目的:探讨异常子宫出血(AUB)患者子宫内膜病变的危险因素,建立区分不同子宫内膜AUB病因的预测模型。
方法:我们在接受超声检查和子宫内膜组织病理学检查的连续778名AUB女性中进行了这项横断面研究。建立模型来区分正常子宫内膜和(1)子宫内膜病变,(2)子宫内膜息肉,(3)子宫内膜增生无异型,(4)子宫内膜不典型增生和子宫内膜癌。
结果:274例(35.2%)子宫内膜正常,504例(64.8%)子宫内膜病变,包括337(43.3%)子宫内膜息肉,139(17.9%)子宫内膜增生无异型,28例(3.6%)子宫内膜不典型增生和子宫内膜癌。年龄(OR=1.122,95CI1.002-1.257,P<0.001),ET(子宫内膜厚度,OR=2.702,95CI1.629-4.402,P<0.001),CA125(U/ml)(OR=1.007,95CI1.003~1.021,P<0.001)是AUB女性子宫内膜病变的独立危险因素。BMI(OR=1.109,95CI1.067-1.433,P=0.038),ET(OR=20.741,95CI16.136-98.842,P<0.001),年龄(OR=1.182,95CI1.031-1.433,P=0.016)、CA125(U/ml)(OR=1.690,95CI1.506-1.929,P=0.001),高血压(OR=1.350,95CI1.051~67.82,P=0.014)和糖尿病(OR=1.108,95CI1.008~20.194,P=0.001)是AUB患者不典型增生和子宫内膜癌的独立危险因素。我们建立的模型可以预测不典型增生和子宫内膜癌,灵敏度为87.5%。特异性为80.7%,AUC为0.921。
结论:在患有AUB的女性中,基于年龄的新模型,BMI,子宫内膜厚度,高血压,糖尿病和CA125可以区分不典型增生,子宫内膜癌和正常女性。该模型可用于AUB的管理。
OBJECTIVE: To explore the risk factors of endometrial lesions in patients with abnormal uterine bleeding(AUB) and establish prediction models which can discriminate between different endometrial etiologies of AUB.
METHODS: We conducted this cross-sectional study in consecutive 778 women with AUB who received ultrasound examination and endometrial histopathological examination. Models were developed to distinguish between normal endometrium and (1) endometrial lesions, (2) endometrial polyps, (3) endometrial hyperplasia without atypia, (4) endometrial atypical hyperplasia and endometrial carcinoma.
RESULTS: 274 (35.2%) women had normal endometrium; 504 (64.8%) had endometrial lesions, including 337(43.3%) endometrial polyps, 139(17.9%) endometrial hyperplasia without atypia, 28(3.6%) endometrial atypical hyperplasia and endometrial carcinoma. Age (OR = 1.122, 95%CI 1.002-1.257, P < 0.001), ET (endometrial thickness, OR = 2.702, 95%CI 1.629-4.402, P < 0.001), and CA125(U/ml) (OR = 1.007, 95%CI 1.003-1.021, P < 0.001) are independent risk factors of endometrial lesions in women with AUB. BMI(OR = 1.109, 95%CI 1.067-1.433,P = 0.038), ET(OR = 20.741, 95%CI 16.136-98.842, P < 0.001), age(OR = 1.182, 95%CI1.031-1.433,P = 0.016)、CA125(U/ml) (OR = 1.690, 95%CI 1.506-1.929,P = 0.001), prevalence of hypertension(OR = 1.350, 95%CI 1.051-67.82, P = 0.014) and diabetes(OR = 1.108, 95%CI 1.008-20.194,P = 0.001) were independent risk factors for atypical hyperplasia and endometrial carcinoma in patients with AUB. The model we built could predict atypical hyperplasia and endometrial carcinoma with the sensitivity of 87.5%, specificity of 80.7% and the AUC of 0.921.
CONCLUSIONS: In women with AUB, the new-built model based on age, BMI, endometrial thickness, hypertension, diabetes and CA125 could discriminate reliable between atypical hyperplasia, endometrial carcinoma and normal women. The model may be useful for management of AUB.