保护女性生育能力的子宫内膜异位症最新药物治疗进展

doi:10.12114/j.issn.1007-9572.2025.0302

中国全科医学 ›› 2026, Vol. 29 ›› Issue (35): 5281-5289.DOI: 10.12114/j.issn.1007-9572.2025.0302

保护女性生育能力的子宫内膜异位症最新药物治疗进展

杨泊娇¹, 师伟²^,^*()

1．250014　山东省济南市，山东中医药大学第一临床医学院
2．250014　山东省济南市，山东中医药大学附属医院妇科

收稿日期:2025-10-13 修回日期:2025-12-15 出版日期:2026-12-15 发布日期:2026-10-26
通讯作者: 师伟
作者贡献：
杨泊娇负责研究资料的收集与整理、拟定写作思路及撰写论文；师伟负责指导撰写论文并最后定稿。
基金资助:
国家自然科学基金资助项目(82474559); 山东省自然科学创新发展联合基金项目(ZR2023LZY024); 山东省自然科学基金资助项目(ZR2021MH198); 山东省中医药科技发展计划项目(M-2023234T); 山东省中医药科技面上项目(M-2023259)

Recent Advances in Medical Therapies for Endometriosis with a Focus on Preserving Female Fertility

YANG Bojiao¹, SHI Wei²^,^*()

1. The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China
2. Gynecology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China

Received:2025-10-13 Revised:2025-12-15 Published:2026-12-15 Online:2026-10-26
Contact: SHI Wei

摘要/Abstract

摘要： 子宫内膜异位症（EMs）是育龄期妇女常见的一种疾病，其引起的炎症微环境改变、卵巢功能受损及内膜容受性改变严重威胁女性的生育能力。传统药物治疗以缓解症状为主，但对生育力保护缺乏针对性，且长期使用可能抑制卵巢功能。近年来，针对EMs病理机制的新型靶向药物研发取得显著进展，为生育力保护提供了新策略。本文总结了传统药物对生育力保护的治疗策略及新型药物如血管生成抑制剂、免疫调节剂、抗氧化剂及新型治疗方式在EMs生育力保护方面的进展，期待优化临床治疗策略，为有生育要求的内异症患者保驾护航。

关键词: 子宫内膜异位症, 生育力, 靶向治疗, 免疫调节

Abstract:

Endometriosis (EMs), a common gynecological disorder among women of reproductive age, severely compromises female fertility by inducing inflammatory microenvironment alterations, impairing ovarian function, and disrupting endometrial receptivity. Conventional pharmacological therapies primarily focus on symptom alleviation but lack specificity in fertility preservation, with potential long-term ovarian suppression. Recent advances in targeted drug development, informed by the elucidation of EMs pathogenesis, have yielded novel strategies for fertility protection. This article comprehensively reviews the therapeutic limitations of traditional agents in fertility preservation and discusses the advancements in emerging therapeutics, including angiogenesis inhibitors, immunomodulators, antioxidants, and innovative treatment modalities. By integrating mechanistic insights with clinical applications, this review aims to optimize clinical management strategies and safeguard fertility outcomes for EMs patients with reproductive aspirations.

Key words: Endometriosis, Fertility, Targeted therapy, Immunomodulation

中图分类号:

R 711.71

杨泊娇,师伟. 保护女性生育能力的子宫内膜异位症最新药物治疗进展[J]. 中国全科医学, 2026, 29(35): 5281-5289. DOI: 10.12114/j.issn.1007-9572.2025.0302.
YANG Bojiao,SHI Wei. Recent Advances in Medical Therapies for Endometriosis with a Focus on Preserving Female Fertility[J]. Chinese General Practice, 2026, 29(35): 5281-5289. DOI: 10.12114/j.issn.1007-9572.2025.0302.

图/表 1

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药物类别	代表药物	靶点	作用机制	生育保护优势
孕激素类	地诺孕素	雌激素受体（ER）、孕激素受体（PR）	中枢：抑制下丘脑-垂体-卵巢（HPO）轴外周：抗炎、抗血管生成、抗细胞增殖	提高累积着床率、临床妊娠率和活产率，且获卵数、双原核胚胎数及囊胚形成率显著提升
促性腺激素释放激素（GnRH）激动剂	戈舍瑞林、亮丙瑞林	促性腺激素释放激素受体（GnRHR）	负反馈抑制HPO轴，使用初期会短暂刺激垂体细胞，使卵巢分泌黄体生成素（LH）和促卵泡生长激素（FSH）短暂升高，称为"点火效应"	保守型手术后及胚胎移植前使用以提高活产率和妊娠率
GnRH拮抗剂	艾拉戈利、瑞卢戈利、林扎戈利	GnRHR	直接阻断GnRHR，快速抑制FSH和LH水平，避免了"点火效应"，卵巢功能恢复迅速	快速恢复排卵，改善人类辅助生殖技术（ART）结局
芳香化酶抑制剂	来曲唑	芳香化酶P450	抑制雌二醇合成过程中的关键酶芳香化酶P450来抑制雌激素合成	上调整合素αvβ3和HOXA10的表达以改善子宫内膜容受性
多巴胺受体激动剂	喹高利特、卡麦角林、溴隐亭	血管内皮生长因子（VEGF）/血管内皮生长因子受体2（VEGFR-2）	通过靶向VEGF及VEGFR-2，抑制异位内膜的血管生成与炎症反应	不干扰HPO轴，保留正常排卵及妊娠进程
免疫调节剂	二甲双胍	白介素（IL）-6/IL-8	抑制IL-6/IL-8，上调白血病抑制因子（LIF）/HOXA10	减轻炎症反应提高临床妊娠率
	核因子（NF）-κB抑制剂	NF-κB	下调NF-κB表达，抑制子宫内膜异位病灶的生长
	免疫抑制剂类（雷帕霉素）	哺乳动物雷帕霉素靶蛋白（mTOR）	抑制mTOR信号通路调控的细胞增殖、自噬及炎症反应等	通过抑制哺乳动物雷帕霉素靶蛋白复合物1（mTORC1）通路减轻卵泡液氧化应激，改善颗粒细胞线粒体功能，从而提升卵母细胞成熟度；同时通过调控辅助性T细胞17（Th17）/调节性T细胞（Tregs）和Th1/Th2比值建立母胎界面免疫屏障，增强胚胎着床容受性
抗氧化剂	褪黑素	氧化应激系统	清除过量活性氧（ROS）维持线粒体生物合成功能；另一方面恢复谷胱甘肽过氧化物酶（GPx）、超氧化物歧化酶（SOD）等活性并抑制内质网应激	延缓卵巢颗粒细胞（GCs）衰老以改善生育能力
抗氧化剂	天然多酚类化合物（白藜芦醇、姜黄素）	氧化应激系统	通过发挥抗炎和抗氧化特性抑制病变	缓和卵巢内的氧化应激以及卵泡的闭锁与凋亡，保护卵巢功能，提供"抗炎-抗氧化"双重保护机制
干细胞疗法	骨髓间充质干细胞（BMDSC）	干细胞相关靶点	通过干细胞修复受损组织，调节免疫反应抑制进展	利用子宫内膜干细胞的再生潜力促进内膜修复和生育力
益生菌疗法	益生菌/益生元	肠道和生殖道微生物群	调节肠道和生殖道微生物群，抑制免疫和炎症反应	重塑生育微环境和免疫稳态

