【摘要】 目的：探讨围绝经期女性子宫内膜息肉（EPs）恶变的危险因素，分析微生物-代谢轴与恶变的关系，并构建风险预测模型。方法：前瞻性纳入2023年3月至2025年3月扬州市妇幼保健院收治的120例围绝经期EPs患者，采用16S r RNA测序及LC-MS代谢组学技术对宫腔内容物进行检测，并结合临床资料进行相关分析[根据病理结果分为EP组和子宫内膜癌（EC）组]。结果：与EP组相比，EC组患者年龄、息肉直径均较大，异常子宫出血率、糖尿病比例均更高（P<0.05）。EC组微生物多样性更低，乳酸杆菌属丰度更低，促炎菌属丰度更高（P<0.01）。EC组中前列腺素E₂（PGE₂）等代谢产物水平更高（P<0.01）。多因素分析显示，乳酸杆菌属丰度降低、异常子宫出血、PGE₂水平升高是EPs恶变的独立危险因素（P<0.01）。结论：微生物失衡与代谢紊乱是EPs恶变的重要影响因素，基于微生物-代谢轴构建的预测模型可为其早期筛查提供参考依据。更多还原

【Abstract】 Objective: To investigate the risk factors for malignant transformation of endometrial polyps（EPs） in perimenopausal women, analyze the relationship between the microbiota-metabolism axis and malignant transformation, and construct a risk prediction model. Methods: Prospectively enrolled 120 perimenopausal EPs patients admitted to Yangzhou Maternal and Child Health Hospital from March 2023 to March 2025. Intrauterine contents were examined using 16S r RNA sequencing and LC-MS metabolomic techniques. Clinical data were combined for correlation analysis（patients were divided into an EP group and an EC group based on pathological results）. Results: Compared with the EP group, patients in the EC group were older, had larger polyp diameters, and exhibited higher rates of abnormal uterine bleeding and a higher proportion of diabetes（P < 0.05）. The EC group showed reduced microbial diversity, a significant decrease in Lactobacillus abundance, and an increase in pro-inflammatory bacterial genus abundance（P < 0.01）. Metabolite levels such as PGE₂ were significantly elevated in the EC group（P < 0.01）. Multivariate analysis revealed that decreased Lactobacillus abundance, abnormal uterine bleeding, and elevated PGE₂ were independent risk factors for malignant transformation of EPs（P < 0.01）. Conclusion: Microbial imbalance and metabolic disorders are significant influencing factors in the malignant transformation of EPs. The prediction model constructed based on the microbiota-metabolism axis can provide a reference for early screening.更多还原