بررسی ارتباط آندومتریوز و بروز اختلالات فشارخون حاملگی در زنان نخست زا

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

2 مربی گروه پرستاری مامایی، مرکز تحقیقات سلامت زنان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

3 دستیار گروه چشم پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران.

چکیده

مقدمه: آندومتریوز یکی از بیماری‌های شایع سنین باروری و پره اکلامپسی یک بیماری سیستمیک با درگیری ارگان‌های مختلف است که خطرات زیادی برای مادر به ویژه در سندرم HELLP و اکلامپسی و برای جنین به دنبال دارد. نتایج متناقضی از مطالعات در زمینه ارتباط آندومتریوز و اختلالات هیپرتانسیو بارداری گزارش شده است. بنابراین با توجه به زمینه مشترک فعالیت آنژیوژنز در دو اختلال آندومتریوز و پره اکلامپسی، مطالعه حاضر با هدف بررسی فراوانی پره اکلامپسی و اختلالات هیپرتانسیون بارداری در زنان نخست زا مبتلا به آندومتریوز و افراد سالم انجام شد.
روش کار: در این مطالعه کوهورت تاریخی پرونده‌های 893 زن که به دلیل ناباروری طی سال‌های 86-1382 در بیمارستان‌های الزهرا (س)، شهید بهشتی و مرکز باروری و ناباروری اصفهان تحت عمل لاپاروسکوپی قرار گرفته بودند، استخراج شد. 101 بیمار مبتلا به آندومتریوز و 101 نفر از افراد غیر مبتلا به آندومتریوز در هر گروه وارد و ابتلاء به پره اکلامپسی و فشارخون بارداری، در حاملگی بعد از انجام لاپاراسکوپی در دو گروه مقایسه شد. تجزیه و تحلیل داده‌ها با استفاده از نرم افزار آماریSPSS  (نسخه 16) و آزمون‌های کای اسکوئر، تی دانشجویی و تست دقیق فیشر انجام شد. میزان p کمتر از 05/0 معنی دار در نظر گرفته شد.
یافته ها: در این مطالعه ارتباط معنی داری بین آندومتریوز با پره اکلامپسی و هیپرتانسیون بارداری وجود نداشت (5/0=p). 2 نفر (2%) از زنان مبتلا به آندومتریوز و 3 نفر (3%) از زنان غیر مبتلا به آندومتریوز به پره اکلامپسی مبتلا بودند. فراوانی فشارخون بارداری در زنان مبتلا به آندومتریوز 9/6% و در زنان بدون آندومتریوز 9/8% به دست آمد که این اختلاف نیز از نظر آماری معنی دار نبود (3/0=p).
نتیجه گیری: فراوانی آندومتریوز و اختلالات فشارخون بارداری در زنان با و بدون سابقه آندومتریوز تفاوتی با هم ندارد و سابقه آندومتریوز با افزایش اختلالات هیپرتانسیو بارداری همراه نمی باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Association between endometriosis and pregnancy hypertension disorders in nulliparous women

نویسندگان [English]

  • Farahnaz Mardanian 1
  • Maryam Kianpour 2
  • Elaheh Sharifian 3
1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Instructor of Nursing and Midwifery, Women's Health Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Resident of Ophthalmology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Endometriosis is one of the common diseases of reproductive age and preeclampsia is a systemic disease with different organs involvement that has much risk for mother especially in HELLP syndrome and eclampsia and for fetus. There are controversy reports about association between endometriosis and pregnancy hypertension disorders. Therefore, regarding to the common background of angiogenesis activity in two disorders of endometriosis and preeclampsia, this study was performed with aim to determine the frequency of preeclampsia and pregnancy hypertension disorders in nulliparous women with endometriosis and the healthy women.
Methods: In this historical cohort study, the files of 893 infertile women who had referred to Alzahra and Beheshti hospitals and Fertility and Infertility center of Isfahan and had undergone laparoscopy due to infertility during 1993-1997 were extracted. 101 women were assigned in each group and preeclampsia and pregnancy hypertension disorders were compared between two groups after laparoscopy. Data were analyzed using SPSS software (version 16), and Fisher Exact, t-test, and Chi-square tests. PResults: There was no significant association between endometriosisand preeclampsia and pregnancy hypertension disorders (P=0.5). 2 women (2%) with endometriosis and 3 (3%) without endometriosis had preeclampsia. Frequency of pregnancy hypertension in women with endometriosis was 6.9% and in women without endometriosis was 8.9% and the difference was not significant (P=0.3).
Conclusion: Frequency of endometriosis and pregnancy hypertension disorders was not different in women with endometriosis and women without endometriosis and the history of endometriosis is not associated with pregnancy hypertension disorders.

