绝经后子宫内膜增厚的临床病理特征分析

Clinicopathological features of postmenopausal thickening of the endometrium

目的分析绝经后子宫内膜增厚的临床病理特点。方法收集新疆石河子大学医学院第一附属医院妇科自2017年1至12月收治的180例绝经后因子宫内膜增厚(≥4mm)接受内膜活检的患者的临床病理资料,根据绝经后有无阴道异常出血(AUB)分为AUB组和无AUB组各90例。分析两组组间及组内多个临床指标与内膜病理检查结果的关系,多因素Logistic逐步回归分析AUB组内的独立危险因素,通过ROC曲线确定绝经后内膜增厚且不伴AUB的女性人群内膜癌筛查的最佳预测值。结果①AUB组和无AUB组组内最常见的子宫内膜良性病理检查均是绝经期内膜(33.34%vs.48.90%),其次为内膜息肉(17.78%vs.24.44%)和内膜单纯性增生(14.44%vs.17.78%)。AUB组的内膜癌发生率显著高于无AUB组(χ^2=18.127,P<0.05),无AUB组的绝经期内膜发生率高于AUB组(χ^2=6.763,P<0.05)。②AUB组患者的平均内膜厚度为(10.01±5.69)mm,显著高于无AUB组患者的内膜厚度(7.59±3.34)mm(t=17.516,P<0.05)。③AUB组的单因素分析:年龄≥60岁、初潮年龄≤12岁、绝经年龄≥50岁、不孕史均是AUB组内膜恶变的影响因素(χ^2值分别为6.731、5.494、4.935、6.732,均P<0.05),AUB组中恶性内膜的平均内膜厚度显著高于良性内膜(t=-4.163,P<0.05),而绝经年限≥25年的患者发生内膜癌的几率低于绝经年限<25年的患者(χ^2=5.400,P<0.05);多因素分析:内膜厚度(OR=1.254,95%CI:1.094~1.436)、年龄≥60岁(OR=7.775,95%CI:1.550~39.003)、初潮年龄≤12岁(OR=6.123,95%CI:1.780~20.926)及绝经年限≥25年(OR=0.100,95%CI:0.011~0.881)均是AUB组患者发生内膜恶变的独立影响因素(均P<0.05)。④在无AUB组,仅发现恶性病变患者的平均内膜厚度高于良性病变(t=-3.085,P<0.05),其他比较均无统计学差异(均P>0.05)。⑤在已绝经人群中子宫内膜增厚且不伴AUB者,ROC曲线上约登指数最高时的临界点为9.50mm时,AUC最大,为0.808(95%CI:0.785~0.904,P<0.05),其灵敏度、特异度、阳性预测值、阴性预测值分别为75.00%、95.35%、42.85%、98.80%。结论绝经后子宫内膜增厚且无AUB的人群,内膜活检大多数为内膜良性疾病,当内膜厚度≥9.50mm时,建议行内膜活检排除内膜病变。

Objective To analyze the clinicopathological features of postmenopausal endometrial thickening of the female patients.Methods The clinical and pathological data of 180 patients with endometrial thickening(≥4 mm) undergoing endometrial biopsy admitted during the period from January 2017 to December 2017 were collected from the First Affiliated Hospital of Shihezi University Medical College in Xinjiang.Based on whether abnormal uterine bleeding(AUB) happened after menopause,they were divided into AUB group and non-AUB group with 90 cases in each group to study the relationship between multiple clinical indicators and the pathological findings of endometrial disease within each group and between the two groups. Multivariate logistic regression analysis was performed to determine the independent risk factors in AUB group and the ROC curve was developed to determine the best predictive value for endometrial cancer screening among the female patients with menopausal endometrial thickening but without AUB.Results 1)The most common endometrial benign lesions in the AUB and non-AUB groups were all menopausal membrane(33.34% vs.48.90%),followed by endometrial polyps(17.78% vs.24.44%) and endometrial simple hyperplasia(14.44% vs. 17.78%).The incidence of endometrial cancer in the AUB group was significantly higher than that in the non-AUB group(χ^2=18.127,P<0.05).The incidence of postmenopausal intima in the AUB group was higher than that in the AUB group(χ^2=6.763,P<0.05).2)The mean intima thickness of patients in the AUB group was(10.01±5.69) mm,which was significantly higher than that of the patients without AUB(7.59±3.34) mm(t=17.516,P<0.05).3) Univariate analysis of AUB group found that Age≥60 years,menarche age≤12 years,menopause age≥50 years,having an infertility history were risk factors for endometrial malignant transformation in AUB group(χ^2=6.731,5.494,4.935,6.732,respectively,P<0.05 for all).The mean intima thickness of the malignant endometrium in the AUB group was significantly higher than that in the benign endometrium(t=-4.163,P<0.05).While patients with menopause years ≥25 years were less likely to develop endometrial cancer than patients with menopausal <25 years(χ^2=5.400,P<0.05);Multivariate analysis found that intimal thickness(OR=1.254,95%CI:1.094-1.436),age ≥60 years(OR=7.775,95%CI:1.550-39.003),menarche age ≤12 years(OR=6.123,95%CI:1.780-20.926) and menopausal years ≥25(OR=0.100,95%CI:0.011-0.881) were independent influencing factors of endometrial malignant transformation in patients with AUB(P<0.05 for all).4)In the group of non-AUB,only the mean intima thickness of patients with malignant lesions was higher than that of patient with benign lesions(t=-3.085,P<0.05).And no other statistical difference was found(P>0.05 for all).5) In the population with menopausal endometrial thickening but without AUB,the maximum point of the ROC curve was 9.50 mm,the maximum AUC was 0.808(95%CI:0.785-0.904,P<0.05).The sensitivity,specificity,positive predictive value,and negative predictive value were 75.00%,95.35%,42.85%,and 98.80%,respectively.Conclusion Most people undergoing with postmenopausal endometrial thickening without AUB,endometrial biopsy can prove that they have benign endometrial diseases.When the intima thickness is ≥9.50 mm,endometrial biopsy is recommended to exclude endometrial lesions.