本文選題：子宮腺肌病　切入點(diǎn)：子宮內(nèi)膜息肉　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：子宮腺肌病是指子宮內(nèi)膜的腺體和間質(zhì)侵入子宮肌層局限或彌漫性的生長，達(dá)一個高倍視野以上，是一種內(nèi)在性的子宮內(nèi)膜異位。子宮腺肌病多發(fā)生于40歲以上的經(jīng)產(chǎn)婦，臨床主要表現(xiàn)為月經(jīng)量多或經(jīng)期延長（40%-50%）、逐漸進(jìn)性加劇的痛經(jīng)（25%）、不孕（1%-14%）等，約三分之一患者無任何臨床癥狀。近年來,國內(nèi)外文獻(xiàn)報告該病的發(fā)病率和診斷率呈明顯上升趨勢,但其臨床漏診率較高。子宮息肉按發(fā)病部位可分為子宮內(nèi)膜息肉和宮頸息肉，是引起異常子宮出血和不孕常見的原因之一。有關(guān)研究發(fā)現(xiàn)子宮腺肌病能在子宮內(nèi)膜水平上促進(jìn)生長因子的表達(dá)或改變雌激素相關(guān)基因（如Bcl-2）的表達(dá)，這些改變一方面能夠引起子宮息肉的生長，另一方面又可導(dǎo)致不孕。另有學(xué)者研究發(fā)現(xiàn)通過“組織損傷與修復(fù)”生理機(jī)制闡述子宮雌激素分泌及其靈敏度的增加與炎癥的關(guān)系，可以解釋子宮腺肌病與子宮息肉之間的相關(guān)性。 目的 探討子宮腺肌癥與子宮內(nèi)膜息肉或?qū)m頸息肉之間存在的相關(guān)性，深化對其臨床特點(diǎn)的認(rèn)識，從而提高臨床診斷率，為患者提供最佳的臨床治療。 材料與方法 回顧性分析2010年6月至2012年12月鄭州大學(xué)第三附屬醫(yī)院婦科所有經(jīng)宮腔鏡行子宮息肉切除、子宮肌瘤剔除、子宮內(nèi)膜電切、子宮內(nèi)膜活檢及診刮術(shù)的809例住院患者相關(guān)臨床資料。用SPSS統(tǒng)計軟件進(jìn)行單因素分析和多因素非條件logistic回歸分析。 統(tǒng)計學(xué)處理 應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計分析，所得數(shù)據(jù)均以x±s表示，計量資料單因素分析用t檢驗(yàn)，計數(shù)資料單因素分析用x2檢驗(yàn)，，影響因素采用非條件logistic回歸分析，檢驗(yàn)水準(zhǔn)均設(shè)為α=0.05。 結(jié)果 1、單因素分析發(fā)現(xiàn)子宮內(nèi)膜息肉患病與身體質(zhì)量指數(shù)(BMI)、肥胖、高血壓、子宮腺肌病有關(guān)（p＜0.05），其中，多發(fā)子宮內(nèi)膜息肉患病與BMI、年齡、肥胖、高血壓、子宮腺肌病有關(guān)（p＜0.05），單發(fā)子宮內(nèi)膜息肉患病與年齡、絕經(jīng)、高血壓、子宮腺肌病有關(guān)（p＜0.05）；宮頸息肉患病與BMI、子宮腺肌病有關(guān)（p＜0.05）。 2、logistic回歸分析結(jié)果顯示BMI、子宮腺肌病是子宮內(nèi)膜息肉和多發(fā)子宮內(nèi)膜息肉患病的危險因素（p＜0.05），高血壓、子宮腺肌病是單發(fā)子宮內(nèi)膜息肉患病的危險因素（p＜0.05），而宮頸息肉患病的危險因素只有子宮腺肌�。╬＜0.05）。 3、子宮腺肌病OR值均大于1，wals值均較高，可推測子宮腺肌病是與子宮息肉患病關(guān)系較密切且較穩(wěn)定的危險因素。 4、子宮腺肌病患者的血清CA125水平的通常不高，陽性率僅約8.5%，表示血清CA125在子宮腺肌病臨床診斷中的價值不高。 結(jié)論 子宮腺肌病可引起子宮內(nèi)膜息肉的生長，但與息肉生長的數(shù)量無確切相關(guān)性；子宮腺肌病是宮頸息肉的危險因素。子宮腺肌病是子宮息肉患病較為穩(wěn)定且密切的危險因素，其致病機(jī)制需進(jìn)一步研究。
[Abstract]:Adenomyosis refers to the localized or diffuse growth of the endometrial glands and stroma invading the myometrium, reaching a high power field of vision and is an intrinsic endometriosis. Adenomyosis occurs mostly in women over 40 years of age. The main clinical manifestations were as follows: more menstrual volume or prolonged menstrual period: 40-50m, progressive aggravation of dysmenorrhea, 25% of dysmenorrhea, 1% -14% of infertility, etc. About 1/3 patients did not have any clinical symptoms. In recent years, the incidence and diagnostic rate of the disease have been reported to be increasing significantly in domestic and foreign literature. However, the rate of clinical missed diagnosis is high. Uterine polyps can be divided into endometrial polyps and cervical polyps according to the location of the disease. Adenomyosis is one of the common causes of abnormal uterine bleeding and infertility. Adenomyosis can promote the expression of growth factor or alter the expression of estrogen related genes (such as Bcl-2) at the endometrial level. On the one hand, these