背景:青少年月经大量出血(HMB),月经过多或异常子宫出血常见于青春期女性。鉴别诊断可能具有挑战性。肺炎:PALM-COEIN(息肉,子宫腺肌病,平滑肌瘤,恶性肿瘤和增生,凝血病,排卵障碍,子宫内膜,医源性,并且尚未分类),是常用的,但它不会对疾病的可能性进行分层。我们试图开发一种基于概率的青少年HMB鉴别诊断,月经过多或异常子宫出血。
方法:使用PubMed进行了全面的文献检索,EMBASE,和SCOPUS数据库。病例系列描述10-19岁患有HMB的青少年,月经过多或异常子宫出血是可以接受的,如果:超过10名患者被纳入;社论,病例报告,和次要来源,如评论文章,或书籍章节被排除在外。未使用语言筛选器,但是需要英文摘要。HMB的病因,月经过多或异常子宫出血,原产国是从符合纳入标准的物品中提取的。累积率估计值通过贝叶斯概率建模确定。
结果:详细回顾了17篇全文文章;包括2,770例患者。HMB最常见的原因是卵巢子宫疾病(23.7%;95%CredI22-25.5%),凝血障碍(19.4%;95%CredI17.8-21.1%),和血小板疾病(6.23%;95%CredI5.27-7.27%),45.9%(95%CredI43.8-47。%9)来源不确定的病例。
结论:健康青春期女性HMB的主要原因是多种多样的。子分析确定了不同的病因,这表明在评估HMB时必须考虑多种因素。而PALM-COEIN(息肉,子宫腺肌病,平滑肌瘤,恶性肿瘤和增生,凝血病,排卵障碍,子宫内膜,医源性,并且尚未分类)为我们提供了女性HMB可能原因的全面图片,这项系统评价为青少年女性HMB的病因分配了概率,为医生提供更加集中和有效的诊断途径。
BACKGROUND: Adolescent heavy menstrual bleeding(HMB), menorrhagia or abnormal uterine bleeding commonly occur in adolescent women. The differential diagnosis can be challenging. The pneumonic: PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified), is commonly used but it does not stratify as to the likelihood of a disorder. We have sought to develop a probability-based differential diagnosis for Adolescent HMB, menorrhagia or abnormal uterine bleeding.
METHODS: A comprehensive literature search was conducted using PubMed, EMBASE, and SCOPUS databases. Case series describing adolescents from 10-19 years of age with HMB, menorrhagia or abnormal uterine bleeding was acceptable if: more than 10 patients were included; editorials, case reports, and secondary sources such as
review articles, or book chapters were excluded. No language filter was used, but an English abstract was required. The etiology of HMB, menorrhagia or abnormal uterine bleeding, and the country of origin was extracted from articles that met inclusion criteria. Cumulative rate estimates were determined by Bayesian probability modeling.
RESULTS: Seventeen full text articles were reviewed in detail; 2,770 patients were included. The most frequent causes of HMB were Ovarian Uterine Disorders (23.7%; 95% CredI 22-25.5%), Coagulation Disorders (19.4%; 95% CredI 17.8-21.1%), and Platelet Disorders (6.23%; 95% CredI 5.27-7.27%) with 45.9% (95% CredI 43.8-47.%9) of the cases of indeterminate origin.
CONCLUSIONS: The leading causes of HMB in healthy adolescent females were varied. The sub-analysis identified distinct etiologies, suggesting that multiple factors must be considered in the evaluation of HMB. While PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) provides us with a comprehensive picture of the possible causes of HMB in females, this systematic
review assigns probabilities to the etiologies of HMB in adolescent females, providing physicians with a more focused and efficient pathway to diagnosis.