Hager Marlene, Wenzl René, Riesenhuber Sonja, Marschalek Julian, Kuessel Lorenz, Mayrhofer Daniel, Ristl Robin, Kurz Christine, Ott Johannes
Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Oncology and General Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
J Clin Med. 2019 Aug 14;8(8):1210. doi: 10.3390/jcm8081210.
To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did not present with any endometriosis symptoms and underwent laparoscopic ovarian drilling (LOD) for clomiphene citrate (CC) resistance, 225 and 630 women with CC-resistant PCOS without classic endometriosis symptoms were included in a retrospective study and a meta-analysis, respectively. All women underwent LOD. The main outcome parameter was the prevalence of incidental endometriosis. Laparoscopy revealed endometriosis in 38/225 (16.9%) women (revised American Fertility Society (rAFS) stage I: 33/38, 86.8%; rAFS stage II: 5/38, 13.2%). When women with CC-resistant PCOS without endometriosis were compared, lower body mass index (BMI) and lower 25-hydroxy-vitamin D levels were associated with the presence of endometriosis at laparoscopy (odds ratios (OR): 0.872, 95% confidence intervals (95%CI): 0.792-0.960; = 0.005 and OR: 0.980, 95%CI: 0.962-0.999; = 0.036; respectively). The inclusion criteria for the meta-analysis were fulfilled by 4/230 reports about LOD. After correction for study heterogeneity, the pooled prevalence of incidental endometriosis was 7.7% in women with CC-resistant PCOS. In conclusion, the rate of incidental endometriosis in women with CC-resistant PCOS might reflect the prevalence of asymptomatic endometriosis. All cases were affected by minimal or mild disease. Since the literature lacks reports on associated clinical outcomes, the relevance of this entity in such patients should be the subject of further studies.
为评估多囊卵巢综合征（PCOS）患者中子宫内膜异位症的发生率，这些患者无任何子宫内膜异位症症状且因克罗米芬（CC）抵抗而接受了腹腔镜卵巢打孔术（LOD），分别有225名和630名无典型子宫内膜异位症症状的CC抵抗性PCOS女性被纳入一项回顾性研究和一项荟萃分析。所有女性均接受了LOD。主要结局参数是偶然发现的子宫内膜异位症的患病率。腹腔镜检查发现225名女性中有38名（16.9%）患有子宫内膜异位症（修订后的美国生育协会（rAFS）I期：33/38，86.8%；rAFS II期：5/38，13.2%）。在比较无子宫内膜异位症的CC抵抗性PCOS女性时，较低的体重指数（BMI）和较低的25-羟基维生素D水平与腹腔镜检查时子宫内膜异位症的存在相关（优势比（OR）：0.872，95%置信区间（95%CI）：0.792 - 0.960；P = 0.005和OR：0.980，95%CI：0.962 - 0.999；P = 0.036；分别）。关于LOD的230份报告中有4份满足荟萃分析的纳入标准。在校正研究异质性后，CC抵抗性PCOS女性中偶然发现的子宫内膜异位症的合并患病率为7.7%。总之，CC抵抗性PCOS女性中偶然发现的子宫内膜异位症发生率可能反映了无症状子宫内膜异位症的患病率。所有病例均为轻度或微小病变。由于文献缺乏关于相关临床结局的报道，该实体在这类患者中的相关性应成为进一步研究的主题。
