子宫内膜非典型增生及子宫内膜癌与代谢综合征关系的研究
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摘要
目的探讨代谢综合征与子宫内膜非典型增生(endometrial atypical hyperplasia,EAH)及子宫内膜癌(endometrial cancer,EC)的关系。方法选取2014年7月至2017年5月本院收治的EAH患者48例,Ⅰ型EC患者132例,Ⅱ型EC患者50例,并选取同期因子宫肌瘤行全子宫切除但无子宫内膜病变或良性子宫内膜病变的患者67例为对照组。采用葡萄糖氧化酶法测定血糖,罗氏电化学发光分析仪测定胰岛素、C肽。分析糖脂代谢及胰岛素抵抗与EAH、EC之间的关系。结果 EAH组、Ⅰ型EC组空腹血糖正常者发生胰岛素抵抗率(43.75%;34.09%)较对照组(17.91%)增加(P<0.05)。多因素logistic回归分析显示:伴有腹型肥胖的54例对照组、42例EAH组、122例Ⅰ型EC组患者中,排除年龄、BMI、腰臀比、绝经状态等的影响后,高胰岛素水平是EAH、Ⅰ型EC的高风险因素(OR=1.134,95%CI:1.010~1.274,P=0.033;OR=1.103,95%CI:1.012~1.201,P=0.015)。HOMA-IR≥2.11时,EAH、Ⅰ型EC的发病风险显著增加,OR值分别为3.881(95%CI:1.153~13.058,P=0.028)和2.339(95%CI:0.998~5.484,P=0.037)。结论空腹血糖正常EAH、Ⅰ型EC患者发生胰岛素抵抗的比例显著增加。高胰岛素水平与EAH、Ⅰ型EC的发生密切相关。
Objective To investigate the relationship between metabolic syndrome and endometrial atypical hyperplasia(EAH) and type Ⅰ endometrial cancer(type Ⅰ EC). Methods Data of 48 cases of EAH, 132 cases of type Ⅰ EC, 50 cases of type Ⅱ EC, 67 cases of controls who underwent a total hysterectomy for uterine myoma(with normal endometrium or benign endometrial conditions such as endometrial polyps and atrophic endometrium) were collected in the same hospital during the same study period. All blood samples were collected and examined for fasting glucose, insulin and C-peptide. Glucose oxidase method was used for the measurement of glucose, and Cobas6000 for the measurement of insulin and C-peptide. Analyze the relationships of glucose and lipid metabolism and insulin resistance with EAH and EC. Results EAH group and type Ⅰ EC group had the proportion of patients with normal fasting blood glucose but in a state of insulin resistance 43.75% and 34.09%, respectively, both with P-values less than 0.05 compared to the control group(17.91%). For 54 cases, 42 cases, 122 cases of patients with abdominal obesity from control group, EAH group and type Ⅰ EC group, respectively: hyperinsulinemia was closely related to EAH and type Ⅰ EC(OR =1.134, 95%CI :1.010 ~ 1.274, P =0.033; OR =1.103, 95%CI :1.012 ~ 1.201, P =0.015); when HOMA-IR ≥ 2.11, the OR for EAH was 3.881(95%CI :1.153~13.058, P =0.028), for type Ⅰ EC was 2.339(95%CI :0.998~5.484, P =0.037). Conclusions The proportion of EAH group and type Ⅰ EC group with normal fasting blood glucose but in a state of insulin resistance were dramatically increased. Hyperinsulinemia was closely related to EAH and type Ⅰ EC.
