High prevalence of autoimmune diseases in women with endometriosis: a case-control study

Abstract

The immune system seems to be involved in the pathogenesis of endometriosis. Peritoneal chronic inflammation is present and natural killer cells and macrophages abnormalities have been reported in women with the disease. Moreover, a higher production of serum autoantibodies has been found, which could be related to various factors; some still need to be clarified. The correlation between endometriosis and autoimmune diseases is still unclear with few and conflicting available data. The aim of this study was to evaluate the prevalence of autoimmune diseases, as conditions with a possible common pathogenetic factor, in women affected by endometriosis, in order to address future research on its pathogenesis. This retrospective case-control study includes one hundred and forty-eight women with endometriosis and 150 controls. All women were aged between 18 and 45. Informed consent was obtained from all participants of the study. Considered autoimmune diseases include systemic lupus erythematosus (SLE), celiac disease (CD), inflammatory bowel disease (IBD), and autoimmune thyroiditis. Statistical comparison of patients and control group was performed by means of chi-square test or Fisher’s exact test as appropriate. Statistical comparison of parametric variable (age) among the groups was performed by t-test for unpaired data. Age was expressed as mean. A value of .05 or less was considered as significant. In the case group, five patients were affected by IBD, while the disease was not observed in the control group (p = .07). SLE was found in eight patients in the case group, while only one was found in the control group (p = .01). Fifteen women in the case group were affected by CD, while the disease was present only in one woman in the control group (p<.0001). A significant correlation was also found between endometriosis and autoimmune thyroiditis: 80 patients with endometriosis had thyroid diseases versus 14 patients in the control group (p<.0001). Our study reports an association between endometriosis and autoimmune disorders, showing a higher prevalence of autoimmune diseases in women affected by endometriosis. These results support a possible autoimmune pathogenesis of endometriosis.

摘要

免疫系统似乎参与了子宫内膜异位症的发病机制。据报道, 子宫内膜异位症疾病的妇女存在腹膜慢性炎症及自然杀伤细胞、巨噬细胞功能异常。此外, 血清自身抗体的产生也较高, 这可能与多种因素有关；有些仍然需要澄清。子宫内膜异位症和自身免疫性疾病之间的相关性尚不清楚, 现有的资料很少, 且相互矛盾。本研究的目的是评估自身免疫性疾病的患病率, 作为一种可能的共同致病因素, 在妇女患子宫内膜异位症中的影响, 以期为其发病机制的进一步研究提供参考。本回顾性病例对照研究包括148例子宫内膜异位症患者和150例对照者。所有女性的年龄都在18岁到45岁之间。所有参与研究者均签署知情同意书。考虑自身免疫性疾病包括系统性红斑狼疮（SLE）、脂泻病（CD）、炎症性肠病（IBD）和自身免疫性甲状腺炎。采用卡方检验或Fisher精确检验对患者与对照组进行统计学比较。组间参数变量(年龄)采用t检验进行非配对数据的统计比较。年龄用平均数表示。认为P＜0.05是有统计学差异的。病例组有5例IBD患者, 而对照组无IBD患者（p= .07）。病例组SLE患者8例, 对照组SLE患者1例（p= .01）。病例组中有15例女性患有脂泻病, 而对照组中仅有1例女性患有此病（p<.0001）。子宫内膜异位症与自身免疫性甲状腺炎之间也存在显著相关性：80例子宫内膜异位症患者与14例对照组患者存在甲状腺疾病（p<.0001）。我们的研究报告了子宫内膜异位症和自身免疫性疾病之间的联系, 显示子宫内膜异位症患者自身免疫性疾病的患病率更高。这些结果支持子宫内膜异位症可能的自身免疫性发病机制。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Endometriosis
• autoimmune diseases
• systemic lupus erythematosus (SLE)
• celiac disease (CD)
• autoimmune thyroiditis
• inflammatory bowel disease (IBD)
• autoimmunity

Acknowledgements

The authors would like to thank Sara Tarantino and Maria Federica Viscardi for the participation in data collection.

Ethical approval

The authors declare that all data were collected meeting ethical guidelines.

Authors’ contributions

MGP and PBP designed the study. MGP performed the original clinical study. CS, VB , MGP and RO collected the new data for this study and IP, CS, LM analyzed the data. MGP and SS wrote the first draft of the manuscript. All authors contributed to the final version of the manuscript and have read and approved the final version of this manuscript.

Disclosure statement

The authors declare that they have no competing interests. The manuscript was not previously submitted.

Availability of data and material

The dataset is available from the corresponding author on reasonable request.