Ferrero Simone, Abbamonte Luiza Helena, Anserini Paola, Remorgida Valentino, Ragni Nicola
Department of Obstetrics and Gynaecology, San Martino Hospital, University of Genoa, Genoa, Italy.
Obstet Gynecol Surv. 2005 Dec;60(12):817-26. doi: 10.1097/01.ogx.0000189153.87365.dc.
In the last few years, our understanding of the pathogenesis of endometriosis at the cellular and molecular levels has improved significantly. This may give us the opportunity to use new, specific agents for the treatment of this disorder. Despite the effectiveness of the available treatments, novel therapeutic strategies may improve our ability to eliminate endometriotic lesions when present and to prevent the recurrence of endometriosis after surgical treatment. This review focuses on the new, experimental approaches to the medical treatment of endometriosis and its symptoms. The blockage of aromatase activity in endometriotic lesions with an aromatase inhibitor may represent a new step in the medical treatment of endometriosis. Preliminary clinical studies have demonstrated the efficacy of third-generation nonsteroidal aromatase inhibitors (ie, anastrozole and letrozole) in reducing the intensity of pain symptoms associated with the presence of endometriosis. The new selective progesterone receptor modulators may represent a valid hormonal treatment option. Therapeutic manipulation of the immune system through TNFalpha inhibitors may be beneficial in women with endometriosis. New pharmaceutical agents affecting inflammation, angiogenesis, and matrix metalloproteinase activity may prevent or inhibit the development of endometriosis. Further clinical trials may determine if these new therapies are superior to current medical treatment strategies for endometriosis.
Obstetricians & Gynecologists, Family Physicians Learning.
After completion of this article, the reader should be able to describe the new experimental medical treatments of endometriosis, state that the clinical use of nonsteroidal aromatase inhibitors for endometriosis appears to be efficacious but is based on preliminary clinical data, and recall that the drugs used for endometriosis in the future may include manipulation of the immune system.
在过去几年中，我们对子宫内膜异位症在细胞和分子水平上的发病机制的理解有了显著提高。这可能使我们有机会使用新的、特异性药物来治疗这种疾病。尽管现有治疗方法有效，但新的治疗策略可能会提高我们消除现存子宫内膜异位病变以及预防手术治疗后子宫内膜异位症复发的能力。本综述重点关注子宫内膜异位症及其症状的新型实验性医学治疗方法。用芳香化酶抑制剂阻断子宫内膜异位病变中的芳香化酶活性可能代表了子宫内膜异位症医学治疗的新进展。初步临床研究已证明第三代非甾体芳香化酶抑制剂（即阿那曲唑和来曲唑）在减轻与子宫内膜异位症相关的疼痛症状强度方面的疗效。新型选择性孕激素受体调节剂可能是一种有效的激素治疗选择。通过肿瘤坏死因子α抑制剂对免疫系统进行治疗性调控可能对患有子宫内膜异位症的女性有益。影响炎症、血管生成和基质金属蛋白酶活性的新型药物制剂可能预防或抑制子宫内膜异位症的发展。进一步的临床试验可能会确定这些新疗法是否优于目前用于子宫内膜异位症的医学治疗策略。
妇产科医生、家庭医生。
阅读本文后，读者应能够描述子宫内膜异位症的新型实验性医学治疗方法，指出非甾体芳香化酶抑制剂用于子宫内膜异位症的临床应用似乎有效，但基于初步临床数据，并回忆起未来用于子宫内膜异位症的药物可能包括对免疫系统的调控。
