【作者】 陈洁；

【导师】 沈媛；

【作者基本信息】 暨南大学 ， 妇产科学 妇科肿瘤（专业学位）， 2022， 硕士

【摘要】 目的高血压、糖尿病及肥胖这三大与代谢相关的疾病被称为子宫内膜癌的三联征,但子宫内膜癌与血脂、血清尿酸等具体代谢指标的相关性尚无明确结论。本研究通过收集子宫内膜癌及子宫内膜良性病变患者的一般情况与代谢指标,对其术前的血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、血清尿酸(UA)水平与子宫内膜发生恶变的相关性进行病例对照研究,探讨相关因素在子宫内膜癌的辅助诊断中是否具有预测价值。方法收集2011年01月01日至2021年10月31日在暨南大学附属第一医院妇科首诊并经病理确诊的子宫内膜癌患者的病历资料,将符合纳入标准的151例患者的临床资料进行整理分析作为病例组,并选取同期在我院接受手术治疗的子宫内膜息肉样增生和子宫内膜息肉患者共151例作为对照组,整理这302例患者的一般情况,包括身高、体重、体质指数(BMI)、月经史、生育史、慢性代谢疾病史及术后病理结果,检索两组患者术前的血清TC、TG、HDL-C、LDL-C、ApoA1、ApoB、UA等代谢指标的检验结果,使用SPSS 27.0版本统计分析血脂及血清尿酸水平与子宫内膜发生恶变的相关性,绘制ROC曲线计算相关因素对诊断子宫内膜癌的预测准确度。结果(1)病例组与对照组的流产次数、月经是否规律、是否初潮早等相比,差异无统计学意义(P>0.05)。两组的发病年龄、生产次数及BMI相比,均存在显著差异(P<0.001)。病例组的发病年龄高于对照组(57.17±9.886 vs 42.09±8.642),病例组的生产次数高于对照组[2(1,3)vs 1(1,2)],病例组的BMI水平高于对照组[24.56(21.98,26.61)vs 21.83(20.1,24)]。(2)校正混杂因素的影响后,病例组与对照组的糖尿病和代谢综合征的发生率差异有统计学意义(P<0.05)。(3)校正混杂因素的影响后,病例组与对照组的血清UA、TG、ApoA1水平差异有统计学意义(P<0.05),其中血清UA、TG水平高于对照组,ApoA1水平低于对照组。(4)校正混杂因素的影响后,病例组与对照组相比,TG≥1.7 mmol/L、HDL-C<1.0 mmol/L、UA≥420 umol/L的发生率差异均有统计学意义(P<0.05)。(5)校正混杂因素的影响后,单因素二元Logistic回归分析结果显示,年龄、糖尿病、代谢综合征、UA、TG为EC的危险因素(P<0.05,OR>1),ApoA1为EC的保护因素(P<0.05,OR<1)。多因素Logistic回归分析显示,年龄是EC的显著危险因素(P<0.001,OR=1.194,95%CI 1.138-1.253),TG是EC的显著危险因素(P<0.001,OR=4.510,95%CI 2.179-9.334),ApoA1是EC的保护因素(P<0.05,OR=0.225,95%CI 0.078-0.645)。(6)ROC曲线结果显示,TG诊断子宫内膜癌的AUC为0.783,灵敏度为70.9%,特异度为76.2%;ApoA1诊断子宫内膜癌的AUC为0.589,灵敏度为70.2%,特异度为48.3%。结论(1)EC患者的TG升高、ApoA1降低,TG可能是EC的危险因素,ApoA1可能是EC的保护因素。(2)TG可作为EC的辅助诊断指标,ApoA1不足以作为EC的辅助诊断指标。(3)年龄与EC的发生显著相关,是EC的独立危险因素。更多还原

【Abstract】 ObjectivesHypertension,diabetes and obesity are known as the triad of endometrial carcinoma,but there is no clear conclusion on the correlation between endometrial carcinoma and specific metabolic indicators,such as blood lipids and serum uric acid.We conducted a case-control study on the correlation between total cholesterol(TC),triglyceride(TG),high-density lipoprotein in cholesterol(HDL-C),low-density lipoprotein in cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),uric acid(UA)and the occurrence of endometrial malignancy in 302 women with general data and metabolic indicators,and explored whether the relevant factors have predictive value in the auxiliary diagnosis of endometrial carcinoma.MethodsThe medical records of patients with endometrial carcinoma who were first seen in the Department of Gynecology of the First Affiliated Hospital of Jinan University from January 1st,2011 to October 31 th,2021 and confirmed by pathology were collected.The clinical data of 151 patients who met the inclusion criteria were selected as the case group,and a total of 151 patients with polypoid hyperplasia of endometrium and endometrial polyps who underwent surgical treatment in the same hospital during the same period were selected as the control group.General data of the two groups were collected,including height,weight,body mass index(BMI),menstrual history,reproductive history,history of chronic diseases,post-operative pathological findings and results of preoperative biochemical blood test: serum TC,TG,HDL-C,LDL-C,ApoA1,ApoB,UA.The correlation between lipid profile and serum uric acid and endometrial malignancy was analysed using SPSS version 27.0 statistics and ROC curves were plotted to calculate the predictive value of the relevant factors for the diagnosis of endometrial carcinoma.Results(1)There were no significant differences in the number of miscarriages,regularity of menstruation and early menarche(P > 0.05).Compared with the control group,the age of onset,number of births and BMI of the EC group were significantly different(P < 0.001).The age of onset of the EC group was higher than that of the control group(57.17 ± 9.886 vs 42.09 ± 8.642),the number of births was higher than the control group [2(1,3)vs 1(1,2)],the BMI was higher than the control group [24.56(21.98,6.61)vs 21.83(20.1,24)].(2)After adjusting for the influence of confounding factors,there were differences in the incidence of diabetes and metabolic syndrome between the case group and the control group(P <0.05).(3)After adjusting for the influence of confounding factors,there were significant differences in the levels of serum UA,TG and ApoA1 between the case group and the control group(P < 0.05),in which the serum levels of UA and TG were higher and the level of ApoA1 was lower than that of the control group.(4)After adjusting for the influence of confounding factors,there were significant differences in the incidence of TG ≥ 1.7 mmol/L,HDL-C < 1.0 mmol/L,and UA ≥ 420 umol/L between the case group and the control group(P < 0.05).(5)After adjusting for the influence of confounding factors,univariate logistic regression analysis showed that age,diabetes,metabolic syndrome,UA and TG were risk factors for EC(P< 0.05,OR < 1),and ApoA1 was protective factor for EC(P < 0.05,OR < 1).Multivariate logistic regression analysis showed that age was a significant risk factor for EC(P < 0.001,OR =1.194,95%CI 1.138-1.253),TG was a significant risk factor for EC(P < 0.001,OR=4.510,95%CI 2.179-9.334),and ApoA1 was a protective factor for EC(P < 0.05,OR = 0.225,95%CI0.078-0.645).(6)The ROC curve showed that the AUC of TG in the diagnosis of EC was 0.783 with a sensitivity of 70.9% and a specificity of 76.2%.The AUC of ApoA1 in the diagnosis of EC was0.589 with a sensitivity of 70.2% and a specificity of 48.3%.Conclusions(1)Patients with endometrial carcinoma have higher TG and lower ApoA1.TG may be a risk factor for endometrial carcinoma,while ApoA1 may be the opposite of it.(2)TG can be used as an auxiliary diagnostic indicator of endometrial carcinoma,while ApoA1 is not qualified.(3)Age is significantly correlated with the occurrence of endometrial carcinoma,and it is an independent risk factor for endometrial carcinoma.更多还原