子宫内膜非典型增生的临床检验指标分析

Analysis of Clinical Examination Indicators of Endometrial Atypical Hyperplasia

目的 分析子宫内膜非典型增生(Endometrial Atypical Hyperplasia,EAH)的临床检验指标,寻找危险因素及诊断预测指标,为疾病的预防及筛查诊断提供新思路。方法 收集2020年6月至2021年12月于首都医科大学附属北京妇产医院妇科行宫腔镜治疗的211例患者的临床资料,EAH患者为研究组(n=107),宫腔粘连患者为对照组(n=104)。回顾性分析两组患者的妊娠次数、初潮年龄、体质指数(Body Mass Index,BMI)、实验室检验指标及子宫内膜厚度、子宫体积等项目,并探寻疾病相关危险因素及有效诊断预测指标。结果 研究组BMI、血小板计数、低密度脂蛋白胆固醇、子宫内膜厚度及子宫体积均高于对照组,差异有统计学意义(P<0.001);研究组甘油三酯高于对照组,差异有统计学意义(P<0.01);研究组国际标准比值(International Normalized Ratio,INR)及高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol,HDL-C)低于对照组,差异有统计学意义(P<0.001);研究组妊娠次数低于对照组,差异有统计学意义(P<0.05)。HDL-C、INR、子宫内膜厚度及子宫体积为EAH的独立危险因素(P<0.05),其中子宫内膜厚度危险性最大(OR=5.984)。子宫体积预测EAH的受试者工作特征曲线下面积为0.947(95%CI:0.912~0.982),优于子宫内膜厚度。结论 HDL-C、INR、子宫内膜厚度及子宫体积为EAH的独立危险因素,其中子宫内膜厚度危险性最大,而子宫体积对疾病预测有较好的临床意义。应在工作中提高对以上检验检查指标的重视,并对临床诊断截断值的确定进行深入研究,以利于疾病的快速筛查及预防。

Objective To analyze the clinical examination indicators for finding the risk factors and the prediction indicators of the endometrial atypical hyperplasia(EAH),and provide new ideas for treatment and prevention of this disease.Methods Clinical data of 211 patients who underwent hysteroscopy in the Department of Gynecology from June 2020 to December 2021 at Beijing Obstetrics and Gynecology Hospital,Capital Medical University were collected.Among them,107 patients with EAH were the study group and 104 patients with intrauterine adhesion were the control group.The number of pregnancies,menarche age,body mass index(BMI),laboratory test results,endometrial thickness and uterine volume and so on of the two groups were retrospectively analyzed,and to explore disease related risk factors and effective diagnostic predictive indicators.Results The values of BMI,platelet count,low density lipoprotein cholesterol,endometrial thickness and uterine volume in the study group were higher than those in the control group,and the difference was extremely significant(P<0.001).Triglyceride in study group was higher than in control group,and the difference was significant(P<0.01).International normalized ratio(INR)and high density lipoprotein cholesterol(HDL-C)in the study group were lower than those in the control group,and the difference was extremely significant(P<0.001).The number of pregnancies in the study group was lower than that in control group,and the difference was significant(P<0.05).HDL-C,INR,endometrial thickness and uterine volume were independent risk factors for EAH(P<0.05),the risk of endometrial thickness was the highest(OR=5.984).The area under receiver operating characteristic curve of uterine volume in predicting EAH was 0.947(95%CI:0.912-0.982),which was better than that of endometrial thickness.Conclusion HDL-C,INR,endometrial thickness and uterine volume are independent risk factors of EAH,and endometrial thickness has the greatest risk.Uterine volume is the best indicator for clinical significance in predicting EAH.We should pay more attention to those indicators and delve into diagnostic cutoff values in order to facilitate the rapid screening and prevention of EAH.