绝经后MHT期间出血内膜监测及诊刮界值研究

Ultrasound monitoring and defining the cut-off value of bleeding endometrium during menopause hormone therapy

目的利用经阴式超声对绝经后激素治疗(MHT)期间发生出血的妇女子宫内膜进行观察,结合病理结果探讨出血内膜的诊刮界值。方法以2009年至2014年间于西安交通大学第一附属医院妇女保健门诊就诊的311例绝经后采用替勃龙治疗的妇女为研究对象,定期随访2年,对出血子宫内膜进行超声监测,收集出血内膜组织,进一步分析发生出血时内膜诊刮的界值。结果治疗组出血内膜厚度与对照组比较差异无统计学意义(t=1.543,P>0.05);治疗组诊刮内膜厚度及内膜病理改变的构成比与对照组比较差异均无统计学意义(t=0.443,χ~2=4.711,均P>0.05)。当以7.55mm为界值时,其病理检出的灵敏度和特异度分别为85.71%和93.02%,曲线下面积(AUC)=0.96,P<0.05。结论绝经后替勃龙治疗对出血内膜厚度及病理改变未产生明显影响,治疗期间发生子宫不规则出血时,可适当考虑放宽内膜诊刮界值。

Objective To observe the bleeding endometrium of women during menopause hormone therapy（MHT）with vaginal ultrasound and explore the cut-off value for curettage during uterine bleeding combining pathological results.Methods From 2009 to2014 totally 311 post-menopausal women visiting the First Affiliated Hospital of Xi＇an Jiaotong University and accepting tibolone were selected as study objects,and they were followed up for two years.The bleeding endometrial was monitored by transvaginal ultrasound and endometrial specimens were collected for further analysis of cut-off value for curettage.Results There was not significant difference in bleeding endometrial thickness between treatment group and control group（t=1.543,P〈0.05）.The differences in endometrial thickness for curettage and proportion of endometrial pathological changes between two groups were not significant（t=0.443,χ~2=4.711,both P〈0.05）.When the cut-off value of endometrial thickness was 7.55 mm,the sensitivity and the specificity were 85.71% and 93.02%,respectively（P〈0.05）.The AUC was 0.96（P〈0.05）.Conclusion There is no obvious influence on bleeding endometrial thickness and pathological change with tibolone treatment.The cut-off value for endometrial thickness may be appropriately adjusted for curettage when irregular bleeding of uterus occurs during therapy.