Inserm U1018, Centre for Research in Epidemiology and Population Health, Nutrition, Hormones and Women's Health Team, Institut Gustave Roussy, Villejuif, France.
Epidemiology. 2013 Mar;24(2):261-9. doi: 10.1097/EDE.0b013e3182806445.
Because endometriosis is diagnosed predominantly in young women, exposures occurring during childhood or adolescence may have a major impact on the disease. However, potential risk factors during this time period have received little attention. Our objective was to investigate relationships between childhood and adolescent exposures and the risk of endometriosis.
E3N is a prospective cohort of 98,995 French women aged 40-65 at enrollment in 1990. Follow-up questionnaires were sent every 2-3 years. Using a nested case-control design, we computed odds ratios (ORs) and 95% confidence intervals using unconditional logistic regression models.
A total of 2684 endometriosis cases were reported as surgically ascertained among the 75,918 included women. There were inverse relationships of endometriosis risk with menarcheal age (test for trend, P < 0.0001) and with menstrual cycle length before 17 years of age (test for trend, P = 0.06), whereas menstrual cycle regularity before 17 years of age was not associated with risk. There were modest associations of endometriosis risk with exposure to pet animals (OR = 1.12 [95% confidence interval =1.02-1.22]) or living in a farm for 3 or more consecutive months during childhood (1.12 [1.02-1.24]), although with no link to any specific type of farm animal. In addition, there were positive linear associations between endometriosis risk and level of indoor exposure to passive smoking during childhood (up to 1.34 [1.09-1.64] with several hours exposure a day), experiencing food deprivation during World War II (1.34 [0.94-1.91]), and walking activity at 8-15 years of age (1.17 [1.05-1.31] for 5+ hours a week).
This large study suggests that some exposures during childhood or adolescence may influence the risk of endometriosis. Further research is needed to confirm and better understand these relationships.
因为子宫内膜异位症主要在年轻女性中诊断出来，所以儿童期或青春期的暴露可能对该疾病有重大影响。然而，这一时期的潜在危险因素受到的关注甚少。我们的目的是调查儿童期和青春期暴露与子宫内膜异位症风险之间的关系。
E3N 是一项前瞻性队列研究，纳入了 1990 年入组时年龄在 40-65 岁的 98995 名法国女性。每 2-3 年发送一次随访问卷。我们使用嵌套病例对照设计，使用非条件逻辑回归模型计算比值比（OR）和 95%置信区间。
在纳入的 75918 名女性中，共有 2684 例子宫内膜异位症病例经手术证实。子宫内膜异位症风险与初潮年龄呈负相关（趋势检验，P<0.0001），与 17 岁前的月经周期长度呈负相关（趋势检验，P=0.06），而 17 岁前的月经周期规律性与风险无关。子宫内膜异位症风险与接触宠物动物（OR=1.12[95%置信区间=1.02-1.22]）或儿童期连续 3 个月以上生活在农场（1.12[1.02-1.24]）有适度关联，但与任何特定类型的农场动物无关。此外，子宫内膜异位症风险与儿童期室内被动吸烟水平呈正线性关联（每天接触数小时，最高达 1.34[1.09-1.64]），与第二次世界大战期间的食物短缺（1.34[0.94-1.91]）和 8-15 岁时的步行活动（每周 5 小时以上，1.17[1.05-1.31]）有关。
这项大型研究表明，儿童期或青春期的一些暴露可能会影响子宫内膜异位症的风险。需要进一步研究来证实和更好地理解这些关系。
