维生素补充剂对子宫内膜异位症女性相关症状的影响：一项系统评价和荟萃分析。

Effects of vitamin supplementation on related symptoms in women with endometriosis: a systematic review and meta-analysis.

作者信息

Pan Bing, Bi Beilei, Ruan Fan, Jiang Yi

机构信息

Department of Gynecology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China.

出版信息

Ann Med Surg (Lond). 2025 May 26;87(7):4404-4413. doi: 10.1097/MS9.0000000000003370. eCollection 2025 Jul.

BACKGROUND: Endometriosis is a gynecological disease with high occurrence, and symptoms include dysmenorrhea, infertility, and dyspareunia, which seriously affect women's quality of life. Antioxidants are beneficial in improving the symptoms of endometriosis, but there are still differences in their results. The aim of this study was to comprehensively evaluate the effects of vitamin supplementation (vitamin C, vitamin E, and vitamin D) on the related symptoms in women with endometriosis. METHODS: Electronic databases including PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang Data were searched up to June 2024, and the randomized controlled trials were included to evaluate the effects of vitamins on endometriosis symptoms. The primary outcomes included the scores of dysmenorrhea, pelvic pain, and dyspareunia. RESULTS: Nine studies involving 562 patients were included in this meta-analysis. Compared with the placebo group, vitamin E supplementation significantly alleviated the pelvic pain in patients with endometriosis [ < 0.00001, standardized mean difference (SMD) = -1.63, confidence interval (CI) = -1.98 to -1.29], but no significant differences were observed in vitamin D monotherapy or vitamin C in combination with vitamin E groups ( = 0.13, SMD = 0.32, CI = -0.10 to 0.75; = 0.10, SMD = -0.98, CI = -2.15 to 0.18). However, vitamin E and vitamin D monotherapy or vitamin C in combination with vitamin E did not obviously improve dysmenorrhea ( = 0.14, SMD = -0.23, CI = -0.52 to 0.07; = 0.56, SMD = -0.12, CI = -0.51 to 0.28; = 0.35, SMD = -0.34, CI = -1.06 to 0.37) and dyspareunia ( = 0.72, SMD = 0.05, CI = -0.24 to 0.35; = 0.10, SMD = -0.37, CI = -0.82 to 0.07; = 0.70, SMD = 0.06, CI = -0.24 to 0.36; total = 0.81, SMD = -0.02, CI = -0.22 to 0.17). In addition, vitamin D monotherapy or vitamin C in combination with vitamin E could significantly reduce the level of malondialdehyde in the serum of women with endometriosis. Moreover, no significant side effects occurred. CONCLUSIONS: When taking vitamin E, vitamin D, or vitamin C combined with vitamin E to improve endometriosis-related symptoms, only vitamin E supplementation is beneficial to alleviate pelvic pain in women with endometriosis, and none of these vitamins can relieve endometriosis-related dysmenorrhea and dyspareunia. This study will provide a clinical reference for the treatment of endometriosis-related symptoms.

背景：子宫内膜异位症是一种高发的妇科疾病，症状包括痛经、不孕和性交困难，严重影响女性的生活质量。抗氧化剂有助于改善子宫内膜异位症的症状，但结果仍存在差异。本研究的目的是全面评估补充维生素（维生素C、维生素E和维生素D）对子宫内膜异位症女性相关症状的影响。方法：检索截至2024年6月的电子数据库，包括PubMed、科学网、考克兰图书馆、EMBASE、中国知网和万方数据，纳入随机对照试验以评估维生素对子宫内膜异位症症状的影响。主要结局包括痛经、盆腔疼痛和性交困难的评分。结果：本荟萃分析纳入了9项涉及562例患者的研究。与安慰剂组相比，补充维生素E显著减轻了子宫内膜异位症患者的盆腔疼痛[<0.00001，标准化均数差（SMD）=-1.63，置信区间（CI）=-1.98至-1.29]，但维生素D单药治疗组或维生素C联合维生素E组未观察到显著差异（=0.13，SMD=0.32，CI=-0.10至0.75；=0.10，SMD=-0.98，CI=-2.15至0.18）。然而，维生素E和维生素D单药治疗或维生素C联合维生素E并未明显改善痛经（=0.14，SMD=-0.23，CI=-0.52至0.07；=0.56，SMD=-0.12，CI=-0.51至0.28；=0.35，SMD=-0.34，CI=-1.06至0.37）和性交困难（=0.72，SMD=0.05，CI=-0.24至0.35；=0.10，SMD=-0.37，CI=-0.82至0.07；=0.70，SMD=0.06，CI=-0.24至0.36；总计=0.81，SMD=-0.02，CI=-0.22至0.17）。此外，维生素D单药治疗或维生素C联合维生素E可显著降低子宫内膜异位症女性血清中的丙二醛水平。而且，未发生明显的副作用。结论：服用维生素E、维生素D或维生素C联合维生素E改善子宫内膜异位症相关症状时，只有补充维生素E有利于减轻子宫内膜异位症女性的盆腔疼痛，这些维生素均不能缓解子宫内膜异位症相关的痛经和性交困难。本研究将为治疗子宫内膜异位症相关症状提供临床参考。