473例肝病患者异常子宫出血的病因分析

Etiological analysis of abnormal uterine bleeding in 473 patients with different types of chronic hepatic diseases

目的探讨肝病患者异常子宫出血的临床特点和子宫内膜的病理特点。方法对473例异常子宫出血的肝病患者进行宫腔镜检查及诊断性刮宫,根据病理学检查结果进行分析,总结肝病患者异常子宫出血的原因。结果在肝炎病毒携带者、肝炎肝硬化代偿期和肝炎肝硬化失代偿期3组患者中,各组发生率最高的病变为子宫内膜息肉,分别为29.6%、28.6%和30.0%,差异无统计学意义。非典型增生发生率为3.8%,子宫内膜癌发生率为1.7%。子宫内膜癌的比例随年龄的增长而呈上升趋势,绝经期患者发生率达6.5%,与围绝经期患者相比差异有统计学意义(P<0.05)。绝经期肝炎肝硬化失代偿的患者中子宫内膜癌的发生率为14.3%,显著高于肝炎病毒携带者的发生率,但无统计学意义。结论肝病患者的异常子宫出血原因复杂,病理类型多样,子宫内膜癌在绝经期肝炎肝硬化失代偿患者中发生率显著增高,需引起高度重视。

Objective To investigate the clinical and pathological characteristics of abnormal uterine bleeding in patients with different types of chronic hepatic disease. Methods A total of 473 hepatic disease patients with abnormal uterine bleeding underwent hysteroscopy and diagnostic curettage in Beijing You＇ an Hospital. The pathological type of ab- normal uterine bleeding and pathological diagnosis of patients at different stages and different types chronic hepatic diseas- es were summarized, Results Among the chronic hepatitis virus carriers, the compensated and decompensated liver cir- rhosis patients, the endometrial polyp had the highest rate. The average percentage was 29.6%,28.6% and 30.0% respec- tively. There was no significant difference among the three groups. The incidence ofendometrial atypical hyperplasia was 3.8% and the incidence of endometrial carcinoma was 1.7%. The incidence of endometrial carcinoma increased with age. The incidence was 6.5% in postmenopausa! women. Compared with perimenopausal women, the difference was signifi- cant. The incidence of endometrial carcinoma among the decompensated liver cirrhosis patients could reach 14.3% in post- menopausal period. It was higher than the chronic hepatitis virus carriers,but there were no significant differences. Con- clusion The causes of abnormal uterine bleeding are complicated and the pathologic types are diverse in hepatitis patients, The incidence of endometrial carcinoma increases significantly in the decompensated liver cirrhosis patients in postmenopausal period.