Latthe Pallavi, Mignini Luciano, Gray Richard, Hills Robert, Khan Khalid
Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham B15 2TG.
BMJ. 2006 Apr 1;332(7544):749-55. doi: 10.1136/bmj.38748.697465.55. Epub 2006 Feb 16.
To evaluate factors predisposing women to chronic and recurrent pelvic pain. DESIGN, DATA SOURCES, AND METHODS: Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors.
There were 122 studies (in 111 articles) of which 63 (in 64,286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18,601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12,040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain.
Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.
评估导致女性慢性和复发性盆腔疼痛的易患因素。
设计、数据来源及方法：通过对Medline、Embase、PsycINFO、Cochrane图书馆、SCISEARCH、会议论文以及检索到的原始文章和综述文章的参考文献进行系统回顾，纳入无语言限制的相关研究。两名评审员独立提取有关研究特征、质量和结果的数据。比较有盆腔疼痛和无盆腔疼痛女性的危险因素暴露情况。结果在由疼痛类型和危险因素定义的亚组中进行汇总。
共有122项研究（发表于111篇文章），其中63项研究（涉及64286名女性）评估了痛经的54个危险因素，19项研究（涉及18601名女性）评估了性交困难的14个危险因素，40项研究（涉及12040名女性）评估了非周期性盆腔疼痛的48个因素。年龄<30岁、低体重指数、吸烟、初潮早（<12岁）、月经周期长、月经量多、未生育、经前综合征、绝育、临床怀疑盆腔炎、性虐待以及心理症状与痛经有关。首次分娩年龄较小、运动和口服避孕药与痛经呈负相关。绝经、盆腔炎、性虐待、焦虑和抑郁与性交困难有关。药物或酒精滥用、流产、月经量多、盆腔炎、既往剖宫产、盆腔病变、虐待以及心理合并症与非周期性盆腔疼痛风险增加有关。
多种妇科和社会心理因素与慢性盆腔疼痛密切相关。需要针对这些潜在可改变因素进行干预的随机对照试验，以评估它们在慢性盆腔疼痛中的临床相关性。
