绝经后子宫内膜无创性评估指标的相关研究

Study on non-invasive assessment indexes of endometrium after menopause

目的探讨绝经后子宫内膜状态的无创性评估指标。方法选择2012年12月至2014年2月期间,就诊于东南大学附属中大医院妇产科绝经门诊的绝经女性160例,均未接受绝经激素治疗。自然绝经1~2年为绝经早期组、3~5年为绝经中期组、6~10年为绝经晚期组。记录初潮年龄、绝经年龄、绝经年限、体重指数(body mass index,BMI)、腰臀比、绝经指数(Kupperman menopausal index,KMI)。检测血清雌二醇(estradiol,E_2)、卵泡刺激素(follicle-stimulating hormone,FSH)水平。采用经阴道彩色多普勒超声测量子宫内膜厚度、子宫螺旋动脉阻力指数(resistive index,RI)、搏动指数(pulsatility index,PI)、收缩期峰值流速(peak systolic velocity,PSV),计算子宫体积、卵巢体积。统计学方法采用单因素方差分析、非参数检验、Spearman相关分析。结果绝经早、中、晚期3组间初潮年龄、绝经年龄、BMI、腰臀比比较,差异均无统计学意义(P﹥0.05)。绝经早、中期组KMI(24.4±5.3和25.2±7.2)均高于绝经晚期组(15.9±8.8),差异有统计学意义(P﹤0.001)。3组间E_2和FSH比较,差异无统计学意义(P﹥0.05)。绝经早期组与绝经晚期组的子宫体积分别为(37.2±16.2)与(20.9±8.0)cm3、卵巢体积为(1.9±0.8)与(1.4±0.4)cm3、子宫螺旋动脉PSV为14.6±11.2与8.0±3.1,绝经晚期组较低(P﹤0.05);子宫螺旋动脉RI分别为0.77±0.07与0.85±0.05、PI分别为2.1±0.6与3.1±0.7,绝经晚期组较高(P﹤0.05)。绝经早、中、晚期组3组间子宫内膜厚度分别为(0.48±0.20)、(0.42±0.13)、(0.44±0.22)cm,差异无统计学意义(P﹥0.05)。绝经年限与子宫螺旋动脉RI及PI均呈显著正相关(R分别为0.466和0.544,P值均<0.001);绝经年限与子宫螺旋动脉PSV呈显著负相关(R=-0.395,P﹤0.001)。24例内膜厚度﹥0.5 cm者中,16例(66.7%)发生良性病变,8例(33.3%)发生非良性改变;10例内膜厚度≤0.5 cm者中,内膜组织学均为良性改变。结论子宫螺旋动脉频谱多普勒血流参数RI、PI、PSV与绝经年限相关,有望与子宫内膜厚度联合作为绝经后子宫内膜无创性监测的有效指标。

Objective To explore non-invasive assessment indexes for state of endometrium after menopause. Methods Total 160 menopause women who had not undergone menopausal hormone treatment （MHT） were selected in menopause clinical of department of gynaecology ＆ obstetrics at Zhongda Hospital, Southeast University from December 2012 to February 2014. They were classified into three groups, early menopause group （1-2 years）, middle menopause group （3-5 years） and late menopause group （6-10 years）. Menarche age, menopause age, duration of menopause, body mass index （BMI）, waist to hip ratio （WHR） and Kupperman menopausal index （KMI） were recorded. Serum estradiol （E2） and follicle stimulating hormone （FSH） levels were determined. The endometrial thickness and Doppler flow spectrum parameters of uterine spiral artery including resistance index （RI）, pulse index （PI） and peak systolic velocity （PSV） were measured via transvaginal ultrasonography. Uterine volume and ovarian volume were calculated. One-way ANOVA, nonparametric test and Spearman correlation analysis were used for statistical analysis. Results There was no significant difference on menarche age, menopause age, BMI and WHR in early menopause group, middle menopause group and late menopause group （P 〉 0.05）. KMI was significant higher in the early menopause group and middle menopause group [ （24.4 ± 5.3） and （25.2 ± 7.2） ] than late menopause group （15.9 ± 8.8） （P 〈 0.001）. There was no significant difference on the serum levels of E2 and FSH in the three groups （P 〉 0.05）. The uterine volume of early menopause group and the late menopause group were respectively （37.2 ± 16.2） vs （20.9 ± 8.0） cm^3. Ovarian volume were （1.9 ± 0.8） vs （1.4 ± 0.4） cm^3. Uterine spiral artery PSV were 14.6 ± 11.2 vs 8.0 ± 3.1, The above three parameters of late menopause group were lower （P 〈 0.05）. The uterine spiral artery RI of early menopause group and late menopause group were 0.77 ± 0.07 vs 0.85 ± 0.05. Uterine spiral artery PI were 2.1 ± 0.6 vs 3.1 ± 0.7. The above two parameters of late menopause group were higher （P 〈 0.05）.The endometrial thickness of early menopause group, middle menopause group and late menopause group were （0.48 ± 0.20）, （0.42 ± 0.13） and （0.44 ± 0.22） cm, respectively, with no significant difference （P 〉 0.05）. There were positive correlation （R = 0.466 and R = 0.544, both P 〈 0.001） between duration of menopause and uterine spiral artery RI and PI; while negative correlation between duration of menopause and uterine spiral artery PSV （R=-0.395, P 〈 0.001）. Among the 24 patients with endometrium thickness over 0.5 cm, 16 （66.7%） of them were diagnosed as benign lesions, 8 （33.3%） diagnosed as non-benign lesions. All the 10 cases with endometrium thickness ≤0.5 cm were diagnosed as benign lesions. Conclusions Doppler flow spectrum parameters of uterine spiral artery including RI, PI and PSV are correlated with duration of menopause. They are expected to be effective indicators combined with endometrial thickness for postmenopausal endometrial noninvasive monitoring.