کلیدواژه‌ها [English]

  • Endometriosis
  • Epidemiology
  • Preeclampsia
  • Pregnancy hypertension
  1. Kyama CM, Debrock S, Mwenda JM, Hooghe TM. Potentioal involvement of the immune system in the development endometriosis. Reprod Biol Endocrinol 2003; 1:123.
  2. Othman Eel-D, Hornung D, Salem HT, Khulifa EA, EL-Metwally TH, AL-Hendy A. Serum cytokines as biomarkers for nonsurgical prediction of endometriosis. Eur J Obstet Gynecol Reprod Biol 2008; 137(2):240-6.
  3. Taylor RN, Lebovic DI, Mueller MD. Angiogenic factors in endometriosis. Ann N Y Acad Sci 2002; 955:89-100.
  4. Katorza E, Soriano D, Stockheim D, Mashiach R, Zolti M, Seidman DS, et al. Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy. Am J Obstet Gynecol 2007; 197(5):501.e1-4.
  5. Grope Italian per lo Studio dell’ Endometriosis. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Hum Reprod 1994; 9(6):1158-62.
  6. Halliwell B, Gutteridge JM. Role of free radicals and catalytic metal ions in human disease: an overview. Methods Enzymol 1990; 186:1-85.
  7. Hippeli S, Elstner EF. Transition metal ion-catalyzed oxygen activation during pathogenic processes. FEBS Lett 1999; 443(1):1-7.
  8. Malhotra N, Karmakar D, Tripathi V, Luthra K, Kumar S. Correlation of angiogenic cytokines-leptin and IL-8 in stage, type and presentation of endometriosis. Gynecol Endocrinol 2012; 28(3):224-7.
  9. D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med 2003; 21(2):243-54.
  10. Berek JS, Adashi EY, Hillard PA. Novak's textbook of gynecology. 15th ed. Philadelphia: Lippincott Raven Publishers; 2012.
  11. Mclaren J, Prentice A, Charnock-Jones DS, Millican SA, Muller KH, Sharkey AM, et al. Vascular endothelial growth factor is produced by peritoneal fluid macrophages in endometriosis and is regulated by ovarian steroids. J Clin Invest 1996; 98(2):482-9.
  12. Charnock–Jones DS, Sharkey AM, Rajput-Williams J, Burch D, Schofield JP, Fountain SA, et al. Identification and localization of alternatively spliced mRNAs for vascular endothelial growth factor in human uterus and estrogen regulation in endometrial carcinoma cell line. Biol Reprod 1993; 48(5):1120-8.
  13. Houck KA, Ferrara N, Winer J, Cachianes G, Li B, Leung DW. The vascular endothelial growth factor family: identification of a fourth molecular species and characterization of alternative splicing of RNA. Mol Endocrinal 1991; 5(12):1806-14.
  14. Mardanian F, Sheikh-Soleimani Z. The diagnostic role of cervico-vaginal fluid interleukins-1α in endometriosis: a case-control study. J Res Med Sci 2014; 19(12):1145-9.
  15. Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B, et al. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod 2007; 22(6):1725-9.
  16. Wagner LK. Diagnosis and management of preeclampsia. Am Fam Physician 2004; 70(12):2317–24.
  17. Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102(1):181–92.
  18. ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynecol Obstet 2002; 77(1):67–75.
  19. Lindheimer MD, Katz AI. Preeclampsia: pathophysiology, diagnosis, and management. Annu Rev Med 1989; 40:233–50.
  20. Heidary S, Farhadifar F, Rahimi E, Shahgheybi S, Rezayi M, Soufizadeh N. Assessment the prognostic value of platelet indices in preeclampsia. Iran J Obestet Gynecol Infertil 2013; 15(36):8-14. (Persian).
