【作者】 刘丽；

【导师】 尹伶；

【作者基本信息】 武汉科技大学 ， 流行病与卫生统计学， 2013， 硕士

【摘要】 目的：利用子宫肌瘤患者的住院病历及妇产科病历描述武汉市某区2007-2011年子宫肌瘤的基本分布情况，找出患者的自觉症状。探讨影响子宫肌瘤患者出现自觉症状的危险因素，影响子宫肌瘤患者自觉症状严重程度的危险因素，子宫肌瘤的发病危险因素。了解子宫肌瘤患者最终选择的治疗方案及其影响因素，计算因治疗子宫肌瘤所耗费的经济成本。为制定子宫肌瘤的预防对策和措施提供一定科学依据。方法：通过分层随机抽样法抽取武汉市某区两所医院的子宫肌瘤患者形成病例组，按年龄1:1配对选取这两所医院妇产科的非子宫肌瘤患者形成对照组。与医院病案室联系收集近五年妇产科的相关统计资料，并翻阅和收集近两年子宫肌瘤患者的详细住院病历资料及对照组相应的资料，填写各组调查表。用Epidata建立数据库录入病例组和对照组的人口学特征、疾病自觉症状、妇科检查及相关危险因素，整理数据后使用SAS9.2进行相关统计分析。结果：每年就诊的妇科疾病中子宫肌瘤就诊患者所占比例为12.1%-17.7%，而其他妇科肿瘤总的就诊患者所占比例仅为2.6%-6.6%，治疗子宫肌瘤的人均直接费用为6403.61~9623.74元。病例组在阴道不规则出血、贫血、下腹隐痛、腰骶酸胀、痛经、经量增多、经期延长、月经紊乱及尿频的自觉症状上和对照组之间有统计学差异P<0.05。在有自觉症状的子宫肌瘤患者中，子宫体积增大的患者自觉症状严重程度和子宫体积正常的患者之间有统计学差异P=0.0004；子宫体积增大幅度与症状严重程度的等级间也有统计学差异P<0.0001；子宫肌瘤发病危险因素的分析中初潮年龄、生产次数和结婚年龄有统计学差异P<0.05, OR及95%CI分别为0.572（0.348,0.943）、0.488（0.248,0.961）和0.347（0.134,0.897）。年龄和自觉症状严重程度与最终治疗方案之间存在统计学差异。结论：子宫肌瘤就诊的自觉症状有四类：1）出血：阴道不规则出血和贫血；2）疼痛：下腹隐痛、腰骶酸胀和痛经；3）经期问题：经量增多、经期延长和月经紊乱；4）压迫：尿频。子宫肌瘤患者的年龄、职业和子宫体积大小不会影响患者是否出现自觉症状，而对于有自觉症状的子宫肌瘤患者，子宫体积增大的患者更有可能出现较严重的自觉症状。初潮年龄小于14周岁、生产次数小于1次和结婚年龄小于28岁是子宫肌瘤的发病危险因素。年龄及自觉症状的严重程度会影响患者最终治疗方案的选择。更多还原

【Abstract】 Object: To find the subjective symptoms of uterine fibroids（UFS） and the distribution of UFSin some district in WuHan between the year2007to2011according to the basic electronic dataof the department of gynecology and obstetrics and the detail medical records. To explore therisk factors of subjective symptom of UFS patients, and what affected the serious level ofsubjective symptoms of UFS patients, and the risk factors of UFS. To know what therapeuticregimen did patients of UFS choose finally and the reason, also the economic cost due to cureUFS per person.Methods: The case group of UFS patients was selected from stratified random sampling twohospitals at this district, and the control group of patients who was1:1matched with the casegroup selected from whom did not have UFS in these two hospitals. Recently5yearsinformation about the department of gynecology and obstetrics was obtained by communicatedwith the medical records room. The detail medical records about case group patients and controlgroup patients in the recent two years were obtained, and questionnaire of each group were doneaccording to it. The data such as demographic characteristics, subjective symptoms and relatedrisk factors of each group were entered into Epidata, the statistical analysis was done by SAS9.2after data sorted.Results: The proportion of UFS patients in gynecological visits was12.1%to17.7%per year,while the proportion of other gynecological tumors was2.6%to6.6%, the mean cost ofeverybody who had UFS was6403.61yuan to9623.74yuan. There was significant differencebetween case group and control group in vaginal irregular bleeding, anemia, abdominal pain,lumbar acid bilges, dysmenorrhea, menorrhagia, prolonged menstrual symptoms, menstrualdisorders and frequent urination，P<0.05.The subjective symptoms severity of UFS wereaffected by the uterine volume increased, P=0.0004. The size of uterine volume increased alsohad significant difference with subjective symptoms severity level. The age of menarche,production times and marriage age could affect the uterine fibroids,P<0.05.OR and95%CI were0.572(0.348,0.943),0.488(0.248,0.961) and0.347(0.134,0.897).Conclusions: Symptoms of UFS patients could be classified to four kinds:1) hemorrhage:irregular vaginal bleeding and anemia;2) pain: abdominal pain, lumbosacral soreness and pain;3)menstrual problems: menorrhagia, prolonged menstrual cycle and menstrual disorders;4)compression: frequent micturition. Uterine volume increased would affect the symptom seriouslylevel. The age of menarche lower than14years old, production times least than1and marriageage lower than28years old were risk factors for uterine fibroids.The age and symptom seriouslylevel can affected the final therapy way of UFS patients.更多还原