营养补充剂治疗子宫内膜异位症相关症状：一项系统综述。
完整摘要 · 中文译文
摘要：子宫内膜异位症女性常使用膳食补充剂和抗氧化疗法以改善症状；然而，其临床有效性仍不明确。本系统综述评估了膳食补充剂对子宫内膜异位症女性疼痛、生活质量（QoL）、生育结局及病灶进展的影响。检索了MEDLINE（通过PubMed）、Embase和Cochrane Library中的随机对照试验（RCT）。纳入标准为确诊子宫内膜异位症的女性接受膳食补充剂治疗，并与安慰剂、无治疗或标准治疗进行比较。研究结果采用叙述性综合，偏倚风险使用RoB 2进行评估。共纳入24项RCT，涉及2，019名参与者。疼痛研究结果异质性较大。纳米胶束姜黄素（单用或作为地诺孕素的辅助治疗）、在地诺孕素基础上加用硒、Proscur和大蒜均报告了多个疼痛领域的改善；维生素和褪黑素的研究结果不一致，而omega-3脂肪酸、常规姜黄素和白藜芦醇未显示出明确获益。生活质量结局同样异质性较大：纳米姜黄素联合地诺孕素、Proscur及术后多种营养素治疗改善了总体或疾病特异性生活质量，而大多数其他干预措施未显示组间获益。生育结局仅限于生殖成功的中间标志物，部分研究显示改善，但未导致更高的妊娠率。关于病灶进展的证据有限；辅助性纳米姜黄素和硒缩小了子宫内膜瘤体积 术后多种营养素补充并未降低复发率。膳食补充剂可能改善部分症状相关结局，但效果具有干预特异性，且证据仍不足以支持将其作为单独治疗常规使用。仍需开展足够效能的进一步试验。 通俗摘要：子宫内膜异位症是一种类似于子宫内膜的组织在子宫外生长的疾病，可导致严重的慢性盆腔疼痛、限制生活质量并导致不孕。除标准药物治疗（止痛药或激素）外，许多子宫内膜异位症患者使用额外补充剂，如维生素或抗氧化剂，以缓解症状，但这些方法的效果尚不明确。在本研究中，我们回顾了24项临床试验，涉及2，019名子宫内膜异位症女性，以评估膳食补充剂的效果。部分试验报告了疼痛和生活质量的改善，尤其是使用特制姜黄素或硒（单独使用或与地诺孕素联合使用）时。生育相关研究发现在部分生育相关指标上有改善，但并未导致更高的妊娠率。关于疾病进展的证据有限：某些联合治疗减少了卵巢子宫内膜异位症，但补充剂并未减少术后复发。因此，补充剂可能辅助标准治疗，但不应替代标准治疗。
完整摘要 · 英文原文
ABSTRACT: Dietary supplements and antioxidant therapies are frequently used by women with endometriosis to improve symptoms; however, their clinical effectiveness remains unclear. This systematic review evaluated the effects of dietary supplements on pain, quality of life (QoL), fertility outcomes, and lesion progression in women with endometriosis. MEDLINE via PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs). The eligibility criteria included women with diagnosed endometriosis receiving dietary supplements compared with placebo, no treatment, or standard care. Findings were narratively synthesized, and risk of bias was assessed using RoB 2. Twenty-four RCTs, involving 2,019 participants, were included. Pain findings were heterogeneous. Improvements across multiple pain domains were reported with nanomicellar curcumin, used either alone or as an adjunct to dienogest, selenium added to dienogest, Proscur, and garlic; vitamin and melatonin findings were mixed, while omega-3 fatty acids, conventional curcumin, and resveratrol showed no clear benefit. QoL outcomes were similarly heterogeneous: nanocurcumin plus dienogest, Proscur, and postoperative multinutrient therapy improved overall or disease-specific QoL, whereas most other interventions showed no between-group benefit. Fertility outcomes were limited to intermediate markers of reproductive success, which improved in some studies but did not lead to higher pregnancy rates. Evidence on lesion progression was limited; adjunctive nanocurcumin and selenium reduced endometrioma size, while postoperative multinutrient supplementation did not reduce recurrence. Dietary supplements may improve selected symptom-related outcomes, but effects were intervention-specific and evidence remains insufficient to support their routine use as standalone treatments. Further adequately powered trials are needed. LAY SUMMARY: Endometriosis is a condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus, which can cause severe chronic pelvic pain, limit quality of life, and lead to infertility. In addition to standard medical treatment (painkillers or hormones), many patients with endometriosis use additional supplements, such as vitamins or antioxidants, to alleviate symptoms, but it is unclear how well these approaches work. In this study, we reviewed 24 clinical trials involving 2,019 women with endometriosis to evaluate the effects of dietary supplements. Some trials reported improvements in pain and quality of life, particularly with specially formulated curcumin or selenium, alone or alongside dienogest. Studies on fertility found improvements in some fertility-related measures, but these did not lead to higher pregnancy rates. Evidence on progression was limited: some combination treatments reduced ovarian endometriosis, but supplements did not reduce recurrence after surgery. Supplements may therefore support standard treatment, but should not replace it.