子宮內膜異位與發炎性腸道疾病有關


  【24drs.com】根據丹麥研究者線上發表於12月19日Gut期刊的大型長期研究,子宮內膜異位和發生發炎性腸道疾病(IBD)風險增加有關。
  
  子宮內膜異位和IBD都會出現腹痛,一般發生於成年初期,都是慢性發炎性疾病;過去這兩個診斷不會同時存在,不過,丹麥哥本哈根Statens Serum研究中心的Tine Jess醫師等人,檢視了全國資料庫探討兩者沒有互斥的可能性,認為或許是子宮內膜異位導致婦女發生IBD。
  
  研究者檢視了在1997-2007年間因子宮內膜異位住院之37,661名婦女的病史,這些婦女中,320人發生IBD(228名婦女發生潰瘍性結腸炎、92人發生克隆氏症);和一般婦女相比,子宮內膜異位婦女的整體IBD風險增加(標準發生率比率[SIR]為1.5;95%信心區間[CI]為1.4 - 1.7),潰瘍性結腸炎也是(SIR,1.5;95% CI,1.3 - 2.0)。根據接受手術確認有子宮內膜異位的組別,則IBD風險增加80%(潰瘍性結腸炎:SIR,1.8 [95% CI,1.4 - 2.3];克隆氏症:SIR,1.7 [95% CI,1.2 - 2.5])。
  
  診斷有IBD後,風險增加持續廿年,診斷子宮內膜癌與發生IBD之間的平均時間差為將近10年,事實上,這個關聯因為具有強度而持續顯著。
  
  研究者假設,這兩個異常之間的關聯有兩種解釋:有共同的潛在發炎問題,或者是治療子宮內膜異位(口服避孕藥)增加了IBD風險。
  
  作者們寫道,研究強度包括,研究對象自由參加各項普遍健康照護,有相當好的診斷登記而可以前瞻式收集資料、使回憶偏差最小化;這篇研究為期多年,校正了一般族群的年紀與期間特定IBD發生率。
  
  研究限制包括,忽略了輕微的子宮內膜異位案例、確定性偏差的風險,兩種診斷都是來自相同的登記者;另一個干擾變項可能是因為子宮內膜異位的平均年齡增加(38.6歲),有些婦女是在尋求不孕症治療時被診斷出來。
  
  研究者結論指出,依舊需要大範圍的未篩選世代研究,以確認使用口服避孕藥對於IBD的短期或長期風險的影響,至少要分析同時發生子宮內膜異位時的情況。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6683&x_classno=0&x_chkdelpoint=Y
  

Endometriosis Linked to Later Inflammatory Bowel Disease

By Ricki Lewis, PhD
Medscape Medical News

December 20, 2011 — Endometriosis is associated with an increased risk of developing inflammatory bowel disease (IBD), according to a large-scale, long-term study by Danish researchers published online December 19 in Gut.

Both endometriosis and IBD present with abdominal pain, typically begin in early adulthood, and are chronic inflammatory disorders. In the past, diagnosis of one has precluded diagnosis of the other. However, Tine Jess, MD, and colleagues from the Statens Serum Institute in Copenhagen, Denmark, examined national registers to investigate the possibility that instead of being mutually exclusive, perhaps endometriosis predisposes a woman to developing IBD.

The researchers examined the medical histories of 37,661 women hospitalized for endometriosis at any time between 1977 and 2007. Of these women, 320 developed IBD (228 women developed ulcerative colitis, 92 developed Crohn's disease). The women with endometriosis had an increased risk for IBD overall (standardized incidence ratio [SIR], 1.5; 95% confidence interval [CI], 1.4 - 1.7), as well as for ulcerative colitis (SIR, 1.5; 95% CI, 1.3 - 2.0), compared with women in the general population. Stratifying the patient groups by those who underwent surgery that verified the endometriosis led to an increase in IBD risk of 80% (ulcerative colitis: SIR, 1.8 [95% CI, 1.4 - 2.3]; Crohn's disease: SIR, 1.7 [95% CI, 1.2 - 2.5]).

The increased risk persisted for 2 decades after diagnosis of IBD, and the average lag between endometriosis diagnosis and development of IBD was approximately 10 years. The fact that the association persists argues for its strength.

The researchers hypothesize 2 explanations for the association between the 2 disorders: that they share a common underlying inflammatory problem, or that treatment for endometriosis (oral contraceptive use) increases the risk for IBD.

Strengths of the study, the authors write, include that the population has free, universal health care and excellent diagnosis registries that collect data prospectively, minimizing recall bias. The study covered many years and adjusted for age and period-specific IBD incidence in the general population.

Limitations of the study include omission of mild endometriosis cases and risk of ascertainment bias, as both types of diagnoses came from the same register. Another confounding factor might arise from the fact that the mean age at endometriosis was elevated (38.6 years), suggesting that some women may have been diagnosed when seeking infertility treatment.

The researchers conclude, "there is still a need for large-scale unselected cohort studies to confirm the influence of oral contraceptive use on the short- and long-term risk of IBD, not least in the context of concurrent endometriosis."

The lead author was supported by a grant from the Danish Council of Independent Research. The researchers have disclosed no relevant financial relationships.

Gut. Published online December 19, 2011.

    
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