Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan.
Department of Infertility and Gynecology, Ms.Clinic MayOne, Kashihara, Japan.
Gynecol Obstet Invest. 2021;86(1-2):185-192. doi: 10.1159/000514972. Epub 2021 Mar 29.
Endometriosis-related pain can be caused by anatomical distortions as well as environmental factors such as inflammation and oxidative stress. The aim of this study is to investigate the relationship between the severity of dysmenorrhea in patients with ovarian endometrioma (OMA) and cyst fluid (CF) concentrations of irons, including total iron, heme iron, and free iron.
Eighty-three patients who were histologically diagnosed with OMA were enrolled in the Department of Gynecology, Nara Medical University Hospital, between 2013 and 2019. The patients were divided into 4 groups according to the severity of dysmenorrhea: no pain, mild, moderate, and severe. Iron concentration was measured by the inductively coupled plasma optical emission spectrometry method.
There were no significant differences among the 4 groups in variables such as age at diagnosis, preoperative CA125, preoperative CA19-9, cyst size, and tumor laterality (unilateral or bilateral). There was a positive correlation between the severity of dysmenorrhea and total iron (p < 0.001) and heme iron (p = 0.016) concentrations. Multiple regression analyses revealed that the CF concentration of total iron (hazard ratio 18.75, 95% confidence interval: 2.26-155.35, p = 0.007) was a significant independent variable associated with the severity of dysmenorrhea. A receiver operating characteristic curve analysis showed that a total iron exceeding 290.8 mg/L was associated with severe dysmenorrhea with a sensitivity of 90.9% and a specificity of 65.7%.
This study excluded patients with adenomyosis, superficial endometriosis, or deep endometriosis, resulting in a smaller number of cases. Iron levels could not be compared to the endometriosis stage using the r-ASRM score.
There is no clear evidence that iron predicts the severity of endometriosis-related pain. However, iron may be closely associated with dysmenorrhea.
子宫内膜异位症相关的疼痛可能是由解剖学扭曲以及炎症和氧化应激等环境因素引起的。本研究旨在探讨卵巢子宫内膜异位症（OMA）患者痛经严重程度与囊液（CF）中铁的浓度（包括总铁、血红素铁和游离铁）之间的关系。
2013 年至 2019 年，在奈良医科大学医院妇科共纳入 83 例经组织学诊断为 OMA 的患者。根据痛经严重程度将患者分为 4 组：无痛、轻度、中度和重度。采用电感耦合等离子体光学发射光谱法测量铁浓度。
4 组患者在年龄、术前 CA125、术前 CA19-9、囊肿大小和肿瘤侧别（单侧或双侧）等变量方面无显著差异。痛经严重程度与总铁（p < 0.001）和血红素铁（p = 0.016）浓度呈正相关。多元回归分析显示，CF 总铁浓度（危险比 18.75，95%置信区间：2.26-155.35，p = 0.007）是与痛经严重程度相关的显著独立变量。受试者工作特征曲线分析显示，总铁超过 290.8mg/L 与重度痛经相关，其敏感性为 90.9%，特异性为 65.7%。
本研究排除了合并子宫腺肌病、表浅型子宫内膜异位症或深部子宫内膜异位症的患者，导致病例数较少。铁水平无法与 r-ASRM 评分的子宫内膜异位症分期进行比较。
目前尚无明确证据表明铁可预测子宫内膜异位症相关疼痛的严重程度。然而，铁可能与痛经密切相关。
