Medikamentozno zdravljenje endometrioze: pregled stanja in nove možnosti zdravljenja
DOI:
https://doi.org/10.6016/ZdravVestn.1416Ključne besede:
medikamentozno zdravljenje, protivnetne učinkovine, hormonsko zdravljenje, antiangiogene učinkovine, antioksidanti, inhibitorji histon deacetilaze.Povzetek
Endometrioza je ginekološka bolezen definirana kot prisotnost endometriju podobnega tkiva zunaj maternične votline in predstavlja enega najpomembnejših vzrokov ženske neplodnosti. Najbolj optimalnega zdravljenja endometrioze na žalost še ne poznamo. Ločimo tri možnosti zdravljenja in sicer medikamentozno, kirurško in kombinirano zdravljenje. Zlati standard za postavitev diagnoze endometrioze je diagnostična laparoskopija, ki pa je obenem tudi terapevtska. Za medikamentozno zdravljenje endometrioze se odločimo empirično pri bolnici s pelvično bolečino pri kateri je ginekološki pregled normalen, ob ponovitvi simptomov bolezni ali kot dodatek h kirurškemu zdravljenju. V vsakodnevni praksi za medikamentozno zdravljenje endometiroze uporabljamo nesteroidne antirevmatike, oralne kontraceptive in per os progestine kot prvo linijo zdravljenja ter agoniste gonadoliberinov, kot drugo linijo zdravljenja, vendar pa se uporaba slednjih opušča. Omenjena zdravila lahko uporabljamo samostojno ali v kombinaciji. Študije zadnjih deset let so razkrile veliko učinkovin, ki imajo potencial za zdravljenje endometrioze. Te učinkovine lahko v grobem razvstimov v več skupin: protivnetne zdravilne učinkovine, zdravilne učinkovine, ki se vpletajo v delovanje hormonov in v druge patofiziološke procese, kot so moten imunski sistem, zmanjšana apoptoza, pospešena angiogeneza in razgradnja zunajceličnega matriksa, povečan oksidativni stres ter epigenetske spremembe. Vendar pa je za njihovo vpeljavo v rutinsko uporabo potrebnih več kvalitetnih kliničnih študij, ki bodo potrdile njihovo učinkovitost pri bolnicah.
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