Mumford Sunni L, Weck Jennifer, Kannan Kurunthachalam, Buck Louis Germaine M
Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; and
Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; and.
J Nutr. 2017 Feb;147(2):227-234. doi: 10.3945/jn.116.238840. Epub 2016 Dec 28.
Phytoestrogens have been associated with subtle hormonal changes, but their effects on endometriosis are largely unknown.
We assessed the association between urinary concentrations of phytoestrogens and incident endometriosis.
We included an operative sample of 495 premenopausal women aged 18-44 y undergoing laparoscopies and laparotomies at 14 clinical sites between 2007 and 2009 and a general population sample of 131 women from the same geographic area who were matched on age and menstruation status. Endometriosis in the surgical sample was assessed by surgical visualization (clinical gold standard), whereas disease in the general population sample was assessed with the use of a pelvic MRI. Urine concentrations of genistein, daidzen, O-desmethylangolensin, equol, enterodiol, and enterolactone were measured at baseline. Poisson regression with robust error variance was used to estimate the risk of an endometriosis diagnosis for each sample after adjusting for age and body mass index (in kg/m). Separate models were run for each phytoestrogen.
Overall geometric mean urine concentrations of phytoestrogens were as follows: genistein [88 nmol/L (95% CI: 72, 108 nmol/L)], daidzein [194 nmol/L (95% CI: 160, 236 nmol/L)], O-desmethylangolensin [4 nmol/L (95% CI: 3, 6 nmol/L)], equol [4 nmol/L (95% CI: 4, 6 nmol/L)], enterodiol [29 nmol/L (95% CI: 22, 38 nmol/L)], and enterolactone [355 nmol/L (95% CI: 395, 544 nmol/L)]. Geometric mean concentrations of phytoestrogens did not significantly differ by endometriosis status in either sample. Adjusted RRs for endometriosis ranged from 0.87 to 1.09 for the 6 phytoestrogens measured, with all CIs including a value ≥1. Phytoestrogens were not associated with the severity of endometriosis when restricting the analysis to women with moderate-to-severe disease per the revised American Society for Reproductive Medicine criteria. Furthermore, no associations were observed between self-reported high soy intake and endometriosis.
Despite endometriosis being an estrogen-dependent disease, we found no evidence that urinary phytoestrogens were associated with a higher risk of an endometriosis diagnosis in either a sample of premenopausal women or in a surgical sample.
植物雌激素与细微的激素变化有关，但其对子宫内膜异位症的影响大多未知。
我们评估了尿中植物雌激素浓度与子宫内膜异位症发病之间的关联。
我们纳入了2007年至2009年间在14个临床地点接受腹腔镜检查和剖腹手术的495名年龄在18 - 44岁的绝经前女性的手术样本，以及来自同一地理区域的131名在年龄和月经状态上匹配的普通人群样本。手术样本中的子宫内膜异位症通过手术可视化评估（临床金标准），而普通人群样本中的疾病则通过盆腔MRI评估。在基线时测量尿中染料木黄酮、大豆苷元、O - 去甲基安哥拉紫檀素、雌马酚、肠二醇和肠内酯的浓度。在调整年龄和体重指数（kg/m²）后，使用具有稳健误差方差的泊松回归来估计每个样本中子宫内膜异位症诊断的风险。对每种植物雌激素分别运行单独的模型。
植物雌激素的总体几何平均尿浓度如下：染料木黄酮[88 nmol/L（95% CI：72，108 nmol/L）]，大豆苷元[194 nmol/L（95% CI：160，236 nmol/L）]，O - 去甲基安哥拉紫檀素[4 nmol/L（95% CI：3，6 nmol/L）]，雌马酚[4 nmol/L（95% CI：4，6 nmol/L）]，肠二醇[29 nmol/L（95% CI：22，38 nmol/L）]，肠内酯[355 nmol/L（95% CI：395，544 nmol/L）]。在两个样本中，植物雌激素的几何平均浓度在子宫内膜异位症状态方面均无显著差异。所测量的6种植物雌激素的子宫内膜异位症调整后RR范围为0.87至1.09，所有CI均包含≥1的值。根据修订的美国生殖医学学会标准，将分析限制在中重度疾病的女性时，植物雌激素与子宫内膜异位症的严重程度无关。此外，在自我报告的高大豆摄入量与子宫内膜异位症之间未观察到关联。
尽管子宫内膜异位症是一种雌激素依赖性疾病，但我们没有发现证据表明尿中植物雌激素与绝经前女性样本或手术样本中子宫内膜异位症诊断的较高风险相关。
