Endometriosis
Endometriosis
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DOI：
10.1038/s41572-018-0008-5
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发表时间：
2018-07-19
影响因子：
81.5
通讯作者：
Vigano, Paola
中科院分区：
文献类型：
--
作者：
Zondervan, Krina T.;Becker, Christian M.;Vigano, Paola
子宫内膜异位症是一种常见的炎症性疾病，其特征是子宫外有类似子宫内膜的组织，主要位于盆腔器官和组织上。它影响着大约5%-10%的育龄妇女--相当于全世界1.76亿妇女--并与骨盆疼痛和不孕不育有关。尽管卵巢子宫内膜异位症和深部结节状疾病可以通过超声和核磁共振检查发现，但只有通过手术可视化和组织学验证才能可靠地确定诊断。月经逆行被认为是子宫内膜沉积的重要来源，但也涉及其他因素，包括良好的内分泌和代谢环境、上皮-间充质转化以及遗传易感女性免疫和炎症反应的改变。目前的治疗是由主要适应症(不孕症或盆腔疼痛)决定的，仅限于手术、激素治疗和止痛药，具有许多不良反应，很少能提供长期缓解。子宫内膜异位症严重影响妇女及其家庭的生活质量，并与2型糖尿病、克罗恩病和类风湿性关节炎等其他慢性病类似，给社会带来成本。未来的研究必须集中在了解发病机制，确定疾病亚型，开发非侵入性诊断方法，并针对希望怀孕的女性可接受的非激素治疗。
Endometriosis is a common inflammatory disease characterized by the presence of tissue outside the uterus that resembles endometrium, mainly on pelvic organs and tissues. It affects similar to 5-10% of women in their reproductive years - translating to 176 million women worldwide - and is associated with pelvic pain and infertility. Diagnosis is reliably established only through surgical visualization with histological verification, although ovarian endometrioma and deep nodular forms of disease can be detected through ultrasonography and MRI. Retrograde menstruation is regarded as an important origin of the endometrial deposits, but other factors are involved, including a favourable endocrine and metabolic environment, epithelial-mesenchymal transition and altered immunity and inflammatory responses in genetically susceptible women. Current treatments are dictated by the primary indication (infertility or pelvic pain) and are limited to surgery and hormonal treatments and analgesics with many adverse effects that rarely provide long-term relief. Endometriosis substantially affects the quality of life of women and their families and imposes costs on society similar to those of other chronic conditions such as type 2 diabetes mellitus, Crohn's disease and rheumatoid arthritis. Future research must focus on understanding the pathogenesis, identifying disease subtypes, developing non-invasive diagnostic methods and targeting non-hormonal treatments that are acceptable to women who wish to conceive.