绝经后妇女子宫内膜增厚的病理分型及其危险因素分析  

Pathological staging of endometrial thickening in postmenopausal women and analysis of its risk factors

作　　者：谢佳翊 王真真 沈雪 XIE Jia-yi;WANG Zhen-zhen;SHEN Xue(Department of Obstetrics and Gynecology,the Affiliated Hospital of Hubei University of Medicine/Graduate Training Base,Xiangyang No.1 People's Hospital,Jinzhou Medical University,Xiangyang 441100,Hubei,CHINA;Department of Obstetrics and Gynecology,Xiangyang No.1 People's Hospital,Hubei University of Medicine,Xiangyang 441100,Hubei,CHINA)

机构地区：[1]锦州医科大学襄阳市第一人民医院研究生培养基地湖北医药学院附属医院妇产科,湖北襄阳441100 [2]湖北医药学院附属襄阳第一人民医院妇产科,湖北襄阳441100

出　　处：《海南医学》2023年第13期1884-1887,共4页Hainan Medical Journal

基　　金：湖北省襄阳市第一人民医院科技创新项目(编号:XYY2021Q14)。

摘　　要：目的分析绝经后妇女发生子宫内膜增厚的病理分型,并探讨绝经后子宫内膜增厚患者发生子宫内膜病变的危险因素。方法收集2018年11月至2021年11月因绝经后子宫内膜增厚(经阴道超声检查子宫内膜厚度≥5mm)在襄阳市第一人民医院就诊的104例患者作为观察组,89例正常子宫内膜厚度的绝经后妇女作为对照组。比较两组妇女的临床资料,采用多因素Logistic回归分析绝经后子宫内膜增厚的独立危险因素,并研究子宫内膜厚度与子宫内膜病变各病理类型的关系,通过受试者工作特征曲线(ROC)确定绝经后女性内膜增厚人群子宫内膜病变筛查的最佳预测值。结果经单因素分析结果显示,年龄、体质量、初潮年龄、绝经年龄、足月产次数及有无糖尿病史与绝经后子宫内膜增厚有关(P<0.05),而与流产次数及有无高血压史无关(P>0.05);经多因素Logistic回归分析结果显示,体质量、初潮年龄、绝经年龄、足月产次及合并糖尿病是绝经后子宫内膜增厚的独立危险因素(P<0.05);随着子宫内膜厚度的增加,内膜恶性病变的比例也不断升高,其中子宫内膜厚度为5~10mm的64例患者发生子宫内膜恶变者5例(7.8%),10~15mm的30例患者发生子宫内膜恶变者11例(36.7%),15~20mm的10例患者发生子宫内膜恶变者8例(80%);经ROC分析结果显示,以子宫内膜厚度9.7mm为界值可预测子宫内膜不典型增生或子宫内膜癌,其ROC曲线下的面积(AUC)为0.745,其敏感度为77.27%,特异度为73.75%。结论高体质量、初潮早、绝经晚、足月产次少,且患有糖尿病等为绝经后子宫内膜增厚的独立危险因素,对于绝经后子宫内膜增厚并伴有危险因素的妇女应尽早筛查,尤其是当子宫内膜厚度超过9.7mm时应进一步行子宫内膜活检以排除恶变可能。Objective To analyze the pathological staging of endometrial thickening in postmenopausal wom-en and to explore the risk factors for endometrial lesions in postmenopausal patients with endometrial thickening.Methods A total of 104 patients visited Xiangyang No.1 People's Hospital for postmenopausal endometrial thicken-ing(endometrial thickness≥5 mm by transvaginal ultrasound)from November 2018 to November 2021 were collect-ed as the observation group,and 89 menopausal women with normal endometrial thickness were enrolled as the control group.The clinical data of the two groups of women were compared,and the independent risk factors for postmenopaus-al endometrial thickening was analyzed using multifactorial logistic regression.The relationship between endometrial thickness and each pathological type of endometrial lesion was investigated.The receiver operating characteristic(ROC)curve was used to determine the best predictive value for endometrial lesion screening in postmenopausal women with endometrial thickening.Results Univariate analysis showed that age,body mass,age at menarche,age at menopause,number of full-term births,and history of diabetes mellitus were associated with postmenopausal endometrial thickening(P<0.05),but not with number of abortions and history of hypertension(P>0.05).Multifactorial logistic regression analy-sis showed that weight,age at menarche,age at menopause,number of full-term births,and diabetes mellitus were inde-pendent risk factors for postmenopausal endometrial thickening(P<0.05).As the thickness of the endometrium increas-es,the proportion of malignant endometrial lesions also increases,with endometrial malignancy occurring in 5(7.8%)of the 64 patients with an endometrial thickness of 5 mm to 10 mm,11(36.7%)of the 30 patients with an endometrial thick-ness of 10 mm to 15 mm,and 8(80%)of the 10 patients with an endometrial thickness of 15 mm to 20 mm.The ROC curve analysis showed that endometrial thickness of 9.7 mm was the cut-off value for predicting endometrial atypical hy

关 键 词：子宫内膜增厚 绝经后女性 子宫内膜病变 危险因素 最佳预测值 

分 类 号：R711.74[医药卫生—妇产科学]