子宫内膜癌相关危险因素的探讨

Investigation of the risk factors of endometrial cancer

目的分别探讨绝经前、绝经后女性子宫内膜癌(EC)发病的相关因素,为进一步防治EC提供依据。方法回顾性分析81例EC患者以及112例非EC患者,包括子宫内膜正常者56例(增生期宫内膜、分泌期宫内膜、萎缩性宫内膜),子宫内膜增生者56例(子宫内膜单纯增生、子宫内膜复杂增生、子宫内膜不典型增生),将发病年龄、初潮年龄、婚育史、体质量指数(body mass index,BMI)、高血压、糖尿病、激素替代(hormone replacement therapy,HRT)、乳腺癌术后使用他莫昔芬(tamifen,TAM)、甲状腺功能减退、多囊卵巢综合征(polycysticovariansyndrome,PCOS)、肿瘤家族史作为观察指标,通过单因素和多因素Logistic回归,分析绝经前、后EC发病的相关危险因素。结果 (1)未绝经女性:单因素分析显示高血压、PCOS、甲减、孕次、初潮年龄在2组间差异有统计学意义(P<0.05);多因素Logistic回归显示初潮年龄高、孕次多是绝经前女性EC患病的保护因素,而高血压是绝经前女性EC患病的危险因素。(2)绝经妇女:单因素分析显示BMI、孕次、初潮年龄在2组间差异有统计学意义(P<0.05);多因素Logistic回归分析显示初潮年龄高、孕次多是绝经后女性EC患病的保护因素。结论高血压是绝经前女性患EC的主要危险因素;而初潮年龄高、孕次多是绝经前及绝经后的女性EC患病的共同保护因素。

Objective To explore the risk factors of endometrial cancer in pre and post menopausal women. Methods A retrospective analysis was conducted, and 81 patients with endometrial cancer （ both pre and post menopausal cases）, and 112 cases without endometrial cancer,including 56 normal endometrium （proliferative endometrium, secretory endometrium, atrophic endometrium） and 56 hyperplasia （endometrial hyperplasia, endometrial complex hyperplasia, atypical endometrial hyperplasia） were erolled. Age of onset, age of menarche, obstetrical history, body mass index （BMI）, hypertension, diabetes, hormone replacement （HRT）, breast cancer treatment, hypothyroidism, polycystic ovary syndrome （PCOS）, and family history of cancer were analyzed by univariate and multivariate logistic regression. Results （1） Premenopausal women： There were signifcant difference in high blood pressure, PCOS, hypothyroidism, pregnancies, age of menarche between the two groups （P〈0. 05）. Multivariate logistic regression analysis showed that higher age of menarche, more pregnancies were protective factors and hypertension was risk factor of endometrial cancer in premenopausal women. （2）Postmenopausal women： There were signifcant difference in BMI, pregnancies, age of menarche between the two groups （P〈 0. 05）. Logistic multivariate regression analysis showed that higher age of menarche, more pregnancies were protective factors of endometrial cancer in postmenopausal women. Conclusions Hypertension is a major risk factor in premenopausal women. Age of menarche and multiple pregnancies are protective factors for endometrial cancer in both pre- and postmenopausal women.