Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel.
Obstet Gynecol. 2012 Sep;120(3):565-72. doi: 10.1097/AOG.0b013e3182657de6.
To estimate the effectiveness of enoxaparin-a low-molecular-weight heparin with antiheparanase properties-in treating localized provoked vulvodynia.
Forty women with severe localized provoked vulvodynia were randomly and blindly assigned to self-administer either 40 mg enoxaparin or saline subcutaneously for 90 days. Dyspareunia and local sensitivity were evaluated before, at the end, and 90 days after treatment. The most painful focus was biopsied at the beginning of the study and a parallel site at the end of study for mast cells, PGP 9.5 nerve fiber staining, and heparanase quantification.
The enoxaparin-treated women showed a greater reduction in vestibular sensitivity at the end of treatment and 3 months later (29.6% compared with 11.2%, P=.004). Seventy-five percent (15 of 20) of them reported more than 20% pain reduction compared with 27.8% (five of 18) in the placebo group (P=.004). Seven enoxaparin-treated women compared with three in the placebo group had almost painless intercourse at the end of the study. In women who had improvement of sensitivity at the site parallel to the original biopsy site, there was a histologically documented reduction in the number of intraepithelial-free nerve fibers in the enoxaparin group.
Enoxaparin reduced the vestibular sensitivity and dyspareunia, concomitant with a reduction in intraepithelial free nerve fibers, in women with localized provoked vulvodynia.
评估具有抗乙酰肝素酶特性的低分子肝素依诺肝素治疗局限性激惹性外阴痛的疗效。
40 名严重局限性激惹性外阴痛的女性患者被随机、盲法分为两组，分别皮下注射 40mg 依诺肝素或生理盐水，治疗 90 天。在治疗前、治疗结束时和治疗后 90 天评估性交痛和局部敏感度。在研究开始时和研究结束时对最痛焦点进行活检，并行检测肥大细胞、PGP 9.5 神经纤维染色和乙酰肝素酶定量。
依诺肝素治疗的女性患者在治疗结束时和 3 个月后外阴敏感度降低更明显（29.6%比 11.2%，P=.004）。与安慰剂组 27.8%（18 名中有 5 名）相比，75%（20 名中有 15 名）的患者报告疼痛减轻 20%以上（P=.004）。7 名依诺肝素治疗的女性患者与安慰剂组 3 名患者在研究结束时几乎无痛性交。在与原始活检部位平行的部位敏感性改善的女性中，依诺肝素组的上皮内游离神经纤维数量在组织学上有所减少。
依诺肝素降低了局限性激惹性外阴痛患者的外阴敏感度和性交痛，同时减少了上皮内游离神经纤维。
