二甲双胍治疗子宫内膜异位症的研究进展

Advances in Metformin for Treatment of En-dometriosis

摘要: 子宫内膜异位症的定义是子宫腔外存在子宫内膜样组织，发病人群多为育龄期女性，发病机制复杂，临床表现异质性大，早期诊断和治疗存在困难。目前治疗方式多为激素类药物及手术，均存在一定的副作用及局限性，长期应用药物所带来的不良反应及安全性问题不容忽视，治疗效果更特异，副作用小，安全性好的药物需要发掘。二甲双胍是一种胰岛素增敏剂，在临床研究、体内、体外实验中均显示可缩小子宫内膜异位症病灶、改善患者疼痛症状及子宫内膜容受性，提升生育力。其机制主要为抗炎、抗血管增殖、抑制黏附侵袭、调节细胞间通讯、增殖和分化等，此外，二甲双胍还可影响异位子宫内膜间充质干细胞异常的自我更新能力，从干细胞水平调节异常增殖。因此，二甲双胍可能成为临床治疗子宫内膜异位症的潜在治疗选择。

Abstract: Endometriosis is defined as the presence of endometrium-like tissue outside the uterus, which af-fects mostly women of childbearing age. Because of complex pathogenesis and heterogeneous clini-cal manifestations, there are many difficulties in early diagnosis and treatment. At present, most of the treatment methods are hormonal drugs and surgeries, which have certain side effects and limi-tations. The adverse reactions and safety problems caused by long-term application of drugs should not be ignored. Drugs with more specific therapeutic effects, fewer side effects and good safety pro-file need to be discovered. Metformin, an insulin sensitizer, has been shown to shrink endometriosis lesions and improve patients’ pain symptoms and endometrial tolerance, enhancing fertility in en-dometriosis patients in clinical studies, vivo and vitro experiments, by exerting anti-inflammatory, anti-vascular proliferation, inhibiting adhesion and invasion, regulating intercellular communica-tion, proliferation and differentiation, etc. In addition, metformin can affect the abnormal self-renewal ability of ectopic endometrial mesenchymal stem cells and regulate the abnormal pro-liferation from the stem cell level. Therefore, metformin may be a potential therapeutic option for the clinical treatment of endometriosis.