Gibran Luciano, Maranhão Raul C, Abrão Mauricio S, Baracat Edmundo C, Podgaec Sergio
Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:153-8. doi: 10.1016/j.ejogrb.2014.05.028. Epub 2014 Jun 2.
Endometriosis, defined as the presence of endometrial glands and/or stroma outside the uterine cavity, is an estrogen-dependent disease that affects about 10% of reproductive age women. Theories to explain the etiology of endometriosis abound. These include the alteration of epithelial cells on peritoneal surface, metaplasia of embryonic remnants of the mullerian ducts, immune system abnormalities, and the dissemination of endometrial cells through the circulation or lymphatic system, as well as retrograde menstruation, the hypothesis currently favored for the development of endometriosis. Angiogenesis, the development of new capillaries from pre-existing blood vessels, has been proposed as a key mechanism in the pathogenesis of endometriosis. Again from an etiological perspective, the formation of endometriotic implants requires ectopic fixation and proliferation of endometrial stroma and glands. The process of invasive insertion of endometriotic tissues involves the degradation of the extracellular matrix, and altered expression of matrix metalloproteinases (MMPs) in the eutopic and ectopic endometrium. Considering the antiproliferative, antiangiogenic, antioxidant, anti-inflammatory properties and matrix metalloproteinase activity inhibition of statins and the original studies addressing the possible mechanisms of action in endometriosis, the aim of this systematic review was to synthesize the research conducted to date in order to propose statins as possible and effective tools for controlling this disease.
子宫内膜异位症被定义为子宫腔外存在子宫内膜腺体和/或间质，是一种雌激素依赖性疾病，影响约10%的育龄妇女。关于子宫内膜异位症病因的理论众多。这些理论包括腹膜表面上皮细胞的改变、苗勒管胚胎残余的化生、免疫系统异常、子宫内膜细胞通过血液循环或淋巴系统的播散，以及逆行月经，这是目前子宫内膜异位症发病最受青睐的假说。血管生成，即从已有的血管发育出新的毛细血管，被认为是子宫内膜异位症发病机制中的关键机制。同样从病因学角度来看，子宫内膜异位种植体的形成需要子宫内膜间质和腺体的异位固定和增殖。子宫内膜异位组织的侵袭性植入过程涉及细胞外基质的降解，以及在位和异位子宫内膜中基质金属蛋白酶（MMPs）表达的改变。鉴于他汀类药物具有抗增殖、抗血管生成、抗氧化、抗炎特性以及对基质金属蛋白酶活性的抑制作用，且有最初的研究探讨了其在子宫内膜异位症中可能的作用机制，本系统评价的目的是综合迄今为止开展的研究，以便提出他汀类药物作为控制这种疾病的可能有效工具。
