Parazzini F, Ferraroni M, Fedele L, Bocciolone L, Rubessa S, Riccardi A
Institute of Pharmacological Research, Mario Negri, Milan, Italy.
J Epidemiol Community Health. 1995 Feb;49(1):61-4. doi: 10.1136/jech.49.1.61.
To analyse the relationship between reproductive and menstrual factors and different stages of pelvic endometriosis.
Between 1987 and 1990 a case-control study of risk factors for pelvic endometriosis was conducted. Cases comprised 376 women (median age 32 years) with pelvic endometriosis confirmed by laparoscopy or laparotomy admitted to any one of three clinics in Lombardy, northern Italy. A total of 129 (34.3%) of these women were at stage 1, 76 (20.2%) at stage 2, 96 (25.5%) at stage 3, and 75 (19.9%) at stage 4, according to the American Fertility Society revised classification of endometriosis. Controls comprised 522 women admitted to hospital for acute conditions.
The risk of endometriosis decreased with increasing number of births. The estimated odds ratios (OR) were similar in different stages of the disease: for example, compared with nulliparous women, the OR of endometriosis at stage 1 was 0.1 in women who reported two or more births and the corresponding values were respectively 0.1, 0.2, and 0.2 for endometriosis at stages 2, 3, and 4. Cases reported fewer induced abortions than controls: the estimated ORs compared with no induced abortion were 0.4, 0.5, 0.2, and 0.2 in women who reported one or more induced abortions for subsequent stages of endometriosis. Women with irregular menstrual cycles were at less risk of the disease: compared with women who reported lifelong regular cycles the estimated ORs were 0.3, 0.5, 0.5, and 0.3 for disease stages 1-4 respectively. No consistent association emerged between the ages at menarche and at first delivery and the risk of endometriosis.
This analysis provides further evidence that reproductive and menstrual factors are associated with the risk of endometriosis. The observation that early and late stages of the disease share similar epidemiological characteristics suggests an epidemiological (and pathogenetic) continuum between various stages of the disease.
分析生殖和月经因素与盆腔子宫内膜异位症不同阶段之间的关系。
1987年至1990年，对盆腔子宫内膜异位症的危险因素进行了一项病例对照研究。病例包括376名女性（中位年龄32岁），她们经腹腔镜检查或剖腹手术确诊为盆腔子宫内膜异位症，入住意大利北部伦巴第地区的三家诊所中的任何一家。根据美国生育协会修订的子宫内膜异位症分类，这些女性中共有129名（34.3%）处于1期，76名（20.2%）处于2期，96名（25.5%）处于3期，75名（19.9%）处于4期。对照包括522名因急性疾病入院的女性。
子宫内膜异位症的风险随着生育次数的增加而降低。在疾病的不同阶段，估计的优势比（OR）相似：例如，与未生育的女性相比，报告生育两次或更多次的女性中1期子宫内膜异位症的OR为0.1，而2期、3期和4期子宫内膜异位症的相应值分别为0.1、0.2和0.2。病例报告的人工流产次数少于对照：对于报告有一次或多次人工流产的女性，与未进行人工流产相比，后续阶段子宫内膜异位症的估计OR分别为0.4、0.5、0.2和0.2。月经周期不规律的女性患该病的风险较低：与报告终身月经周期规律的女性相比，1-4期疾病的估计OR分别为0.3、0.5、0.5和0.3。月经初潮年龄和首次分娩年龄与子宫内膜异位症的风险之间未出现一致的关联。
该分析进一步证明生殖和月经因素与子宫内膜异位症的风险相关。疾病早期和晚期具有相似流行病学特征的观察结果表明，该疾病不同阶段之间存在流行病学（和发病机制）的连续性。
