子宫内膜息肉患者的胰岛素抵抗状态及其发病危险因素分析

发布时间：2018-04-05 21:38

  本文选题：子宫内膜息肉　切入点：胰岛素　出处：《郑州大学》2017年硕士论文

【摘要】：目的通过对子宫内膜息肉组(EP组)与非子宫内膜息肉组(非EP组)的胰岛素抵抗相关的临床指标进行病例对照分析,探究子宫内膜息肉的发生与胰岛素抵抗的关系,进一步筛选其发病危险因素,为临床上子宫内膜息肉的预防、监测及治疗提供了新思路、新方法。材料及方法选自2015年6月到2016年3月在郑州大学第三附属医院(即河南省妇幼保健院)妇科就诊的异常子宫出血、绝经后子宫出血、不孕症和宫腔异常回声患者作为研究对象,均行宫腔镜检查。EP组120例为病例组。入选标准:阴道三维彩超结果高度怀疑子宫内膜息肉(EP),和(或)经宫腔镜检查并组织学证实为EP者;不合并子宫内膜癌或其他肿瘤病史;无卵巢切除史;无严重内科合并症或其他器质性病变。非EP组120例为对照组。入选标准:行宫腹联合手术或宫腔镜检查确诊无子宫内膜息肉患者;半年内未行子宫内膜息肉手术;不合并子宫内膜癌或其他肿瘤病史;无卵巢切除史;无严重内科合并症或其他器质性病变。用SPSS 21.0软件进行统计学处理。正态分布的计量资料用((?)±S)表示,两独立样本的t检验;分类资料的比较用χ2检验;关联分析用Pearsonχ2检验;应用二元多因素Logistic回归分析筛选统计学上子宫内膜息肉发病危险因素。以α=0.05为检验水准。结果1.EP组患者中单发性息肉与多发性息肉分别占34.17%和65.83%。2.本文分析得出EP组与非EP组在年龄、BMI方面差异无统计学意义(P均0.05)。EP组在胰岛素抵抗指数、空腹胰岛素、胰岛素120分钟、服糖后1小时、2小时、3小时血糖、总胆固醇及腰围明显高于非EP组,差异均有统计学意义(P均0.05);而性激素六项水平及甘油三脂、高密度脂蛋白、低密度脂蛋白水平在两组中差异无统计学意义(P0.05)。3.EP组与非EP组中胰岛素抵抗者分别占60.83%和27.50%,腹型肥胖者分别为40.83%和22.50%,绝经者占15.83%和7.50%,差异均有统计学意义(χ2=27.035,P0.001;χ2=9.320,P=0.002;χ2=4.043,P=0.044);而高血压、糖尿病患者在两组中差异无统计学意义(P均0.05)。关联性分析得出胰岛素抵抗、腹型肥胖与EP发生呈正相关(r=0.318,r=0.515)。4.多因素逻辑回归分析得出胰岛素抵抗、绝经及HOMA-IR2.69的OR值均大于1,95%CI下限值均大于1,说明胰岛素抵抗、绝经及HOMA-IR2.69是EP发病的危险因素。结论1.多发性息肉在子宫内膜息肉的发病中居多。2.胰岛素抵抗、腹型肥胖与子宫内膜息肉发生正相关。3.胰岛素抵抗、绝经及HOMA-IR≥2.69是子宫内膜息肉发病的危险因素。
[Abstract]:Objective to investigate the relationship between the occurrence of endometrial polyps and insulin resistance through case-control analysis of insulin resistance in endometrium polyp group (EP group) and non-endometrial polyp group (non-EP group).Further screening the risk factors of endometrial polyps provides a new idea and method for clinical prevention, monitoring and treatment of endometrial polyps.Materials and methods patients with abnormal uterine bleeding, postmenopausal uterine bleeding, infertility and abnormal echo of uterine cavity were selected from June 2015 to March 2016 in the third affiliated Hospital of Zhengzhou University (Henan Maternal and Child Health Hospital).All cases were examined by hysteroscopy. 120 cases in group EP were treated with hysteroscopy.Criteria for inclusion: highly suspected EPU of endometrial polyps and / or histologically proved EP by hysteroscopy; no history of endometrial carcinoma or other tumors; no history of ovariectomies;No serious medical complications or other organic diseases.120 cases in non-EP group were used as control group.Inclusion criteria: abdominal surgery or hysteroscopy to confirm the absence of endometrial polyps; no endometrial polyp surgery within six months; no history of endometrial carcinoma or other tumors; no history of ovariectomies;No serious medical complications or other organic diseases.SPSS 21. 0 software was used for statistical processing.T test for two independent samples, 蠂 2 test for classification data, Pearson 蠂 2 test for association analysis, and binary multivariate Logistic regression analysis were used to screen statistical risk factors for endometrial polyps.The test level was 伪 -0. 05.Results in 1.EP group, single polyp and multiple polyp accounted for 34.17% and 65.83%, respectively.The results showed that there was no significant difference in age and BMI between EP group and non-EP group. There were no significant differences in insulin resistance index, fasting insulin, insulin 120min, blood glucose for 1 hour and 2 hours after taking glucose in 0.05).EP group.Total cholesterol and waist circumference were significantly higher than those of non-EP group (P < 0.05), while the levels of sex hormone, triglyceride, high density lipoprotein (HDL), triglyceride (TG), high density lipoprotein (HDL) were significantly higher than those in non-EP group.There was no significant difference between the two groups in diabetes mellitus (P < 0.05).The correlation analysis showed that insulin resistance, abdominal obesity and EP were positively correlated with the incidence of EP.Multivariate logistic regression analysis showed that the OR values of menopause and HOMA-IR2.69 were all greater than 1, indicating that insulin resistance, menopause and HOMA-IR2.69 were risk factors of EP.Conclusion 1.Multiple polyps are most common in endometrial polyps.Insulin resistance, abdominal obesity and endometrial polyps were positively correlated.Insulin resistance, menopause and HOMA-IR 鈮，

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