Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
Department of Statistics, University of Virginia, Charlottesville, Virginia.
F S Sci. 2023 May;4(2):172-180. doi: 10.1016/j.xfss.2023.03.006. Epub 2023 Apr 5.
To examine the association between keloids, hypertrophic scars, and uterine fibroid incidence as well as growth. Both keloids and fibroids are fibroproliferative conditions that have been reported to be more prevalent among Blacks than Whites, and they share similar fibrotic tissue structures, including extracellular matrix composition, gene expression, and protein profiles. We hypothesized that women with a history of keloids would have greater uterine fibroid development.
A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds to detect and measure fibroids ≥0.5 cm in diameter, assess the history of keloid and hypertrophic scars, and update covariates.
Detroit, Michigan area.
A total of 1,610 self-identified Black and/or African American women aged 23-35 years at enrollment without a previous clinical diagnosis of fibroids.
EXPOSURE(S): Keloids (raised scars that grow beyond the margins of the original injury) and hypertrophic scars (raised scars that stay within the bounds of the original injury). Because of the difficulties in distinguishing keloids and hypertrophic scars, we separately examined the history of keloids and the history of either keloids or hypertrophic scars (any abnormal scarring) and their associations with fibroid incidence and growth.
MAIN OUTCOME MEASURE(S): Fibroid incidence (new fibroid after a fibroid-free ultrasound at enrollment) was assessed using Cox proportional-hazards regression. Fibroid growth was assessed using linear mixed models. The estimates for the change in log volume per 18 months were converted to the estimated percentage difference in volume for scarring vs. no-scarring. Both incidence and growth models were adjusted for time-varying demographic, reproductive, and anthropometric factors.
RESULT(S): Of the 1,230 fibroid-free participants, 199 (16%) reported ever having keloids, 578 (47%) reported keloids or hypertrophic scars, and 293 (24%) developed incident fibroids. Neither keloids (adjusted hazard ratio = 1.04; 95% confidence interval: 0.77, 1.40) nor any abnormal scarring (adjusted hazard ratio = 1.10; 95% confidence interval: 0.88, 1.38) were associated with fibroid incidence. Fibroid growth differed little by scarring status.
CONCLUSION(S): Despite molecular similarities, self-reported keloid and hypertrophic scars did not show an association with fibroid development. Future research may benefit from the examination of dermatologist-confirmed keloids or hypertrophic scars; however, our data suggest little shared susceptibility for these 2 types of fibrotic conditions.
探讨瘢痕疙瘩、增生性瘢痕与子宫肌瘤发病及生长的关系。瘢痕疙瘩和纤维瘤都是纤维增生性疾病，据报道黑人比白人更为常见，且它们具有相似的纤维组织结构，包括细胞外基质组成、基因表达和蛋白谱。我们假设有瘢痕疙瘩病史的女性子宫肌瘤的发展程度更大。
一项前瞻性社区队列研究（2010-2012 年招募），在 5 年内进行 4 次研究访问，进行标准化超声检查以检测和测量直径≥0.5 厘米的肌瘤，评估瘢痕疙瘩和增生性瘢痕的病史，并更新协变量。
密歇根州底特律地区。
共纳入 1610 名自认为是黑人或非裔美国女性，年龄在 23-35 岁之间，入组前无子宫肌瘤的临床诊断。
瘢痕疙瘩（隆起的疤痕，超出原始损伤的边缘生长）和增生性瘢痕（隆起的疤痕，保持在原始损伤的范围内）。由于难以区分瘢痕疙瘩和增生性瘢痕，我们分别检查了瘢痕疙瘩病史和瘢痕疙瘩或增生性瘢痕（任何异常瘢痕）病史及其与肌瘤发病和生长的关系。
肌瘤发病（入组时无肌瘤的超声检查后新发肌瘤）采用 Cox 比例风险回归评估。肌瘤生长采用线性混合模型评估。每 18 个月的体积对数变化估计值转换为瘢痕与无瘢痕的体积百分比差异估计值。发病率和生长模型均根据随时间变化的人口统计学、生殖和人体测量因素进行调整。
在 1230 名无肌瘤的参与者中，199 名（16%）报告曾有瘢痕疙瘩，578 名（47%）报告有瘢痕疙瘩或增生性瘢痕，293 名（24%）发生了子宫肌瘤。瘢痕疙瘩（调整后的危险比=1.04；95%置信区间：0.77，1.40）或任何异常瘢痕（调整后的危险比=1.10；95%置信区间：0.88，1.38）均与肌瘤发病率无关。瘢痕状态对肌瘤生长的影响差异不大。
尽管分子相似，但自我报告的瘢痕疙瘩和增生性瘢痕与子宫肌瘤的发展没有关联。未来的研究可能受益于皮肤科医生确诊的瘢痕疙瘩或增生性瘢痕的检查；然而，我们的数据表明这两种纤维性疾病的易感性几乎没有共同之处。
