子宫息肉与子宫腺肌病的相关性分析

发布时间：2018-03-21 14:28

本文选题：子宫腺肌病　切入点：子宫内膜息肉　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：子宫腺肌病是指子宫内膜的腺体和间质侵入子宫肌层局限或弥漫性的生长，达一个高倍视野以上，是一种内在性的子宫内膜异位。子宫腺肌病多发生于40岁以上的经产妇，临床主要表现为月经量多或经期延长（40%-50%）、逐渐进性加剧的痛经（25%）、不孕（1%-14%）等，约三分之一患者无任何临床症状。近年来,国内外文献报告该病的发病率和诊断率呈明显上升趋势,但其临床漏诊率较高。子宫息肉按发病部位可分为子宫内膜息肉和宫颈息肉，是引起异常子宫出血和不孕常见的原因之一。有关研究发现子宫腺肌病能在子宫内膜水平上促进生长因子的表达或改变雌激素相关基因（如Bcl-2）的表达，这些改变一方面能够引起子宫息肉的生长，另一方面又可导致不孕。另有学者研究发现通过“组织损伤与修复”生理机制阐述子宫雌激素分泌及其灵敏度的增加与炎症的关系，可以解释子宫腺肌病与子宫息肉之间的相关性。目的探讨子宫腺肌症与子宫内膜息肉或宫颈息肉之间存在的相关性，深化对其临床特点的认识，从而提高临床诊断率，为患者提供最佳的临床治疗。材料与方法回顾性分析2010年6月至2012年12月郑州大学第三附属医院妇科所有经宫腔镜行子宫息肉切除、子宫肌瘤剔除、子宫内膜电切、子宫内膜活检及诊刮术的809例住院患者相关临床资料。用SPSS统计软件进行单因素分析和多因素非条件logistic回归分析。统计学处理应用SPSS17.0软件进行统计分析，所得数据均以x±s表示，计量资料单因素分析用t检验，计数资料单因素分析用x2检验，，影响因素采用非条件logistic回归分析，检验水准均设为α=0.05。结果 1、单因素分析发现子宫内膜息肉患病与身体质量指数(BMI)、肥胖、高血压、子宫腺肌病有关（p＜0.05），其中，多发子宫内膜息肉患病与BMI、年龄、肥胖、高血压、子宫腺肌病有关（p＜0.05），单发子宫内膜息肉患病与年龄、绝经、高血压、子宫腺肌病有关（p＜0.05）；宫颈息肉患病与BMI、子宫腺肌病有关（p＜0.05）。 2、logistic回归分析结果显示BMI、子宫腺肌病是子宫内膜息肉和多发子宫内膜息肉患病的危险因素（p＜0.05），高血压、子宫腺肌病是单发子宫内膜息肉患病的危险因素（p＜0.05），而宫颈息肉患病的危险因素只有子宫腺肌病（p＜0.05）。 3、子宫腺肌病OR值均大于1，wals值均较高，可推测子宫腺肌病是与子宫息肉患病关系较密切且较稳定的危险因素。 4、子宫腺肌病患者的血清CA125水平的通常不高，阳性率仅约8.5%，表示血清CA125在子宫腺肌病临床诊断中的价值不高。结论子宫腺肌病可引起子宫内膜息肉的生长，但与息肉生长的数量无确切相关性；子宫腺肌病是宫颈息肉的危险因素。子宫腺肌病是子宫息肉患病较为稳定且密切的危险因素，其致病机制需进一步研究。
[Abstract]:Adenomyosis refers to the localized or diffuse growth of the endometrial glands and stroma invading the myometrium, reaching a high power field of vision and is an intrinsic endometriosis. Adenomyosis occurs mostly in women over 40 years of age. The main clinical manifestations were as follows: more menstrual volume or prolonged menstrual period: 40-50m, progressive aggravation of dysmenorrhea, 25% of dysmenorrhea, 1% -14% of infertility, etc. About 1/3 patients did not have any clinical symptoms. In recent years, the incidence and diagnostic rate of the disease have been reported to be increasing significantly in domestic and foreign literature. However, the rate of clinical missed diagnosis is high. Uterine polyps can be divided into endometrial polyps and cervical polyps according to the location of the disease. Adenomyosis is one of the common causes of abnormal uterine bleeding and infertility. Adenomyosis can promote the expression of growth factor or alter the expression of estrogen related genes (such as Bcl-2) at the endometrial level. On the one hand, these changes can cause the growth of uterine polyps, on the other hand, they can lead to infertility. Other researchers have found that the physiological mechanism of "tissue damage and repair" illustrates the relationship between the increase of uterine estrogen secretion and its sensitivity and inflammation. This may explain the association between adenomyosis and uterine polyps. Purpose. To explore the relationship between adenomyosis and endometrial polyps or cervix polyps, to deepen the understanding of its clinical characteristics, so as to improve the clinical diagnosis rate and provide the best clinical treatment for patients. Materials and methods. From June 2010 to December 2012, all gynecological patients in the third affiliated Hospital of Zhengzhou University underwent hysteroscopic hysterectomy, uterine myomectomy and endometrial electrotomy. The clinical data of 809 inpatients with endometrial biopsy and curettage were analyzed by SPSS software and multivariate conditional logistic regression analysis. Statistical processing. The data are expressed as x 卤s, t test is used for single factor analysis of metrological data, x 2 test is used for single factor analysis of counting data, and non conditional logistic regression analysis is used for influencing factors. The test level is set as 伪 0. 05. Results. 1. Univariate analysis showed that the prevalence of endometrial polyps was associated with BMI, obesity, hypertension and adenomyosis (P < 0.05), among which multiple endometrial polyps were associated with BMI, age, obesity and hypertension. The incidence of single endometrial polyps was associated with age, menopause, hypertension, adenomyosis (P < 0.05), and cervical polyps with BMIand adenomyosis (p < 0.05). 2logistic regression analysis showed that adenomyosis was the risk factor of endometrial polyps and multiple endometrial polyps (P < 0.05). Adenomyosis was the risk factor of single endometrial polyp (P < 0.05), but the risk factor of cervical polyp was only adenomyosis (p < 0.05). 3. The OR value of adenomyosis was higher than that of 1wals, which suggested that adenomyosis was a more stable risk factor associated with the incidence of uterine polyps. 4. The level of serum CA125 in patients with adenomyosis is usually not high, and the positive rate is only about 8.5%, indicating that the value of serum CA125 in the clinical diagnosis of adenomyosis is not high. Conclusion. Adenomyosis can cause the growth of endometrial polyps, but it has no definite correlation with the number of polyps. Adenomyosis is the risk factor of cervical polyps, and adenomyosis is a stable and close risk factor for the development of uterine polyps. The pathogenetic mechanism needs further study.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

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