黄素艳　贺青蓉　秦炜　黄彩云　张栋武

[關键词] 子宫内膜息肉;病因;术后复发;Logistic回归分析

[中图分类号] R711.3          [文献标识码] B          [文章编号] 1673-9701（2021）23-0064-04

Logistic regression analysis of etiologies and postoperative recurrence factors of endometrial polyps

HUANG Suyan1   HE Qingrong1   QIN Wei1   HUANG Caiyun1   ZHANG Dongwu2

1.Department of Gynecology and Obstetrics， People′s Hospital of Gaoming District in Foshan City， Foshan   528500， China; 2.Department of Clinical Laboratory， People′s Hospital of Gaoming District in Foshan City， Foshan   528500， China

[Abstract] Objective To investigate the etiologies of endometrial polyps and the postoperative recurrence factors， and carry out Logistic regression analysis， so as to provide evidence-based foundation for the prevention and control of endometrial polyps. Methods Patients with endometrial polyps admitted to People′s Hospital of Gaoming District in Foshan City from January 2018 to June 2020 were selected as the study group （n=115）， while healthy people undergoing physical examination in People′s Hospital of Gaoming District in Foshan City in the same period were selected as the control group （n=100）. The multiple factors such as cultural structure， occupational structure， body mass index （BMI） and estrogen receptor infection in the two groups were compared and analyzed， respectively， and the etiologies of endometrial polyps were investigated. Multivariate Logistic regression analysis was carried out on the above-mentioned statistically different indices to investigate the high-risk factors leading to endometrial polyps. The factors of recurrence of endometrial polyps 2 years after surgical removal were analyzed and summarized， and the predisposing factors of recurrence of endometrial polyps after surgery were investigated. Results There were no statistically significant differences in the aspects of education level and occupational structure between the study group and the control group （P>0.05）. The BMI， the expression of estrogen receptor （ER） and progesterone receptor （PR） in the local endometrium of the study group were significantly higher than those of the control group （P<0.05）. And the incidences of infection and inflammation were significantly higher than those in the control group （P<0.05）. There were statistically significant differences in the incidences of abnormal expression of CD4 and CD8 between the study group and the control group （P<0.05）. Logistic regression analysis results showed that endocrine disorders， abnormal expression of immune cells， obesity and hypertension were independent risk factors for recurrence of endometrial polyps （P<0.05）. The odds ratio （OR） values and 95% CI ranges were 5.631 （2.579-9.186）， 3.872 （1.943-10.142）， 3.731 （1.596-8.014） and 6.637 （1.779-9.082）， respectively. Conclusion Obesity， over-expression of ER and local immune imbalance may be the etiologies of endometrial polyps. And the correction of endocrine disorders and abnormal expression of immune cells may be the priority of clinical prevention for postoperative recurrence of endometrial polyps.

[Key words] Endometrial polyps; Etiologies; Postoperative recurrence; Logistic regression analysis

子宫内膜息肉是一种以子宫内膜增生凸起于子宫腔为主要表现的常见妇科疾病，常因阴道不规则出血、不孕等因素就诊而被发现，部分可恶变，病因未明;手术治疗成为治疗子宫内膜息肉的常用首选方法，但子宫内膜息肉术后复发率偏高，又成为该病防控的新课题。研究发现：子宫内膜息肉患者常见局部雌激素受体（estrogen receptor，ER）及孕激素受体（progesterone receptor，PR）的异常表达[1-2]，而部分患者术后激素治疗又能有效延缓该病的复发率，故该病又被称为激素依赖性疾病[3];肥胖及高血压等内分泌疾病与子宫内膜息肉患病相系密切[4]。课题小组成员在研究该病过程中，发现子宫内膜息肉患者T淋巴细胞群之CD4、CD8表达比率异常，故而推测该病与患者局部免疫调节失衡有关联，为印证前述推测，课题小组成员对115例子宫内膜息肉患者疾病成因、术后复发因素进行了两年的跟踪随访研究，旨在对子宫内膜息肉的防控提供循证依据。

1 资料与方法

1.1一般资料

所有入选对象为2018年1月至2020年6月期间到佛山市高明区人民医院就诊的子宫内膜息肉患者共115例为研究组，其年龄结构为29～44岁，中位年龄（35.8±9.8）岁; 纳入标准[1，3，5]：超声诊断子宫内膜有凸起性赘生物、手术切除经病理诊断为子宫内膜息肉者;所有患者均未做过子宫部分切除、未进行过雌性激素治疗、肝肾功能未见明显异常者、能够配合临床完成各种检查、治疗且依从性较好者，患者资料齐全，愿意接受追踪随访。排……