子宫内膜息肉发病及癌变的危险因素分析

Analysis of risk factors for endometrial polyps and carcinogenesis

目的探讨子宫内膜息肉(EP)发生及癌变的临床危险因素,旨在加强对高危人群的监测与筛查,为临床防治提供科学依据。方法选择2015年9月至2018年9月昆山市第四人民医院妇产科收治的超声检查提示子宫内膜息肉可疑患者158例,所有患者均行宫腔镜检查,详细记录患者的临床症状体征、年龄、绝经情况、体质量、孕次、合并疾病、既往病史、激素替代治疗等临床资料,并使用SPSS21.0统计软件对临床资料行单因素、多因素非条件Logistic回归分析。结果病理检查结果显示正常子宫内膜68例,子宫内膜息肉90例,90例子宫内膜息肉患者中良性子宫内膜息肉78例,恶性子宫内膜息肉12例;单因素分析结果显示,年龄、绝经、高血压、糖尿病、子宫息肉是EP发病的相关因素(P<0.05);经多因素Logistic回归性分析,结果显示年龄、绝经、息肉与EP的发病显著相关(OR值依次为1.12、2.58、1.95);单因素分析结果显示,年龄、绝经、肥胖、异常子宫出血、息肉直径、激素替代治疗是EP恶变的相关因素(P<0.05);经Logistic多因素逐步回归分析,结果显示年龄、异常子宫出血、息肉直径、激素替代治疗与EP的恶变显著相关(OR值依次为1.09、3.92、1.82、21.38)。结论年龄、绝经、息肉是EP发病的独立因素,年龄、异常子宫出血、息肉直径、激素替代治疗是EP恶变的独立因素,因此在临床中应提高警惕,加强对此类人群的筛查,同时对于绝经后合并这些危险因素的妇女应及时行病理组织学检查排除恶变。

Objective To investigate the clinical risk factors of endometrial polyps (EP) and carcinogenesis,to strengthen the monitoring and screening of high-risk people,and to provide scientific evidence for clinical prevention and treatment.Methods From September 2015 to September 2018,the ultrasound examination in Department of Gynaecology and Obstetrics,the Fourth People's Hospital of Kunshan City showed 158 suspicious patients with endometrial polyps.All patients underwent hysteroscopy.The clinical symptoms,signs,age,menopause,body mass,times of pregnancy, combined disease,past medical history,hormone replacement therapy of the patients were recorded.The data were analyzed by single-factor,multi-factor unconditional logistic regression analysis using SPSS statistical software. Results The results of pathological examination showed 68 cases of normal endometrium and 90 cases of endometrial polyps (among which there were 78 cases of benign endometrial polyps and 12 cases of malignant endometrial polyps). Univariate analysis results showed that the factors associated with the onset of EP included age,menopause,hypertension, diabetes,uterine polyps (P<0.05).Multivariate logistic regression analysis showed that age,menopause,and polyps were significantly associated with the onset of EP (OR=1.12,2.58,and 1.95,respectively).Univariate analysis showed that factors associated with the malignant transformation of EP included age,menopause,obesity,abnormal uterine bleeding,polyp diameter,and hormone replacement therapy (P<0.05).Multivariate logistic regression analysis showed that age,abnormal uterine bleeding,polyp diameter,hormone replacement therapy were significantly associated with the malignant transformation of EP,with OR values of 1.09,3.92,1.82,and 21.38,respectively.Conclusion Age,menopause, and polyps are independent factors of EP.Age,abnormal uterine bleeding,polyp diameter,and hormone replacement therapy are independent factors of EP malignant transformation.Therefore,it is necessary to increase vigilance in clinical practice and strengthen screening for such people.For women having these risk factors after menopause,pathological examination should be performed in time to eliminate malignant transformation.