药物类别	代表药物	靶点	作用机制	生育保护优势
孕激素类	地诺孕素	雌激素受体（ER）、孕激素受体（PR）	中枢：抑制下丘脑-垂体-卵巢（HPO）轴外周：抗炎、抗血管生成、抗细胞增殖	提高累积着床率、临床妊娠率和活产率，且获卵数、双原核胚胎数及囊胚形成率显著提升
促性腺激素释放激素（GnRH）激动剂	戈舍瑞林、亮丙瑞林	促性腺激素释放激素受体（GnRHR）	负反馈抑制HPO轴，使用初期会短暂刺激垂体细胞，使卵巢分泌黄体生成素（LH）和促卵泡生长激素（FSH）短暂升高，称为"点火效应"	保守型手术后及胚胎移植前使用以提高活产率和妊娠率
GnRH拮抗剂	艾拉戈利、瑞卢戈利、林扎戈利	GnRHR	直接阻断GnRHR，快速抑制FSH和LH水平，避免了"点火效应"，卵巢功能恢复迅速	快速恢复排卵，改善人类辅助生殖技术（ART）结局
芳香化酶抑制剂	来曲唑	芳香化酶P450	抑制雌二醇合成过程中的关键酶芳香化酶P450来抑制雌激素合成	上调整合素αvβ3和HOXA10的表达以改善子宫内膜容受性
多巴胺受体激动剂	喹高利特、卡麦角林、溴隐亭	血管内皮生长因子（VEGF）/血管内皮生长因子受体2（VEGFR-2）	通过靶向VEGF及VEGFR-2，抑制异位内膜的血管生成与炎症反应	不干扰HPO轴，保留正常排卵及妊娠进程
免疫调节剂	二甲双胍	白介素（IL）-6/IL-8	抑制IL-6/IL-8，上调白血病抑制因子（LIF）/HOXA10	减轻炎症反应提高临床妊娠率
	核因子（NF）-κB抑制剂	NF-κB	下调NF-κB表达，抑制子宫内膜异位病灶的生长
	免疫抑制剂类（雷帕霉素）	哺乳动物雷帕霉素靶蛋白（mTOR）	抑制mTOR信号通路调控的细胞增殖、自噬及炎症反应等	通过抑制哺乳动物雷帕霉素靶蛋白复合物1（mTORC1）通路减轻卵泡液氧化应激，改善颗粒细胞线粒体功能，从而提升卵母细胞成熟度；同时通过调控辅助性T细胞17（Th17）/调节性T细胞（Tregs）和Th1/Th2比值建立母胎界面免疫屏障，增强胚胎着床容受性
抗氧化剂	褪黑素	氧化应激系统	清除过量活性氧（ROS）维持线粒体生物合成功能；另一方面恢复谷胱甘肽过氧化物酶（GPx）、超氧化物歧化酶（SOD）等活性并抑制内质网应激	延缓卵巢颗粒细胞（GCs）衰老以改善生育能力
抗氧化剂	天然多酚类化合物（白藜芦醇、姜黄素）	氧化应激系统	通过发挥抗炎和抗氧化特性抑制病变	缓和卵巢内的氧化应激以及卵泡的闭锁与凋亡，保护卵巢功能，提供"抗炎-抗氧化"双重保护机制
干细胞疗法	骨髓间充质干细胞（BMDSC）	干细胞相关靶点	通过干细胞修复受损组织，调节免疫反应抑制进展	利用子宫内膜干细胞的再生潜力促进内膜修复和生育力
益生菌疗法	益生菌/益生元	肠道和生殖道微生物群	调节肠道和生殖道微生物群，抑制免疫和炎症反应	重塑生育微环境和免疫稳态

保护女性生育能力的子宫内膜异位症最新药物治疗进展

Recent Advances in Medical Therapies for Endometriosis with a Focus on Preserving Female Fertility

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