Reproductive/Contraceptive Risk Factors & Endometriosis

描述（申请人提供）：子宫内膜异位症影响5-10%的育龄妇女，表现为慢性盆腔疼痛、痛经、性交困难和不孕。药物治疗6个月达那唑或GnRH激动剂和手术治疗在短期内有效缓解症状，但药物和手术干预的副作用排除了无限期继续或重复治疗，40-50%的妇女在停止治疗后症状复发。因此，了解复发的风险或保护因素非常重要，但患者特征和行为对症状复发可能性的影响在很大程度上尚未得到研究。该竞争性持续申请的主要目的是根据疾病严重程度和治疗，确定首次诊断为子宫内膜异位症的18-49岁女性队列中48-84个月的症状复发率，并评估症状复发与雌激素相关受试者特征和行为之间的关系。该研究假设与较高雌激素水平相关的因素，包括缺乏定期运动，外周体脂肪分布，饮酒，饮食植物雌激素摄入，涉及雌激素代谢的基因中存在低活性等位基因，以及使用激素替代疗法，可能会增加治疗停止后子宫内膜异位症症状复发的长期风险。拟定的回顾性队列研究将利用来自主要研究者在华盛顿州一家大型健康维护组织内进行的子宫内膜异位症风险因素（生殖/避孕风险因素和子宫内膜异位症，R 01 HD 33792）的病例对照研究的病例（n=337）。从该研究中的病例中获得的信息，包括与诊断前医疗、生殖、月经、避孕、行为和其他特征的详细信息的面对面访谈;饮食和人体测量; 4个遗传多态性的值（GSTM 1，COMT，CYP 1A1，CYP 1A 2）将与初次诊断后48-84个月收集的治疗详情的额外访谈信息相结合，任何症状复发的时间和程度，以及诊断后雌激素相关的特征和行为。病历和药房记录将用于补充受试者提供的诊断、治疗和复发信息。

DESCRIPTION (provided by applicant): Endometriosis affects 5-10% of reproductive-age women with chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Medical treatment with 6 months of danazol or a GnRH agonist and surgical treatment are effective in alleviating symptoms in the short term, but the side effects of medical and surgical intervention preclude indefinite continuation or repeated treatment, and symptoms reoccur in 40-50% of women after treatment cessation. Knowledge of risk or protective factors for recurrence is of great importance, therefore, yet the effect of patient characteristics and behaviors on symptom recurrence likelihood has largely been unexamined. The main objectives of this competing continuation application are to determine the 48-84 month symptom recurrence rate in a cohort of 18-49 year old women with a first-time diagnosis of endometriosis, according to disease severity and treatment, and to assess relationships between symptom recurrence and estrogen-related subject characteristics and behaviors. The study hypothesis is that factors associated with higher estrogen levels, including lack of regular exercise, peripheral body fat distribution, alcohol use, dietary phytoestrogen ingestion, presence of low activity alleles in genes involving estrogen metabolism, and use of hormone replacement therapy, may increase long-term risk of endometriosis symptom recurrence after treatment cessation. The proposed retrospective cohort study will utilize cases (n=337) from the principal investigator's current case-control study of endometriosis risk factors (Reproductive/Contraceptive Risk Factors & Endometriosis, R01 HD33792) conducted within a large health maintenance organization in Washington State. Information available from the cases in that study, including in-person interviews with pre-diagnosis details of medical, reproductive, menstrual, contraceptive, behavioral, and other characteristics; dietary and anthropometric measurements; and values of 4 genetic polymorphisms (GSTM1, COMT, CYP1A1, CYP1A2) will be combined with additional interview information to be collected between 48-84 months after initial diagnosis on treatment details, timing and extent of any recurrence of symptoms, and post-diagnosis estrogen-related characteristics and behaviors. Medical records and pharmacy records will be used as to supplement subject-provided diagnosis, treatment and recurrence information.