en نقش گیرنده‌های پروژسترون و استروژن در انتخاب درمان مناسب پس از جراحی آندومتریوز: یک مطالعه‌ی مقطعی Reproductive Surgery Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">عدم بهبود درد در برخی از بیماران آندومتریوز پس از جراحی حتی با استفاده از درمان هورمونی ممکن است نشان</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">دهنده پاسخ نامناسب به درمان</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">های هورمونی معمول باشد.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">این مطالعه با هدف تعیین نقطه برش برای انتخاب مناسب</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ترین درمان بر اساس گیرنده</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">های هورمونی ضایعات آندومتریوز انجام شد.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش &shy;ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در این مطالعه مقطعی، با بررسی پرونده‌های پزشکی بیماران و آزمایش نمونه‌های آرشیوشده بیماران پس از جراحی و در صورت نیاز مصاحبه تلفنی با آنها، 86 بیمار را پس از جراحی آندومتریوز که در بیمارستان‌های دولتی شیراز (شهید فقیهی و حضرت زینب)، از اسفند 1395 لغایت اسفند 1398 تحت عمل جراحی قرار گرفته بودند، به 2 گروه تقسیم شدند: پاسخ</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">دهی به درمان پزشکی و جراحی (73 نفر برای دیسمنوره، 60 نفر برای دیسپارونی) و عدم پاسخگویی (13 نفر، 7 نفر). ما اسلایدهای پاتولوژیک 86 زن را برای تعیین میزان گیرنده هورمونی و ارتباط بین نوع درمان دارویی و سطح گیرنده هورمونی بر کاهش درد در یک سال پس از جراحی بررسی کردیم.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">بر اساس منحنی مشخصه عملکرد گیرنده، دیسمنوره در حضور گیرنده</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">های استروژن بافتی بیشتر از 60% (1065/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، و دیسپارونی در حضور&nbsp;&nbsp; &nbsp;گیرنده</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">های پروژسترون بافتی بیشتر از 80% (0001/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) به درمان پزشکی پاسخ خوبی دادند. بعد از جراحی در حضور آندومتریوما، دیسمنوره بهترین پاسخ را به قرص&nbsp;</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">های ضد بارداری خوراکی نشان داد (4/69%) در حالی که در آندومتریوز عمیق ارتشاحی، دیسپارونی بهترین پاسخ را به درمان با پروژسترون نشان داد (%75).</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه&shy; گیری: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">تجویز هورمون درمانی مناسب بر اساس الگوی رنگ‌آمیزی ایمونوهیستوشیمی خاص می‌تواند کیفیت زندگی زنان مبتلا به آندومتریوز را بعد از عمل بهبود بخشد.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Background:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> The lack of improvement in some endometriotic people&rsquo;s pain after surgery even while using hormone treatment may suggest an inappropriate response to routine hormonal therapies. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Objective:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> This study aimed to determine a cut-off point for selecting the most appropriate treatment based on the hormone receptors of endometriotic lesions.</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Materials and Methods:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> In this cross-sectional study, by reviewing the medical records of participants and testing their archive samples and phone interviews (if needed), 86 symptomatic women after endometriosis surgery who were operated into governmental hospitals, Shahid Faghihi and Hazrate Zeinab Shiraz Iran were enrolled between March 2017 and March 2019. Women were divided into 2 groups: responsiveness (n = 73 for dysmenorrhea, n = 60 for dyspareunia) to medical treatment and surgery, and unresponsiveness (n = 13, n = 7). We examined the pathological slides of 86 women to determine the amount of hormone receptors and the relationship between the type of medical treatment and the level of hormone receptors on pain relief within 1 yr after surgery. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Results: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Based on the receiver operating characteristic curve, dysmenorrhea in the presence of tissue estrogen receptors > 60% (p = 0.1065), and dyspareunia in the presence of tissue progesterone receptors > 80% (p = 0.0001) responded well to medical treatment after surgery. In the presence of endometrioma-dysmenorrhea showed the best response to oral contraceptive pills (69.4%), while in deep infiltrative endometriosis-dyspareunia showed the best response to progesterone treatment (75%).</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Conclusion: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Prescribing an appropriate hormone therapy based on a specific immunohistochemistry staining pattern can improve the life quality of postoperative endometriosis individuals.</span></span></span></span></span></span></div> آندومتریوز, گیرنده استروژن, گیرنده پروژسترون, عود. Endometriosis, Estrogen receptor, Progesterone receptor, Recurrence. 567 578 http://ijrm.ir/browse.php?a_code=A-10-1360-2&slc_lang=en&sid=1 Tahereh Poordast ta.poordast@yahoo.com 0000-0002-0978-2825 No Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Saeed Alborzi alborzisa@gmail.com 0000-0001-6274-0088 No Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Ziba Kiani zkiani3655@gmail.com 0000-0003-2609-2196 No Department of Obstetrics and Gynecology, School of Medicine, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Navid Omidfar omidfar@gmail.com 0000-0003-3391-926X No Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Elham Askary elliaskary_md@yahoo.com 0000-0001-5127-4392 Yes Department of Obstetrics and Gynecology, School of Medicine, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Kefayat Chamanara chamnarak109859@gmail.com 0000-0003-0502-6069 No Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Mansoureh Shokripour shokripurm@sums.ac.ir 0000-0002-8339-322X No Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Alimohammad Keshtvarz Hesam Abadi alimohammad.keshtvarz@gmail.com 0000-0002-9579-9833 No Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.