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目的探讨代谢综合征(MS)患者子宫内膜病理状态与其内分泌代谢改变的关系。方法采用回顾性对照研究,将41例因异常子宫出血行诊断性刮宫+子宫内膜活检的MS患者的子宫内膜病理分为A组(异常组,包括子宫内膜息肉、单纯性增生、复杂性增生、不典型增生及内膜癌)及B组(正常组,包括子宫内膜增生期及分泌期),比较2组子宫内膜病理形态与体质量指数(BMI)、腰围、高血压、性激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)]、空腹血糖、甘油三酯(TG)、高密度脂蛋白(HDL)、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)的关系。结果 41例MS患者中,无排卵型内膜占93%(38/41),子宫内膜息肉7%(3/41),单纯性增生39%(16/41),复杂性增生7%(3/41),不典型增生7%(3/41),子宫内膜癌12%(5/41);A组的BMI、腰围、T、空腹血糖、TG、空腹胰岛素的水平、HOMA-IR、高血压的发生率高于B组,差异有统计学意义(P<0.05),A组的HDL水平低于B组,差异有统计学意义(P<0.05),2组的FSH、LH、E2水平差异无统计学意义(P>0.05)。结论半数以上异常出血的MS患者子宫内膜呈不同程度的增生改变,甚至少部分已经癌变,可能与长期持续的单一雌激素刺激、高雄激素血症、胰岛素抵抗-高胰岛素血症相关,临床上对MS患者应进行早期的干预,从而降低子宫内膜病变的发生率。
Objective To investigate the relationship between endometrial pathology and endocrine and metabolic changes in patients with metabolic syndrome (MS). Methods A retrospective controlled study was conducted in 41 patients with MS who underwent diagnostic curettage and endometrial biopsy due to abnormal uterine bleeding. The endometrial pathology was divided into group A (abnormal group, including endometrial polyps, simple hyperplasia, complicated Dysplasia, atypical hyperplasia and endometrial carcinoma) and group B (normal group, including endometrial hyperplasia and secretory phase). The pathological changes of the endometrium of the two groups were compared with BMI, waist circumference, hypertension, Sex hormones such as follicle stimulating hormone (FSH, LH, estradiol, testosterone), fasting blood glucose, triglyceride (TG), high density lipoprotein (HDL), fasting insulin, Insulin Resistance Index (HOMA-IR) relationship. Results Among the 41 MS patients, the anovulatory endometrium was 93% (38/41), the endometrial polyp was 7% (3/41), the simple hyperplasia was 39% (16/41) and the complex hyperplasia was 7% (BMI, waist circumference, T, fasting blood glucose, TG, fasting insulin, HOMA-IR) in group A were significantly higher than those in group A (P <0.05). The HDL level in group A was lower than that in group B, the difference was statistically significant (P <0.05). The levels of FSH, LH, E2 level difference was not statistically significant (P> 0.05). Conclusion More than half of abnormal MS patients with abnormal hemorrhage showed different degree of proliferative endometrium or even some of them have been cancerous, which may be related to long-term single estrogen stimulation, hyperandrogenism and insulin resistance-hyperinsulinemia. Clinically MS patients should be carried out early intervention, thereby reducing the incidence of endometrial lesions.