绝经后出血的高危因素及预测子宫内膜病变模型的建立  

High Risk Factors of Postmenopausal Bleeding and Establishment of A Model for Predicting Endometrial Lesions

作　　者：王丽[1] 毛文军[1] 白娥[1] 吕淑兰[1] WANG Li;MAO Wenjun;BAI E(Department of Gynecology and Obstetrics,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China)

机构地区：[1]西安交通大学第一附属医院妇产科,陕西西安710061

出　　处：《实用妇产科杂志》2022年第9期679-684,共6页Journal of Practical Obstetrics and Gynecology

基　　金：陕西省卫生健康科研基金项目(编号:2018D054)。

摘　　要：目的:分析绝经后出血(PMB)患者的病因及子宫内膜病变特点,利用子宫内膜病变的高危因素建立预测子宫内膜良性病变(EBL)和子宫内膜癌(EC)的模型。方法:选择2016年1月至2019年12月在西安交通大学第一附属医院就诊的PMB患者328例为研究对象,分析PMB病因,对其中可疑子宫内膜病变行内膜病理检查的208例患者根据其病理检查结果分为正常子宫内膜组(NE组,35例)、EBL组(134例)和EC组(39例),比较不同的绝经年限(1~3年、3~5年、5~10年、≥10年)患者中EBL[子宫内膜息肉(EP)、子宫内膜增生不伴非典型增生(EH)、子宫内膜非典型增生(AEH)]和EC的发生率,并对NE组、EBL组和EC组患者子宫内膜超声影像学特点和高危因素进行分析,使用受试者工作特征曲线(ROC)根据子宫内膜病变高危因素建立预测模型。结果:①328例PMB患者中老年性阴道炎所占比例最高(32.32%),其次EBL中的EH患者占17.68%,而EC患者占11.89%。②不同绝经年限组中EP、EC发生率比较,差异有统计学意义(P<0.05),而EH、AEH发生率比较差异无统计学意义(P>0.05),绝经1~3年组EP和EH的发生率最高(分别为25.68%、20.27%),绝经≥10年组AEH和EC的发生率最高(分别为19.57%、28.26%)。③超声影像学检查中NE组、EBL组及EC组的子宫内膜厚度均值及子宫内膜回声不均匀、内膜与肌层分界线不清晰、内膜血流分级(Ⅱ级、Ⅲ级)的比例随着病变严重程度均呈递增趋势(P<0.05)。④3组患者在子宫内膜病变高危因素:不同的年龄、子宫内膜厚度、绝经年龄,及是否反复阴道流血、肥胖、糖尿病、服用他莫昔芬的比较,差异均有统计学意义(P<0.05)。⑤高危因素预测模型对EBL(灵敏度85.3%,特异度67.8%,AUC=0.791)和EC(灵敏度89.7%,特异度72.3%,AUC=0.854)均有较好的预测价值。结论:PMB患者病因中以老年性阴道炎和EBL为主,但EC不容忽视,特别是伴有子宫内膜病变高危因素者。PMB患者不同子�Objective:To analyze the etiology and characteristics of endometrial lesions in patients with postmenopausal bleeding(PMB),and to establish a model to predict benign endometrial lesions(EBL) and endometrial cancer(EC) using high risk factors of endometrial lesions. Methods:A total of 328 PMB patients admitted to The First Affiliated Hospital of Xi′an Jiaotong University from January 2016 to December 2019 were selected as study subjects. The etiology of PMB was analyzed. According to the pathological examination results, 208 patients with suspected endometrial lesions who underwent endometrial pathological examination were divided into normal endometrial group(NE group, n=35), benign endometrial lesions group(EBL group, n=134) and EC group(n=39).The incidence of EBL[endometrial polyp(EP),endometrial hyperplasia without atypia(EH), and endometrial atypical hyperplasia(AEH)] and EC in different menopausal years(1-3 years, 3-5 years, 5-10 years, ≥10 years) were compared. The endometrial ultrasound imaging characteristics and high risk factors among NE group, EBL group and EC group were analyzed. A prediction model was established according to the high-risk factors of endometrial lesions using the receiver operating characteristic curve(ROC). Results:①Among the 328 PMB patients, senile vaginitis accounted for the highest proportion(32.32%),followed by endometrial hyperplasia without atypical hyperplasia(EH)(17.68%), while EC patients accounted for 11.89%.②There was statistically significant difference in the incidence of EP and EC(P<0.05),while there was no statistically significant difference in the incidence of EH and AEH among groups with different menopause years(P>0.05). The incidence of EP and EH was the highest in 1-3 years menopause group(25.68% and 20.27%, respectively), and the incidence of AEH and EC was the highest in the group with ≥10 years menopause group(19.57% and 28.26%, respectively).③In ultrasound imaging examination, the mean endometrialthickness, the proportion of uneven endometrial e

关 键 词：绝经后出血 子宫内膜良性病变 子宫内膜癌 高危因素 预测模型 

分 类 号：R737.33[医药卫生—肿瘤]