Sharpe K L, Bertero M C, Muse K N, Vernon M W
Department of Obstetrics and Gynecology, University of Kentucky, Lexington 40536.
Am J Obstet Gynecol. 1991 Jan;164(1 Pt 1):187-94. doi: 10.1016/0002-9378(91)90652-8.
Recurrent endometriosis in women is difficult to study because of the ethical consideration of performing repeated surgeries. Previously in the rat model we described therapeutic regression of endometriosis with the gonadotropin-releasing hormone antagonist antide. Presently we report the spontaneous and steroid-induced recurrence of endometriosis after withdrawal from antide therapy. Rats with endometriosis received antide or vehicle on days 0 (proestrus), 3, 6, and 9 and were killed on days 0, 6, 12, 18, 24, 30, and 42 (n = 4 antide-treated and 4 vehicle-treated rats killed per day). Additional antide-treated rats (n = 4 per treatment) received estrogen, progesterone, both estrogen and progesterone, cholesterol, and no steroid on day 9 and were killed on day 12. Antide significantly suppressed endometriotic implant size on days 12, 18, and 24. However, implant size spontaneously returned to pretreatment values by day 30. Administration of steroids on day 9 elicited regrowth of antide-suppressed endometriosis (estrogen plus progesterone greater than estrogen, progesterone, or cholesterol greater than no steroid) by day 12. This resilience of endometriosis offers an explanation for treatment failure and recurrence of the disease in women.
由于重复手术存在伦理考量，女性复发性子宫内膜异位症很难进行研究。此前在大鼠模型中，我们描述了促性腺激素释放激素拮抗剂安替肽对子宫内膜异位症的治疗性消退作用。目前我们报告了在停用安替肽治疗后，子宫内膜异位症的自发复发以及激素诱导的复发情况。患有子宫内膜异位症的大鼠在第0天（动情前期）、第3天、第6天和第9天接受安替肽或赋形剂处理，并在第0天、第6天、第12天、第18天、第24天、第30天和第42天处死（每天处死4只接受安替肽治疗的大鼠和4只接受赋形剂治疗的大鼠）。另外，接受安替肽治疗的大鼠（每种处理4只）在第9天接受雌激素、孕激素、雌激素加孕激素、胆固醇处理，或不接受激素处理，并在第12天处死。安替肽在第12天、第18天和第24天显著抑制了子宫内膜异位症植入物的大小。然而，到第30天时，植入物大小自发恢复到预处理值。在第9天给予激素导致安替肽抑制的子宫内膜异位症在第12天出现再生长（雌激素加孕激素大于雌激素、孕激素或胆固醇大于不接受激素处理）。子宫内膜异位症的这种恢复能力为女性疾病治疗失败和复发提供了解释。
