【摘要】 目的分析多囊卵巢综合征(PCOS)患者子宫内膜增生病变的临床及代谢特征,寻找子宫内膜增生病变的高危因素,以便更好地指导疾病的管理与治疗。方法选取2018年3月至2019年11月在广东省妇幼保健院行宫腔镜检查+诊断性刮宫的111例PCOS患者,根据病理检查结果分为子宫内膜正常组(PCOS-N组)74例和子宫内膜病变组(PCOS-EH组)37例,收集和分析两组患者的人体学测量指标及生化指标,寻找PCOS子宫内膜增生病变相关高危因素。结果 PCOS-N组患者中,增殖期61例(82.4%)、分泌期13例(17.6%);PCOS-EH组患者中子宫内膜息肉20例(54.1%)、子宫内膜增生不伴不典型增生13例(35.1%)、子宫内膜不典型增生3例(8.1%)、子宫内膜癌1例(2.7%)。PCOS-EH组体重、体重指数(BMI)、腰围、臀围、甘油三酯(TG)、2h血糖、空腹胰岛素(FINS)、2h胰岛素、稳态模型法胰岛素抵抗指数(HOMA-IR)、游离雄激素指数(FAI)均高于PCOS-N组,差异有统计学意义(P<0.05)。PCOS-EH组中糖耐量异常(IGT)、糖尿病(DM)、胰岛素抵抗(IR)、高雄激素血症(HA)的发生率均高于PCOS-N组,性激素结合球蛋白(SHBG)、高密度脂蛋白胆固醇(HDL-C)水平低于PCOS-N组,差异有统计学意义(P<0.05)。PCOS子宫内膜增生病变的高危因素有超重或肥胖、IR、IGT、DM、HA(P<0.05),OR值分别为3.07、3.52、2.78、3.80、15.81。结论 IR、HA、超重或肥胖是PCOS子宫内膜增生病变的高危因素,应重视对PCOS患者的体格检查及糖代谢筛查,适度放宽诊断性刮宫的手术指征,预防PCOS子宫内膜增生病变。更多还原

【Abstract】 Objective To analyze the clinical and metabolic features of polycystic ovary syndrome(PCOS) with or without endometrial hyperplasia lesions,find high risk factors for PCOS with endometrial lesions,and better guide the management and treatment of the disease.Methods Totally 111 cases of PCOS patients who underwent dilation and curettage under the hysteroscopy at Guangdong Women and Children’ s Hospital from March 2018 to November2019 were selected,and they were divided into two groups:74 cases of PCOS with normal endometrium group(PCOS-N group) and 37 cases of PCOS with endometrial lesions group(PCOS-EH group) according to the pathology of endometriosis.The data of measurement parametes and biochemical indexes were collected and analyzed to find high risk factors associated with PCOS with endometrial lesions.Results Among 74 cases of PCOS with normal endometrium group,including 61 cases(82.4%) in the proliferative phase and 13 cases(17.6%)in the secretory phase.Among 37 cases of PCOS with endometrial lesions group,including 20 cases(54.1%) of endometrial polyp,13 cases(35.1%) with endometrial hyperplasia without atypia,3 cases(8.1%) with atypical endometrial hyperplasia,and 1 case(2.7%) with endometrial cancer.The results of anthropometric parameters and metabolic characteristics of PCOS patients were:PCOS-EH group had higher weight,body mass index(BMI),waist circumference,hip circumference,triglyceride,2-hour blood glucose,fasting insulin,2-hour insulin,insulin resistance(IR) and free androgen index(FAI) than control group,and the difference was statistically significant(P <0.05).The incidence of impaired glucose tolerance(IGT),diabetes mellitus(DM),IR,and high androgen(HA) in PCOS-EH group was higher than those in PCOS-N group,while the level of sex hormone binding globulin and high density lipoprotein was lower,and the difference was statistically significant(P<0.05).The risk factors for PCOS endometrial hyperplasia lesions were BMI,HA,IR,IGT,DM and HA(P <0.05),and the odds ratio was 3.07,3.52,2.78,3.80 and 15.81 respectively.Conclusion Insulin resistance,hyperandrogenism and obesity are the high risk factors in PCOS with endometrial lesions.Therefore,we should pay more attention to physical examination and glycometabolic indicators screening in PCOS patients,broaden the surgical indications of endometrial curettage appropriately and prevent endometrial hyperplasia lesions in PCOS patients.更多还原