本文選題：子宮內膜息肉　切入點：胰島素　出處：《鄭州大學》2017年碩士論文

【摘要】：目的通過對子宮內膜息肉組(EP組)與非子宮內膜息肉組(非EP組)的胰島素抵抗相關的臨床指標進行病例對照分析,探究子宮內膜息肉的發(fā)生與胰島素抵抗的關系,進一步篩選其發(fā)病危險因素,為臨床上子宮內膜息肉的預防、監(jiān)測及治療提供了新思路、新方法。材料及方法選自2015年6月到2016年3月在鄭州大學第三附屬醫(yī)院(即河南省婦幼保健院)婦科就診的異常子宮出血、絕經后子宮出血、不孕癥和宮腔異�；芈暬颊咦鳛檠芯繉ο�,均行宮腔鏡檢查。EP組120例為病例組。入選標準:陰道三維彩超結果高度懷疑子宮內膜息肉(EP),和(或)經宮腔鏡檢查并組織學證實為EP者;不合并子宮內膜癌或其他腫瘤病史;無卵巢切除史;無嚴重內科合并癥或其他器質性病變。非EP組120例為對照組。入選標準:行宮腹聯(lián)合手術或宮腔鏡檢查確診無子宮內膜息肉患者;半年內未行子宮內膜息肉手術;不合并子宮內膜癌或其他腫瘤病史;無卵巢切除史;無嚴重內科合并癥或其他器質性病變。用SPSS 21.0軟件進行統(tǒng)計學處理。正態(tài)分布的計量資料用((?)±S)表示,兩獨立樣本的t檢驗;分類資料的比較用χ2檢驗;關聯(lián)分析用Pearsonχ2檢驗;應用二元多因素Logistic回歸分析篩選統(tǒng)計學上子宮內膜息肉發(fā)病危險因素。以α=0.05為檢驗水準。結果1.EP組患者中單發(fā)性息肉與多發(fā)性息肉分別占34.17%和65.83%。2.本文分析得出EP組與非EP組在年齡、BMI方面差異無統(tǒng)計學意義(P均0.05)。EP組在胰島素抵抗指數、空腹胰島素、胰島素120分鐘、服糖后1小時、2小時、3小時血糖、總膽固醇及腰圍明顯高于非EP組,差異均有統(tǒng)計學意義(P均0.05);而性激素六項水平及甘油三脂、高密度脂蛋白、低密度脂蛋白水平在兩組中差異無統(tǒng)計學意義(P0.05)。3.EP組與非EP組中胰島素抵抗者分別占60.83%和27.50%,腹型肥胖者分別為40.83%和22.50%,絕經者占15.83%和7.50%,差異均有統(tǒng)計學意義(χ2=27.035,P0.001;χ2=9.320,P=0.002;χ2=4.043,P=0.044);而高血壓、糖尿病患者在兩組中差異無統(tǒng)計學意義(P均0.05)。關聯(lián)性分析得出胰島素抵抗、腹型肥胖與EP發(fā)生呈正相關(r=0.318,r=0.515)。4.多因素邏輯回歸分析得出胰島素抵抗、絕經及HOMA-IR2.69的OR值均大于1,95%CI下限值均大于1,說明胰島素抵抗、絕經及HOMA-IR2.69是EP發(fā)病的危險因素。結論1.多發(fā)性息肉在子宮內膜息肉的發(fā)病中居多。2.胰島素抵抗、腹型肥胖與子宮內膜息肉發(fā)生正相關。3.胰島素抵抗、絕經及HOMA-IR≥2.69是子宮內膜息肉發(fā)病的危險因素。
[Abstract]:Objective to investigate the relationship between the occurrence of endometrial polyps and insulin resistance through case-control analysis of insulin resistance in endometrium polyp group (EP group) and non-endometrial polyp group (non-EP group).Further screening the risk factors of endometrial polyps provides a new idea and method for clinical prevention, monitoring and treatment of endometrial polyps.Materials and methods patients with abnormal uterine bleeding, postmenopausal uterine bleeding, infertility and abnormal echo of uterine cavity were selected from June 2015 to March 2016 in the third affiliated Hospital of Zhengzhou University (Henan Maternal and Child Health Hospital).All cases were examined by hysteroscopy. 120 cases in group EP were treated with hysteroscopy.Criteria for inclusion: highly suspected EPU of endometrial polyps and / or histologically proved EP by hysteroscopy; no history of endometrial carcinoma or other tumors; no history of ovariectomies;No serious medical complications or other organic diseases.120 cases in non-EP group were used as control group.Inclusion criteria: abdominal surgery or hysteroscopy to confirm the absence of endometrial polyps; no endometrial polyp surgery within six months; no history of endometrial carcinoma or other tumors; no history of ovariectomies;No serious medical complications or other organic diseases.SPSS 21. 0 software was used for statistical processing.T test for two independent samples, 蠂 2 test for classification data, Pearson 蠂 2 test for association analysis, and binary multivariate Logistic regression analysis were used to screen statistical risk factors for endometrial polyps.The test level was 偽 -0. 05.Results in 1.EP group, single polyp and multiple polyp accounted for 34.17% and 65.83%, respectively.The results showed that there was no significant difference in age and BMI between EP group and non-EP group. There were no significant differences in insulin resistance index, fasting insulin, insulin 120min, blood glucose for 1 hour and 2 hours after taking glucose in 0.05).EP group.Total cholesterol and waist circumference were significantly higher than those of non-EP group (P < 0.05), while the levels of sex hormone, triglyceride, high density lipoprotein (HDL), triglyceride (TG), high density lipoprotein (HDL) were significantly higher than those in non-EP group.There was no significant difference between the two groups in diabetes mellitus (P < 0.05).The correlation analysis showed that insulin resistance, abdominal obesity and EP were positively correlated with the incidence of EP.Multivariate logistic regression analysis showed that the OR values of menopause and HOMA-IR2.69 were all greater than 1, indicating that insulin resistance, menopause and HOMA-IR2.69 were risk factors of EP.Conclusion 1.Multiple polyps are most common in endometrial polyps.Insulin resistance, abdominal obesity and endometrial polyps were positively correlated.Insulin resistance, menopause and HOMA-IR 鈮，

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