Gynaecology Department, The First Hospital of PuTian City, Putian, 351100, Fujian, China.
Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
Reprod Biol Endocrinol. 2023 Aug 29;21(1):79. doi: 10.1186/s12958-023-01126-1.
This study aimed to clarify the effect of antioxidant vitamins supplementation on endometriosis-related pain.
A systematic search of PubMed, Web of Science, Cochrane Library, Scopus, and China National Knowledge Infrastructure (CNK) databases was conducted to identify relevant studies published in English and Chinese up to 16 March 2023. The search terms used were "endometriosis" OR "endometrioma" OR "endometrium" AND "antioxidant" OR "Vitamin C" OR "Vitamin E" OR "Vitamin D" OR "25-OHD" OR "25(OH)D" OR "25-hydroxyvitamin D". Eligible studies were randomized controlled trials (RCTs) that assessed pain scores using the Visual Analogue Scale (VAS). Mean differences or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to evaluate the effect of antioxidant vitamins supplementation on endometriosis. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
A total of 13 RCTs involving 589 patients were included in this meta-analysis. We identified 11 studies that evaluated the effect of antioxidant vitamins supplementation on endometriosis-related pain. The results indicated that the supplementation of antioxidant vitamins can effectively alleviate endometriosis-related pain. Subgroup analysis showed that the supplementation of vitamin E (with or without vitamin C) had a positive effect on improving clinical pelvic pain in patients with chronic pelvic pain. Conversely, supplementation of vitamin D was associated with a reduction in pelvic pain in endometriosis patients, but the difference was not statistically significant compared to the placebo. Additionally, we observed changes in oxidative stress markers following vitamin supplementation. Plasma malondialdehyde (MDA) concentration decreased in patients with endometriosis after antioxidant vitamin supplementation, and the plasma MDA level was inversely correlated with the time and dose of vitamin E and C supplementation. Furthermore, the inflammatory markers in peritoneal fluid, including RANTES, interleukin-6, and monocyte chemoattractant protein-1, significantly decreased after antioxidant therapy. These findings suggest that antioxidant vitamins may alleviate pain in endometriosis patients by reducing inflammation.
The included studies support the potential role of antioxidant vitamins in the management of endometriosis. Supplementation with antioxidant vitamins effectively reduced the severity of dysmenorrhea, improved dyspareunia and pelvic pain, and enhanced quality of life in these patients. Therefore, antioxidant vitamin therapy could be considered as an alternative treatment method, either alone or in combination with other approaches, for endometriosis-related pain.
PROSPERO registration number: CRD42023415198.
本研究旨在阐明抗氧化维生素补充对子宫内膜异位症相关疼痛的影响。
系统检索 PubMed、Web of Science、Cochrane 图书馆、Scopus 和中国知网（CNKI）数据库，检索时间截至 2023 年 3 月 16 日，检索英文和中文文献，评估抗氧化维生素补充对子宫内膜异位症相关疼痛的影响。检索词为“子宫内膜异位症”或“卵巢子宫内膜异位囊肿”或“子宫内膜”和“抗氧化剂”或“维生素 C”或“维生素 E”或“维生素 D”或“25-羟维生素 D”。纳入随机对照试验（RCT），使用视觉模拟评分（VAS）评估疼痛评分。计算均数差值或比值比（OR）及其 95%置信区间（CI）以评估抗氧化维生素补充对子宫内膜异位症的影响。使用 Cochrane 偏倚风险工具评估纳入研究的质量。本研究遵循系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南进行。
共纳入 13 项 RCT，涉及 589 例患者。我们确定了 11 项评估抗氧化维生素补充对子宫内膜异位症相关疼痛影响的研究。结果表明，抗氧化维生素补充可有效缓解子宫内膜异位症相关疼痛。亚组分析表明，维生素 E（联合或不联合维生素 C）补充对改善慢性盆腔痛患者的临床盆腔痛有积极作用。相反，维生素 D 补充与子宫内膜异位症患者的盆腔痛减轻相关，但与安慰剂相比，差异无统计学意义。此外，我们观察到维生素补充后氧化应激标志物的变化。子宫内膜异位症患者补充抗氧化维生素后血浆丙二醛（MDA）浓度降低，且血浆 MDA 水平与维生素 E 和 C 补充的时间和剂量呈负相关。此外，腹腔液中的炎症标志物，包括 RANTES、白细胞介素-6 和单核细胞趋化蛋白-1，在抗氧化治疗后显著降低。这些发现表明，抗氧化维生素通过减轻炎症可能缓解子宫内膜异位症患者的疼痛。
纳入的研究支持抗氧化维生素在子宫内膜异位症管理中的潜在作用。抗氧化维生素补充可有效减轻痛经、改善性交痛和盆腔痛，提高患者生活质量。因此，抗氧化维生素治疗可作为子宫内膜异位症相关疼痛的一种替代治疗方法，可单独使用或与其他方法联合使用。
PROSPERO 注册号：CRD42023415198。
