子宫内膜非典型增生及子宫内膜癌与代谢综合征关系的研究  

Relationship between metabolic syndrome and endometrial atypical hyperplasia or endometrial cancer

作　　者：刘林枝[1] 冯宗昊 张岩[1] LlU Linzhi, FENG Zonghao, ZHANG Yan.(Department of Obstetrics and Gynecology, Peking University First Hospital Beijing 100034, China)

机构地区：[1]北京大学第一医院妇产科

出　　处：《中国妇产科临床杂志》2018年第2期121-124,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家自然科学基金(81272870)

摘　　要：目的探讨代谢综合征与子宫内膜非典型增生（endometrial atypical hyperplasia,EAH）及子宫内膜癌（endometrial cancer,EC）的关系。方法选取2014年7月至2017年5月本院收治的EAH患者48例,Ⅰ型EC患者132例,Ⅱ型EC患者50例,并选取同期因子宫肌瘤行全子宫切除但无子宫内膜病变或良性子宫内膜病变的患者67例为对照组。采用葡萄糖氧化酶法测定血糖,罗氏电化学发光分析仪测定胰岛素、C肽。分析糖脂代谢及胰岛素抵抗与EAH、EC之间的关系。结果 EAH组、Ⅰ型EC组空腹血糖正常者发生胰岛素抵抗率（43.75%;34.09%）较对照组（17.91%）增加（P〈0.05）。多因素logistic回归分析显示：伴有腹型肥胖的54例对照组、42例EAH组、122例Ⅰ型EC组患者中,排除年龄、BMI、腰臀比、绝经状态等的影响后,高胰岛素水平是EAH、Ⅰ型EC的高风险因素（OR=1.134,95%CI：1.010-1.274,P=0.033;OR=1.103,95%CI：1.012-1.201,P=0.015）。HOMA-IR≥2.11时,EAH、Ⅰ型EC的发病风险显著增加,OR值分别为3.881（95%CI：1.153-13.058,P=0.028）和2.339（95%CI：0.998-5.484,P=0.037）。结论空腹血糖正常EAH、Ⅰ型EC患者发生胰岛素抵抗的比例显著增加。高胰岛素水平与EAH、Ⅰ型EC的发生密切相关。Objective To investigate the relationship between metabolic syndrome and endometrial atypical hyperplasia（EAH） and type Ⅰ endometrial cancer（type Ⅰ EC）. Methods Data of 48 cases of EAH, 132 cases of type Ⅰ EC, 50 cases of type Ⅱ EC, 67 cases of controls who underwent a total hysterectomy for uterine myoma（with normal endometrium or benign endometrial conditions such as endometrial polyps and atrophic endometrium） were collected in the same hospital during the same study period. All blood samples were collected and examined for fasting glucose, insulin and C-peptide. Glucose oxidase method was used for the measurement of glucose, and Cobas6000 for the measurement of insulin and C-peptide. Analyze the relationships of glucose and lipid metabolism and insulin resistance with EAH and EC. Results EAH group and type Ⅰ EC group had the proportion of patients with normal fasting blood glucose but in a state of insulin resistance 43.75% and 34.09%, respectively, both with P-values less than 0.05 compared to the control group（17.91%）. For 54 cases, 42 cases, 122 cases of patients with abdominal obesity from control group, EAH group and type Ⅰ EC group, respectively： hyperinsulinemia was closely related to EAH and type Ⅰ EC（OR =1.134, 95%CI ：1.010 - 1.274, P =0.033; OR =1.103, 95%CI ：1.012 - 1.201, P =0.015）; when HOMA-IR ≥ 2.11, the OR for EAH was 3.881（95%CI ：1.153-13.058, P =0.028）, for type Ⅰ EC was 2.339（95%CI ：0.998-5.484, P =0.037）. Conclusions The proportion of EAH group and type Ⅰ EC group with normal fasting blood glucose but in a state of insulin resistance were dramatically increased. Hyperinsulinemia was closely related to EAH and type Ⅰ EC.

关 键 词：子宫内膜非典型增生 子宫内膜癌 代谢综合征 胰岛素抵抗 临床病理特点 

分 类 号：R589[医药卫生—内分泌] R737.33[医药卫生—内科学]