代谢综合征患者子宫内膜病理状态及其相关因素分析  

The analysis of endometrial pathology and relevant factors in MS cases

作　　者：易红[1] 李晓红[1] 李瑾[1] 

机构地区：[1]深圳市宝安区妇幼保健院,518100

出　　处：《山西医药杂志（下半月）》2013年第5期485-487,共3页Shanxi Medical Journal

基　　金：深圳市宝安区级科技项目(20110611)

摘　　要：目的探讨代谢综合征(MS)患者子宫内膜病理状态与其内分泌代谢改变的关系。方法采用回顾性对照研究,将41例因异常子宫出血行诊断性刮宫+子宫内膜活检的MS患者的子宫内膜病理分为A组(异常组,包括子宫内膜息肉、单纯性增生、复杂性增生、不典型增生及内膜癌)及B组(正常组,包括子宫内膜增生期及分泌期),比较2组子宫内膜病理形态与体质量指数(BMI)、腰围、高血压、性激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)]、空腹血糖、甘油三酯(TG)、高密度脂蛋白(HDL)、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)的关系。结果 41例MS患者中,无排卵型内膜占93%(38/41),子宫内膜息肉7%(3/41),单纯性增生39%(16/41),复杂性增生7%(3/41),不典型增生7%(3/41),子宫内膜癌12%(5/41);A组的BMI、腰围、T、空腹血糖、TG、空腹胰岛素的水平、HOMA-IR、高血压的发生率高于B组,差异有统计学意义(P<0.05),A组的HDL水平低于B组,差异有统计学意义(P<0.05),2组的FSH、LH、E2水平差异无统计学意义(P>0.05)。结论半数以上异常出血的MS患者子宫内膜呈不同程度的增生改变,甚至少部分已经癌变,可能与长期持续的单一雌激素刺激、高雄激素血症、胰岛素抵抗-高胰岛素血症相关,临床上对MS患者应进行早期的干预,从而降低子宫内膜病变的发生率。Objective To study the endometrial patholo-gical characteristics in patients with MS and the effect of endocrine and metabolic changes on endometrium. Methods The pathological features of endometria in the cases with MS and abnormal uterine bleeding were divided into A the abnormal group consisting of endometrial polyp, simple and complex hyperplasia, atypical hyperplasia and adenocarcinoma and B the normal group consisting of endometrial proliferative and secretory phase,then to investigate the relation in pathological features and body mass index （BMI）, waist circumference （WC）, hypertention, sexual hormones （FSH. LH. E~. T）, triglycerides （TG）, high-desity lipoprotein （HDL）, fasting plasma glucose, fasting insulin and homaostasis model assessment of insulin resistance （HOMA-IR） between the two groups applying retrospective control study. Results In 41 cases, the rates of anovulatory endometria, endometrial polyp,simple hyperplastic endometria, complex hyperplastic en- dometria, atypical hyperplastic endometria and cancerous endometria were 93 % （38/41）, 7 ~ （ 3/41 ）, 39 ~ （ 16/41 ）, 7 % （ 3/41）, 7 ~ （3/41） and 12 ~ （5/41） respectively. The level of BMI, WC, T, fasting plasma glucose, fasting insulin, TG, HOMA--IR and the rate of hypertension in A group were higher than those of B group, with statistical signifi- cance（P^0.05） ,the level of HDL in A group was significantly lower than that of B group （P%0.05） ,there were no significant changes of the sexual hormones（FSH, LH, Ez ） between the two groups. Conclusion Endometrial histopathology in more than half of the patients with MS and abnormal uterine bleeding andvaried by hyperplasia at a certain degree and carcinoma. It was possiblely relative with the persistent and long-term single estrogen, hyeran- drogenism insulin resistance and hyperinsulin. Therefore, an early clinical intervention must be performed on the patient with MS so that the incidence of endometrial disorders will be decreased.

关 键 词：代谢综合征 子宫内膜 激素类 

分 类 号：R737.3[医药卫生—肿瘤]