绝经后妇女子宫内膜增厚恶变的危险因素分析及风险预测

Risk factor analysis and risk prediction of malignant transformation among postmenopausal women with thickened endometrium

目的绝经后子宫内膜增厚恶变的危险因素尚不明确,本研究意在探讨其高危因素及风险预测,拟为临床诊治提供一定的参考依据。方法选取2013年1月至2019年1月浙江大学附属邵逸夫医院妇科诊治的529例宫腔镜治疗绝经后子宫内膜增厚病例进行回顾性分析。分析其恶变的高危因素。结果良性组357例,恶性组172例。单因素分析示:恶变组在绝经年龄、身高、体重指数(BMI)、产次、绝经后出血(PMB)、患糖尿病、患高血压和患乳腺癌方面与良性组比较,差异具有统计学意义(P<0.05);多因素非条件Logistic回归分析示:绝经后子宫内膜增厚恶变与PMB(OR=10.218);糖尿病(OR=2.267),肥胖(OR=2.322),身高(OR=0.926),乳腺癌(OR=3.469)相关,差异具有统计学意义(P<0.05)。结论绝经后子宫内膜增厚患者,若合并绝经后出血、糖尿病、肥胖、乳腺癌等高危因素,恶变概率高,建议尽早诊治。另外,身高也作为一项危险因素需纳入思考。

Objective To study the risk factors and risk prediction of endometrial hyperplasia and its malignant transformation,in order to provide some references for the clinical diagnosis and treatment.Methods Retrospective analysis was performed on 529 patients received hysteroscopic surgery due to postmenopausal endometrial hyperplasia,and the risk factors of malignant transformation were analyzed.Results There were 357 cases in the benign group and 172 cases in the malignant group.Univariate analysis showed that there were statistically significant differences in menopause age,height,body mass index(BMI),parity,postmenopausal bleeding(PMB),diabetes,hypertension and breast cancer between the two groups(P<0.05).Multivariate logistic regression analysis showed that postmenopausal endometrial hyperplasia and malignant transformation were positively correlated with PMB(OR=10.218),diabetes(OR=2.267),obesity(OR=1.656),height(OR=0.926)and breast cancer(OR=3.469)(P<0.05).Conclusions Endometrial hyperplasia in postmenopausal women have a high malignant transformation probability when it is combined with PMB,diabetes,obesity and breast cancer,so early diagnosis and treatment is recommended.Besides,height is also a risk factor that needs to be considered.