Park Jongchan, Chang Hye Jin, Hwang Kyung Joo, Yum Sun Hyung, Park Chang Eun, Kim Joo Hee, Kim Miran
Department of Convergence Healthcare Medicine, Graduate School of Ajou University, Suwon, Korea.
Department of Obstetrics & Gynecology, Ajou University School of Medicine, Suwon, Korea.
Yonsei Med J. 2025 Jun;66(6):374-382. doi: 10.3349/ymj.2024.0255.
This retrospective cohort study aimed to investigate the association between the use of pain medications with varying cyclooxygenase-2 (COX-2) selectivity and the incidence of endometriosis (EMS) in women.
Medical records from January 1, 1994, to December 31, 2022, were retrospectively analyzed. The cohort included 33406 patients diagnosed with any pain-related condition who were prescribed either selective COX-2 inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs). Patients were followed for up to 5 years from the cohort entry date. The incidence of EMS was compared between the two medication groups using Cox proportional hazards models, adjusting for confounding factors such as age, past drug use, and prior diagnosis.
The incidence rates of EMS were 3.00 per 1000 person-years in the COX-2 inhibitor group and 3.97 per 1000 person-years in the NSAIDs group. After adjustment for confounders, the hazard ratio for EMS incidence in the COX-2 inhibitor group compared to the NSAIDs group was 0.77 [95% confidence interval (CI), 0.63 to 0.93; <0.01], indicating a significantly lower risk in the COX-2 inhibitor group. Subgroup analysis revealed that this association was particularly significant in younger women aged 20-44 years, with a hazard ratio of 0.71 (95% CI, 0.54 to 0.95; <0.05) in this age group.
The findings suggest that COX-2 inhibitors may reduce the incidence of EMS compared to traditional NSAIDs, highlighting their potential as a strategic option for managing EMS, particularly among younger women. Further prospective studies are needed to confirm these findings.
这项回顾性队列研究旨在调查使用不同环氧化酶-2（COX-2）选择性的止痛药物与女性子宫内膜异位症（EMS）发病率之间的关联。
对1994年1月1日至2022年12月31日的医疗记录进行回顾性分析。该队列包括33406名被诊断患有任何疼痛相关疾病并被开具选择性COX-2抑制剂或非甾体抗炎药（NSAIDs）的患者。从队列进入日期开始对患者进行长达5年的随访。使用Cox比例风险模型比较两个药物组之间的EMS发病率，并对年龄、既往用药情况和既往诊断等混杂因素进行调整。
COX-2抑制剂组的EMS发病率为每1000人年3.00例，NSAIDs组为每1000人年3.97例。在对混杂因素进行调整后，与NSAIDs组相比，COX-2抑制剂组EMS发病的风险比为0.77[95%置信区间（CI），0.63至0.93；P<0.01]，表明COX-2抑制剂组的风险显著更低。亚组分析显示，这种关联在20至44岁的年轻女性中尤为显著，该年龄组的风险比为0.71（9
