多囊卵巢综合征患者并发子宫内膜增生症的临床研究

目的:探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者并发子宫内膜增生症(endometrial hyperplasia,EH)的患病率、病理类型、高危因素及超声检查在筛查该并发症的作用和临床转归。方法:根据是否合并EH将440例PCOS患者分为组1(合并EH组,n=18)和组2(非EH组,n=422),比较2组的一般特征、月经失调的类型、超声指标、生殖内分泌激素和糖代谢,随访治疗后子宫内膜的病理改变。结果:PCOS患者并发EH的发病率为4.1%,简单型和复杂型17例(94.44%),不典型1例(5.45%);月经失调类型中,表现为功血者发生EH的风险大于其它类型月经失调(P<0.01,拟然比为21.47),表现为月经稀发继发闭经者发生EH的风险小于其它类型月经失调(P<0.05,拟然比6.282)。组1的年龄及相应病程大于组2(28.82±6.80岁vs23.05±5.32岁,12.42±7.13年vs7.28±5.65年,P<0.01);组1的子宫内膜厚度大于组2(11.75±4.77mmvs7.72±3.14mm,P<0.01),组1子宫内膜异常回声高于组2(100%vs0.47%,P<0.01),子宫动脉的搏动指数和阻力指数低于组2(1.68±0.54vs2.85±1.98,0.77±0.08vs0.88±0.27,P<0.01);两组FSH、LH、LH/FSH、总睾酮和游离雄激素指数的差别没有统计学意义,但组1的性激素结合蛋白低于组2(82.94±41.80mmol/Lvs128.17±117.21mmol/L,P<0.01);两组空腹胰岛素、胰岛素释放试验的曲线下面积、空腹血糖、葡萄糖耐量试验的曲线下面积和稳态模型的胰岛素抵抗指数的差异无统计学意义(P>0.05);治疗后子宫内膜均转化为正常。结论:PCOS患者合并EH的临床转归良好,超声检查在PCOS患者并发EH筛查中有重要作用。

The clinical study of polycystic ovary syndrome complicated with endometrial hyperplasia

Objective:To investigate the incidence,pathological subtype,high risk factors,ultrasonographic examination,clinical outcome of polycystic ovary syndrome(PCOS) complicated with endometrial hyperplasia(EH).Method:Four hundred and forty cases with PCOS were divided into group 1(18 cases complicated with endometrial hyperplasia) and group 2(422 cases without EH).The general characteristic,menstrual history,ultrasonographically indicators,endocrinological parameters,lipid and glucose profiles were compared between two groups.Result:The incidence of Chinese PCOS women complicated with EH was 4.1%,94.44% with simple and/or complex,5.45% with atypia.PCOS who experience symptom of dysfunctional uterine bleeding was more likely to complicated with EH(P<0.01,likelyhood 21.47),while oligomemorrhea second with amenorrhea was on the other hand(P<0.05,likelyhood 6.282).Old age,long history of irregular menstrual cycles,heavy thickness of endometrium,abnormal ultrasonographical estimation of endometrium,low pulse index and resistant index of uterus arteria were existed in group 1 compared with group 2(28.82±6.80 vs 23.05±5.32,12.42±7.13 vs 7.28±5.65 year,11.75±4.77 vs 7.72±3.14mm,100% vs 0.47%,1.68±0.54 vs 2.85±1.98,0.77±0.08 vs 0.88±0.27,respectivelly,P<0.01).There was no statistically difference in LH,LH/FSH ratio,total testosterone and free androgen index(P>0.05),though sexual hormone binding globulin was lower in group 1(82.94±41.80 vs 128.17±117.21 mmol/L,P<0.01).Also no statistically difference were found in fasting plasm insulin and insulin area under curve,fasting plasm glucose and glucose area under curve,the HOMA-IR between two groups.The hyperplasia endometrium were change to normal after therapy.Conclusion:Compared with women without EH,PCOS patient with EH has a good outcome measured by clinical prognosis.Ultrasonographically examination has an important role in predicting EH in PCOS.