  21. Kingdom JC, Kaufmann P. Oxygen and placental vascular development. Adv Exp Med Biol 1999; 474:259-75.
  22. Roberts JM. Objective evidence of endothelial dysfunction in preeclampsia. Am J Kidney Dis 1999; 33(5):992–7.
  23. Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril 2002; 77(6):1148-55.
  24. Garrido N, Pellicer A, Remohi J, Simón C. Uterine and ovarian function in endometriosis. Semin Reprod Med 2003; 21(2):183-92.
  25. Cunninghan FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Spong CY Williams obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010.
  26. Dane B, Dane C, Kiray M, Koldas M, Cetin A. A new metabolic scoring system for analyzing the risk of hypertensive disorders of pregnancy. Arch Gynecol Obstet 2009; 280(6):921-4.
  27. Kortelahti M, Anttila MA, Hippeläinen MI, Heinonen ST. Obstetric outcome in women with endometriosis-- a matched case-control study. Gynecol Obstet Invest 2003; 56(4):207-12.
  28. Isaksson R, Gissler M, Titinen A. Obstetric outcome among women with unexplained infertility after IVF: a matched case-control study. Hum Reprod 2002; 17(7):1755-61.
  29. Hadfield RM, Lain SJ, Rahnes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of pre-eclampsia? A population based study. Hum Reprod 2009; 24(9):2348-52.
  30. Papazoglou D, Galazious G, Koukourakis MI, Panagopoulos I, Kontomanolis EN, Papatheodorou K, et al. Vascular endothelial growth factor gene polymorphisms and pre-eclampsia. Mol Hum Reprod 2004; 10(5):321-4.
  31. Oosterlynck DJ, Meuleman C, Sobis H, Vandeputte M, Koninckx PR. Angiogenic activity of peritoneal fluid from women with endometriosis. Fertil Steril 1993; 59(4):778–82.
  32. Donnez J, Smoes S, Gillerot S, Casanas-Roux F, Nisolle M. Vascular endothelial growth factor (VEGF) in endometrosis. Hum Reprod 1998; 13(5):1686-90.
  33. Ay J, Asvandiari N, Kasper R. Secretion of vascular endothelial growth factor (VEGF) in three-dimensional culture of human endometrium: a model of endometriosis outside the body. J Reprod Infertil 2009; 10(2):95-100. (Persian).
  34. Wang A, Rana S, Karumanchi SA. Preeclampsia: the role of angiogenic factors in its pathogenesis. Physiology (Bethesda) 2009; 24:147-58.
  35. Xavier P, Beires J, Barros H, Martinez-de-Oliveira J. Subendometrial and intraendometrial blood flow during the menstrual cycle in patients with endometriosis. Frtil Steril 2005; 84(1):52-9.
  36. Pandian Z, Bhattacharya S, Templeton A. Review of unexplained infertility and obstetric outcome: a 10 year review. Hum Reprod 2001; 16(12):2593-7.
  37. Giudice LC. Microarray expression profiling reveals candidate genes for human uterine receptivity. Am J Pharmacogenomics 2004; 4(5):299-312.
  38. Saftlas AF, Olson DR, Franks Al, Atrash HK, Pokras R. Epidemiology of preeclampsia and eclampsia in the United states, 1979-1986. Am J Obstet Gynecol 1990; 163(2):460-5.
  39. Wolf M, Shah A, Lam C, Martinez A, Smirnakis KV, Epstein FH, et al. Circulating levels of the antiangiogenic marker sFLT-1 are increased in first versus second pregnancies. Am J Obstet Gynecol 2005; 193(1):16–22.
  40. Kortelahti M, Anttila MA, Hippelainen MI, Heinonen ST. Obstetric outcome in women with endometriosis -- a matched case–control study. Gynecol Obstet Invest 2003; 56(4):207-12.
  41. Carmeliet P. Angiogenesis in life, disease and medicine. Nature 2005; 438(7070):932-6.