目的:梗阻性Müllerian异常(OMA)患者与非梗阻性Müllerian异常(NOMA)患者的子宫内膜异位症患病率是否不同,
结论:已发表数据的定量综合显示,与NOMA患者相比,OMA患者子宫内膜异位症的患病率显著增加,在NOMA患者和没有穆勒异常的患者中,患病率相似。
背景:子宫内膜异位症的发病机制尚未明确阐明。OMA患者子宫内膜异位症的患病率高于NOMA患者,这将支持逆行月经(RM)/植入理论。而NOMA组子宫内膜异位症的患病率高于没有苗勒氏异常的组,则支持胚胎残存/细胞化生假说.
方法:这项具有荟萃分析的系统综述仅限于全长,1980年至2023年在同行评审期刊上发表的英语文章。PubMed和EMBASE数据库使用关键词\'子宫内膜异位症\'和\'穆勒异常\'进行搜索,\'阻塞性穆勒异常\',\'女性生殖器畸形\',\'逆行月经\',\'不孕症\',\'骨盆疼痛\',和“分类”。对相关出版物的参考文献进行了筛选,使用了PubMed的\'类似文章\'和\'引用的\'函数。
方法:如果研究报告了OMA患者与NOMA患者相比手术证实的子宫内膜异位症的患病率,或患有NOMA的患者与没有穆勒异常的患者相比。队列和病例对照研究以及病例系列被认为有资格纳入。非比较研究,研究未报告子宫内膜异位症患者的数量和苗勒氏畸形或其他妇科疾病患者的总数,包括月经功能缺失或不确定患者的专门数据(例如完全Müllerian发育不全类别),或无孔处女膜被排除在外。两个审阅者独立抽象数据。使用非随机暴露研究工具中的偏倚风险评估偏倚风险。证据的总体确定性根据建议评估等级进行分级,开发和评估(等级)指南。
结果:共纳入7项回顾性研究。OMA患者子宫内膜异位症患病率的总体平均估计值为47%(95%CI,36-58%),19%(95%CI,15-24%)的NOMA患者,共同比值比(OR)为4.72(95%CI,2.54-8.77)。NOMA患者子宫内膜异位症患病率的总体平均估计值为23%(95%CI,20-27%),在没有穆勒异常的患者中,21%(95%CI,20-22%),共同OR为0.95(95%CI,0.57-1.58)。对于两种比较,根据GRADE指南的证据的总体确定性被认为较低。
结论:一些NOMA亚型可能会对月经流出造成部分障碍和/或产生功能失调的子宫肌层收缩,从而促进经管反流,从而增加子宫内膜异位症的风险并限制OMA和NOMA之间的差异。由于不孕和盆腔疼痛与子宫内膜异位症密切相关,有这些症状的女性是不适当的控制。适应症的混淆可以解释NOMA患者和无苗勒氏异常患者之间子宫内膜异位症患病率缺乏差异。
结论:此荟萃分析的结果支持RM理论的有效性,但并未明确排除替代假设。因此,RM可能被认为是子宫内膜异位病变发展的发起者,同时不排除可遗传和组织特异性遗传和表观遗传修饰作为疾病促进因子的贡献。
背景:本次审查没有收到资金。P.Ve.是人类生殖开放编辑委员会的成员,加拿大妇产科杂志,和国际妇产科杂志编辑委员会;在临床决策支持资源UpToDate中获得了WoltersKluwer关于子宫内膜异位症管理章节的版税;并保持公共和私人妇科实践。E.S.披露了Ferring的研究补助金和Merck-Serono的讲座酬金。所有其他作者都声明他们没有利益冲突。
背景:不适用。
OBJECTIVE: Does endometriosis prevalence differ in patients with obstructive Müllerian anomalies (OMA) versus those with nonobstructive Müllerian anomalies (NOMA), and in patients with NOMA versus those without Müllerian anomalies?
CONCLUSIONS: The quantitative synthesis of published data demonstrates a substantially increased prevalence of endometriosis in patients with OMA compared with those with NOMA, and a similar prevalence in patients with NOMA and those without Müllerian anomalies.
BACKGROUND: The pathogenesis of endometriosis has not been definitively clarified yet. A higher prevalence of endometriosis in patients with OMA than in those with NOMA would support the retrograde menstruation (RM)/implantation theory, whereas a higher prevalence of endometriosis in the NOMA group than in the group without Müllerian anomalies would support the embryonic remnants/celomic metaplasia hypothesis.
METHODS: This systematic review with meta-analysis was restricted to full-length, English-language articles published in peer-reviewed journals between 1980 and 2023. The PubMed and EMBASE databases were searched using the keyword \'endometriosis\' in combination with \'Müllerian anomalies\', \'obstructive Müllerian anomalies\', \'female genital malformations\', \'retrograde menstruation\', \'infertility\', \'pelvic pain\', and \'classification\'. References from relevant publications were screened, and PubMed\'s \'similar articles\' and \'cited by\' functions were used.
METHODS: Studies were selected if they reported the prevalence of surgically confirmed endometriosis in either individuals with OMA compared to those with NOMA, or patients with NOMA compared to those without Müllerian anomalies. Cohort and case-control studies and case series were deemed eligible for inclusion. Noncomparative studies, studies not reporting both the number of individuals with endometriosis and the total number of those with Müllerian anomalies or with other gynecological conditions, those including exclusively data on patients with absent or uncertain menstrual function (e.g. complete Müllerian agenesis category), or with imperforate hymen were excluded. Two reviewers independently abstracted data. The risk of bias was assessed with the Risk of Bias In Non-randomized Studies of Exposures tool. The overall certainty of the evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.
RESULTS: Seven retrospective studies were included. The overall mean estimate of endometriosis prevalence was 47% (95% CI, 36-58%) in patients with OMA, and 19% (95% CI, 15-24%) in patients with NOMA, with a common odds ratio (OR) of 4.72 (95% CI, 2.54-8.77). The overall mean estimate of endometriosis prevalence in patients with NOMA was 23% (95% CI, 20-27%), and that in patients without Müllerian anomalies was 21% (95% CI, 20-22%), with a common OR of 0.95 (95% CI, 0.57-1.58). The overall certainty of the evidence according to GRADE guidelines was judged as low for both comparisons.
CONCLUSIONS: Some NOMA subtypes may create a partial obstacle to menstrual efflux and/or generate dysfunctional myometrial contractions that favor transtubal reflux, thus increasing the risk of endometriosis and limiting the difference between OMA and NOMA. As infertility and pelvic pain are strongly associated with endometriosis, women with these symptoms are inappropriate controls. Confounding by indication could explain the lack of difference in endometriosis prevalence between patients with NOMA and those without Müllerian anomalies.
CONCLUSIONS: The results of this meta-analysis support the validity of the RM theory but do not definitively rule out alternative hypotheses. Thus, RM may be considered the initiator for the development of endometriotic lesions, while not excluding the contribution of both inheritable and tissue-specific genetic and epigenetic modifications as disease-promoting factors.
BACKGROUND: No funding was received for this review. P.Ve. is a member of the Editorial Board of Human Reproduction Open, the Journal of Obstetrics and Gynaecology Canada, and the International Editorial Board of Acta Obstetricia et Gynecologica Scandinavica; has received royalties from Wolters Kluwer for chapters on endometriosis management in the clinical decision support resource UpToDate; and maintains both a public and private gynecological practice. E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest.
BACKGROUND: N/A.