Maginnis G, Wilk J, Carroll R, Slayden O D
Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA.
J Med Primatol. 2008 Feb;37 Suppl 1:52-5. doi: 10.1111/j.1600-0684.2007.00262.x.
Endometriosis is a condition where endometrium-like tissue forms lesions at ectopic sites outside the uterus. In women, oral contraceptive pills and progestins are often prescribed as therapy for early stage endometriosis. In contrast, in macaques the disease is frequently advanced at the time of diagnosis and ovariectomy is the standard therapy. However, surgery is contraindicated in many patients. A review of 15 endometriosis cases over the past 10 years at the Oregon National Primate Research Center (ONPRC) revealed that 5 failed to show improvement after ovariectomy and were subsequently euthanized. Therefore, our goal was to assess the feasibility of treating endometriosis in macaques with chronic progesterone (P) as an alternative therapy for the disease.
Seven adult rhesus macaques with advanced endometriosis were identified by clinical symptoms and endometriosis was confirmed by abdominal palpation, ultrasound examination, and/or aspiration of menstrual blood from abdominal cysts. The patients were chronically treated with Silastic capsules that released 5-7 ng P /ml in blood for up to 20 months. During treatment the patients were assessed daily and scored numerically for appetite, activity, attitude, abdominal discomfort and menstruation by the Clinical Veterinary staff. The patients were then re-examined by abdominal palpation and ultrasound for the disease at the end of treatment.
During the first 2 weeks of treatment, endometriotic symptoms improved significantly in all the patients (P < 0.05). This was associated with a significant increase in body weight and significant reduction in abdominal discomfort and menstrual bleeding. Two of the patients gradually developed increased symptoms of the disease after 5 months of treatment. Post-treatment abdominal examination revealed that 2/5 patients continued to have an abdominal mass even though symptoms were suppressed.
We conclude that continuous P treatment of rhesus monkeys provides therapeutic benefit to reduce symptoms of endometriosis and may provide an option for cases where ovariectomy is contraindicated.
子宫内膜异位症是一种子宫内膜样组织在子宫外异位部位形成病变的病症。在女性中，口服避孕药和孕激素常被用作早期子宫内膜异位症的治疗药物。相比之下，猕猴在诊断时该病往往已处于晚期，卵巢切除术是标准治疗方法。然而，许多患者存在手术禁忌证。对俄勒冈国家灵长类动物研究中心（ONPRC）过去10年的15例子宫内膜异位症病例进行回顾发现，5例在卵巢切除术后未见改善，随后实施了安乐死。因此，我们的目标是评估用慢性孕激素（P）治疗猕猴子宫内膜异位症作为该病替代治疗方法的可行性。
通过临床症状确定7只患有晚期子宫内膜异位症的成年恒河猴，并通过腹部触诊、超声检查和/或从腹部囊肿抽吸经血确诊子宫内膜异位症。这些患者接受了长达20个月的Silastic胶囊慢性治疗，该胶囊在血液中释放5 - 7 ng P/ml。治疗期间，临床兽医工作人员每天对患者进行评估，并对食欲、活动、态度、腹部不适和月经情况进行数字评分。治疗结束时，通过腹部触诊和超声对患者的疾病进行复查。
在治疗的前2周，所有患者的子宫内膜异位症症状均有显著改善（P < 0.05）。这与体重显著增加、腹部不适和月经出血显著减少有关。2例患者在治疗5个月后疾病症状逐渐加重。治疗后腹部检查发现，尽管症状得到抑制，但2/5的患者仍有腹部肿块。
我们得出结论，对恒河猴持续进行P治疗可减轻子宫内膜异位症症状，为卵巢切除术禁忌的病例提供了一种选择。