Objective To investigate the relationship between metabolic syndrome and endometrial atypical hyperplasia(EAH) and type Ⅰ endometrial cancer(type Ⅰ EC). Methods Data of 48 cases of EAH, 132 cases of type Ⅰ EC, 50 cases of type Ⅱ EC, 67 cases of controls who underwent a total hysterectomy for uterine myoma(with normal endometrium or benign endometrial conditions such as endometrial polyps and atrophic endometrium) were collected in the same hospital during the same study period. All blood samples were collected and examined for fasting glucose, insulin and C-peptide. Glucose oxidase method was used for the measurement of glucose, and Cobas6000 for the measurement of insulin and C-peptide. Analyze the relationships of glucose and lipid metabolism and insulin resistance with EAH and EC. Results EAH group and type Ⅰ EC group had the proportion of patients with normal fasting blood glucose but in a state of insulin resistance 43.75% and 34.09%, respectively, both with P-values less than 0.05 compared to the control group(17.91%). For 54 cases, 42 cases, 122 cases of patients with abdominal obesity from control group, EAH group and type Ⅰ EC group, respectively: hyperinsulinemia was closely related to EAH and type Ⅰ EC(OR =1.134, 95%CI :1.010 ~ 1.274, P =0.033; OR =1.103, 95%CI :1.012 ~ 1.201, P =0.015); when HOMA-IR ≥ 2.11, the OR for EAH was 3.881(95%CI :1.153~13.058, P =0.028), for type Ⅰ EC was 2.339(95%CI :0.998~5.484, P =0.037). Conclusions The proportion of EAH group and type Ⅰ EC group with normal fasting blood glucose but in a state of insulin resistance were dramatically increased. Hyperinsulinemia was closely related to EAH and type Ⅰ EC.
引文
[1]Nieman KM,Romero IL,Van Houten B,et al.Adipose tissue and adipocytes support tumorigenesis and metastasis[J].Biochim Biophys Acta,2013,1831:1533-1541.
[2]Trabert B,Wentzensen N,Felix AS,et al.Metabolic syndrome and risk of endometrial cancer in the United States:a study in the SEER-Medicare linked database[J].Cancer Epidemiol Biomarkers Prev,2015,24:261-267.
[3]Lax SF.New features in the 2014 WHO classification of uterine neoplasms[J].Pathologe,2016,37:500-511.
[4]Uimari O,Auvinen J,Jokelainen J,et al.Uterine fibroids and cardiovascular risk[J].Hum Reprod,2016,31:2689-2703.
[5]Shan WW,Ning CC,Luo XZ,et al.Hyperinsulinemia is associated with endometrial hyperplasia and disordered proliferative endometrium:a prospective cross-sectional study[J].Gynecol Oncol,2014,132:606-610.
[6]魏丽惠.重视子宫内膜癌筛查[J].中华妇产科杂志,2013,48:881-883.
[7]Esposito K,Chiodini P,Capuano A,et al.Metabolic syndrome and endometrial cancer:a meta-analysis[J].Endocrine,2014,45:28-36.
[8]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6:447-498.
[9]王增武,郝光,王馨,等.我国中年人群超重/肥胖现况及心血管病危险因素聚集分析[J].中华流行病学杂志,2014,35:354-358.
[10]刘福康,蔡慧珍,黄桂玲,等.正常BMI腹型肥胖者胰岛素抵抗、血脂及膳食分析[J].中国现代医学杂志,2011,21:3782-3790.
[2]Trabert B,Wentzensen N,Felix AS,et al.Metabolic syndrome and risk of endometrial cancer in the United States:a study in the SEER-Medicare linked database[J].Cancer Epidemiol Biomarkers Prev,2015,24:261-267.
[3]Lax SF.New features in the 2014 WHO classification of uterine neoplasms[J].Pathologe,2016,37:500-511.
[4]Uimari O,Auvinen J,Jokelainen J,et al.Uterine fibroids and cardiovascular risk[J].Hum Reprod,2016,31:2689-2703.
[5]Shan WW,Ning CC,Luo XZ,et al.Hyperinsulinemia is associated with endometrial hyperplasia and disordered proliferative endometrium:a prospective cross-sectional study[J].Gynecol Oncol,2014,132:606-610.
[6]魏丽惠.重视子宫内膜癌筛查[J].中华妇产科杂志,2013,48:881-883.
[7]Esposito K,Chiodini P,Capuano A,et al.Metabolic syndrome and endometrial cancer:a meta-analysis[J].Endocrine,2014,45:28-36.
[8]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6:447-498.
[9]王增武,郝光,王馨,等.我国中年人群超重/肥胖现况及心血管病危险因素聚集分析[J].中华流行病学杂志,2014,35:354-358.
[10]刘福康,蔡慧珍,黄桂玲,等.正常BMI腹型肥胖者胰岛素抵抗、血脂及膳食分析[J].中国现代医学杂志,2011,21:3782-3790.