【摘要】：[目的]通過對子宮內(nèi)膜息肉(EPs)患者的回顧性分析研究,探討子宮內(nèi)膜息肉發(fā)病的相關(guān)高危因素,為子宮內(nèi)膜息肉的一級預防及早期防治提供臨床依據(jù)。[方法]選取2014年9月至2016年9月就診于昆明市延安醫(yī)院婦科,經(jīng)陰道超聲檢查考慮子宮內(nèi)膜息肉行宮腔鏡下子宮內(nèi)膜息肉摘除術(shù)及診斷性刮宮術(shù)患者603例,進行回顧性分析,術(shù)后病檢確診為子宮內(nèi)膜息肉的415例患者納入病例組,術(shù)后病檢診斷為非子宮內(nèi)膜息肉良性的188例患者納入對照組。統(tǒng)計患者所有臨床資料,包括年齡、生育史、絕經(jīng)與否、絕經(jīng)年限、婦科合并癥(子宮腺肌癥、子宮肌瘤、子宮內(nèi)膜異位癥、宮頸息肉、息肉復發(fā))、避孕情況(具有子宮內(nèi)避孕裝置、口服避孕藥)、內(nèi)科合并癥(高血壓、糖尿病、高脂血癥、肥胖、免疫系統(tǒng)疾病)等情況。采用SPSS 22.0軟件進行數(shù)據(jù)處理,計數(shù)資料采用獨立樣本X2檢驗,計量資料采用獨立樣本t檢驗,多因素病因分析采用二元Logistic回歸分析。[結(jié)果]①年齡分布:EPs多發(fā)于30-49歲婦女,絕經(jīng)后EPs的發(fā)病率降低。病例組415例,平均年齡41.34±8.59歲,其中絕經(jīng)患者30例,平均絕經(jīng)年限7.23士5.84年;對照組188例,平均年齡43.21±10.65歲,其中絕經(jīng)患者38例,平均絕經(jīng)年限6.24±6.76年。②臨床表現(xiàn):病例組222例(53.49%)患者無明顯臨床癥狀,193例(46.51%) 伴有相應臨床癥狀;對照組85例(45.21%)患者無明顯臨床癥狀,103例(54.79%)伴有相應臨床癥狀。③單因素分析結(jié)果顯示:年齡、宮頸息肉、既往患有子宮內(nèi)膜息肉、高血壓、糖尿病、炎癥、肥胖(P0.05,差異有統(tǒng)計學意義)是子宮內(nèi)膜息肉發(fā)病的危險因素,絕經(jīng)、患有免疫系統(tǒng)疾病(P0.05,差異有統(tǒng)計學意義)是子宮內(nèi)膜息肉的保護因素。④進行多因素Logistic回歸分析,高血壓(OR 為 3.798, 95%CI 為 1.401 ～10.294, P0.01 )、宮頸息肉(OR 為 2.226,95%CI為1.039～4.768, P0.05)是子宮內(nèi)膜息肉患病的相關(guān)危險因素,絕經(jīng)(OR為0.311, 95%CI為0.163-0.593, P0.01)是子宮內(nèi)膜息肉患病的保護因素。[結(jié)論]子宮內(nèi)膜息肉好于30-49歲婦女,絕經(jīng)后EPs的發(fā)病率降低,53.49%患者無明顯臨床癥狀,有癥狀的子宮內(nèi)膜息肉患者常伴有月經(jīng)的改變;經(jīng)陰道超聲對診斷子宮內(nèi)膜息肉有較高的準確率,可應用于EPs疾病的初篩。高血壓、宮頸息肉是子宮內(nèi)膜息肉患病的相關(guān)危險因素,絕經(jīng)是子宮內(nèi)膜息肉患病的保護因素。年齡、不孕、子宮腺肌癥、子宮肌瘤、子宮內(nèi)膜異位癥、息肉復發(fā)、糖尿病、高脂血癥、肥胖、具有子宮內(nèi)避孕裝置(普通子宮內(nèi)避孕裝置,除外LNG-IUS)、子宮內(nèi)膜炎癥是子宮內(nèi)膜息肉發(fā)病的可能危險因素,下一步將擴大樣本量,進行前瞻性的研究,以明確子宮內(nèi)膜息肉患病的危險因素。
[Abstract]:[objective] to study the risk factors of endometrial polyps in patients with (EPs), and to provide clinical basis for primary prevention and early prevention of endometrial polyps. [methods] 603 patients with endometrial polyps undergoing hysteroscopy and hysteroscopic curettage were selected from September 2014 to September 2016 in Yan'an Hospital of Kunming City. 415 cases of endometrial polyps diagnosed by postoperative pathological examination were included in the case group, and 188 cases of benign non-endometrial polyps were included in the control group. All clinical data including age, reproductive history, menopause, gynecological complications (adenomyosis, uterine leiomyoma, endometriosis, cervical polyp, polyp recurrence), Contraception (with intrauterine devices, oral contraceptive), medical complications (hypertension, diabetes, hyperlipidemia, obesity, immune system diseases) and so on. The data were processed by SPSS 22.0 software. The counting data were analyzed by independent sample X 2 test, the measurement data by independent sample t test, and the multifactor etiology analysis by binary Logistic regression analysis. [results] 1 Age distribution: EPs mainly occurred in 30-49 years old women, the incidence of EPs decreased after menopause. There were 415 cases in the case group with an average age of 41.34 鹵8.59 years. Among them, 30 cases were postmenopausal patients with an average menopausal age of 7.23 鹵5.84 years. 188 cases (mean age 43.21 鹵10.65 years) in the control group, 38 cases were menopausal patients, and the mean menopausal age was 6.24 鹵6.76 years. 2 Clinical manifestations: 222 cases (53.49%) in the case group had no obvious clinical symptoms. 193 cases (46.51%) were accompanied with corresponding clinical symptoms. In the control group, 85 cases (45.21%) had no obvious clinical symptoms, 103 cases (54.79%) had corresponding clinical symptoms. 3 the results of univariate analysis showed that: age, cervical polyps, previous endometrial polyps, hypertension, diabetes mellitus. Inflammation, obesity (P0.05, the difference is statistically significant) is a risk factor for the development of endometrial polyps, menopause, with immune system diseases (P0.05, P0.05. The difference was statistically significant. (4) Multivariate Logistic regression analysis showed that hypertension (OR = 3.798, 95%CI = 1.401 ~ 10.294, P0.01). Cervix polyp (OR = 2.226) (CI = 1.039 ~ 4.768, P0.05) was a risk factor for endometrial polyps, and menopause (OR = 0.311, 95%CI = 0.163-0.593). P0.01) is a protective factor for endometrial polyps. [conclusion] endometrial polyps are better than women aged 30-49 years. The incidence of EPs in postmenopausal women is lower, 53.49% of them have no obvious clinical symptoms, and the patients with symptomatic endometrial polyps often have menstrual changes. Transvaginal ultrasound has a high accuracy in the diagnosis of endometrial polyps and can be used in the screening of EPs disease. Hypertension and cervical polyps are risk factors for endometrial polyps and menopause is the protective factor for endometrial polyps. Age, infertility, adenomyosis, uterine leiomyoma, endometriosis, recurrence of polyps, diabetes, hyperlipidemia, obesity, having an intrauterine contraceptive device (other than LNG-IUS), Endometrial inflammation is a possible risk factor for the development of endometrial polyps. The next step is to expand the sample size and carry out prospective studies to identify the risk factors of endometrial polyps.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.74

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