changes can cause the growth of uterine polyps, on the other hand, they can lead to infertility. Other researchers have found that the physiological mechanism of "tissue damage and repair" illustrates the relationship between the increase of uterine estrogen secretion and its sensitivity and inflammation. This may explain the association between adenomyosis and uterine polyps. Purpose. To explore the relationship between adenomyosis and endometrial polyps or cervix polyps, to deepen the understanding of its clinical characteristics, so as to improve the clinical diagnosis rate and provide the best clinical treatment for patients. Materials and methods. From June 2010 to December 2012, all gynecological patients in the third affiliated Hospital of Zhengzhou University underwent hysteroscopic hysterectomy, uterine myomectomy and endometrial electrotomy. The clinical data of 809 inpatients with endometrial biopsy and curettage were analyzed by SPSS software and multivariate conditional logistic regression analysis. Statistical processing. The data are expressed as x 鹵s, t test is used for single factor analysis of metrological data, x 2 test is used for single factor analysis of counting data, and non conditional logistic regression analysis is used for influencing factors. The test level is set as 偽 0. 05. Results. 1. Univariate analysis showed that the prevalence of endometrial polyps was associated with BMI, obesity, hypertension and adenomyosis (P < 0.05), among which multiple endometrial polyps were associated with BMI, age, obesity and hypertension. The incidence of single endometrial polyps was associated with age, menopause, hypertension, adenomyosis (P < 0.05), and cervical polyps with BMIand adenomyosis (p < 0.05). 2logistic regression analysis showed that adenomyosis was the risk factor of endometrial polyps and multiple endometrial polyps (P < 0.05). Adenomyosis was the risk factor of single endometrial polyp (P < 0.05), but the risk factor of cervical polyp was only adenomyosis (p < 0.05). 3. The OR value of adenomyosis was higher than that of 1wals, which suggested that adenomyosis was a more stable risk factor associated with the incidence of uterine polyps. 4. The level of serum CA125 in patients with adenomyosis is usually not high, and the positive rate is only about 8.5%, indicating that the value of serum CA125 in the clinical diagnosis of adenomyosis is not high. Conclusion. Adenomyosis can cause the growth of endometrial polyps, but it has no definite correlation with the number of polyps. Adenomyosis is the risk factor of cervical polyps, and adenomyosis is a stable and close risk factor for the development of uterine polyps. The pathogenetic mechanism needs further study.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71

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