improved over the 180-day observation period. There was a non-significant trend for reduction of VAS scores for dysmenorrhea. Bowel lesions by TVUS were unchanged. No clear differences between the two dose levels in therapeutic responses were observed.
Results support the safety and feasibility of using LDE-MTX in women with deep infiltrating endometriosis as a novel and promising therapy for the disease. More prolonged treatment schemes should be tested in future placebo-controlled studies aiming to establish the usefulness of this novel nanomedicine approach.