他莫昔芬对绝经前后乳腺癌患者子宫内膜的影响  

Clinical study on the effect of tamoxifen on endometrium in patients with breast cancer

作　　者：江布英 吴耀忠[2] 郭梓耘 黄德萍[1] 雷嘉[1] JIANG Buying;WU Yaozhong;GUO Ziyun;HUANG Deping;LEI Jia(Department of Gynecology,Wuzhou Red Cross Hospital,Wuzhou 543002,China;Department of Mammary Gland,Wuzhou Red Cross Hospital,Wuzhou 543002,China)

机构地区：[1]广西壮族自治区梧州市红十字会医院妇科,广西梧州543002 [2]广西壮族自治区梧州市红十字会医院乳腺科,广西梧州543002

出　　处：《中国医药科学》2018年第24期79-82,共4页China Medicine And Pharmacy

基　　金：广西壮族自治区梧州市科学研究与技术开发计划项目(201302018)

摘　　要：目的随访观察乳腺癌患者术后或化疗后长期服用他莫昔芬,对不同绝经状态下子宫内膜的病理学影响及探讨适宜的随访策略。方法连续选取2014年3月～2017年3月于本院确诊乳腺癌患者共90例,经病理证实为雌、孕激素受体阳性,其中未绝经患者40例,绝经患者50例;随访至2018年1月,两组临床资料不完善或失随访各5例,根据患者是否绝经进行分组,最终入组未绝经患者35例,绝经患者45例,未绝经组随访中位时间25.5个月,绝经组27.5个月。观察两组患者月经和异常阴道流血情况,结合阴道B超、宫腔镜或子宫内膜活检诊断子宫内膜的病理改变。结果未绝经组共发生异常阴道流血10例(28.57%),异常阴道流血率显著高于绝经组,子宫内膜病变发生率显著低于绝经组,差异有统计学意义(P <0.05)。阴道B超诊断无子宫内膜病变的准确性显著高于诊断子宫内膜病变,差异有统计学意义(P <0.05);宫腔镜诊断子宫内膜病变和无子宫内膜病变均有较高的准确性。结论他莫昔芬对乳腺癌患者绝经前后状态下子宫内膜的病理学影响不同,应制定适宜的随访策略,早期发现和治疗。Objective To explore the pathologic effect of endometrium in different menopausal conditions and the appropriate follow-up strategy by follow-up observation of breast cancer patients taking tamoxifen after surgery or after chemotherapy. Methods Ninety patients who were diagnosed with breast cancer in our hospital from March 2014 to March2017 were continuously selected and they were pathologically confirmed as positive for estrogen and progesterone receptors.There were 40 cases of non-menopausal patients and 50 cases of menopausal patients.During the follow-up period to January 2018,the clinical data of the two groups were incomplete or lost to follow-up in 5 cases.According to whether the patients were menopausal,35 cases of non-menopausal patients and 45 cases of menopausal patients were finally enrolled.The median time for follow-up was 25.5 months in the non-menopausal group and 27.5 months in the menopausal group.Menstruation and abnormal vaginal bleeding were observed in two groups.The pathological changes of endometrium were diagnosed by vaginal B-ultrasound,hysteroscopy or endometrial biopsy. Results There were 10 cases(28.57%)with abnormal vaginal bleeding in the non-menopausal group.Abnormal vaginal bleeding rate of the non-menopausal group was significantly higher than that in the menopausal group and the incidence of endometrial lesions was significantly lower than that in the menopause group.The difference was statistically significant(P < 0.05).The accuracy of B-ultrasound in the diagnosis of without endometrial lesions was significantly higher than that in the diagnosis of endometrial lesions,and the difference was statistically significant(P < 0.05).Hysteroscopic diagnosis of endometrial lesions and no endometrial lesions have higher accuracy. Conclusion Tamoxifen has different pathological effects on endometrium in patients with breast cancer before and after menopause.Appropriate follow-up strategies should be developed for early detection and treatment.

关 键 词：他莫昔芬 乳腺癌 雌、孕激素受体 子宫内膜 

分 类 号：R737.9[医药卫生—肿瘤]