摘要
目的：探讨孕激素刺激试验(progesterone challengetest,PCT)和阴道超声(transvaginal ultrasonography,TVS)在绝经后妇女子宫内膜病变筛查中的作用。方法：对106例无症状的绝经后妇女进行血清雌二醇(E2)、孕激素(P)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(TT)的测定，并行TVS检查，测定其矢状面下子宫内膜前后径最大厚度(双层)及其形态，子宫内膜厚度≥5mm者视为异常。所有研究对象在超声检查后服用安宫黄体酮10mg／d，共服10d，停药，观察半月内是否有阴道流血。若有阴道流血，无论多少，均为阳性；若无阴道流血则为阴性。对PCT阳性或阴性及阴道超声显示不同子宫内膜厚度者均给予诊断性刮宫，以确定子宫内膜的生理或病理状态。另外，对31例绝经后子宫内膜癌病人进行性激素水平测定。结果：11例妇女PCT为阳性，其中9例为异常子宫内膜。PCT用于检测子宫内膜疾病的敏感度、特异度、阳性预测值、阴性预测值分别为81.8％，97.9％，81.8％，97.9％。子宫内膜癌妇女和PCT阳性的妇女血清E2水平明显高于PCT阴性妇女。31例妇女子宫内膜厚度≥5mm，其中10例为异常子宫内膜。以5mm为分界点，TVS用于检测子宫内膜疾病的敏感度、特异度、阳性预测值、阴性预测值分别为90.9％、77.9％、32.3％、98.7％。对于子宫内膜厚度≥5mm
论文：孕激素刺激试验和阴道超声对绝经后妇女子宫内膜病变的筛查
者，若联合应用PCT，则其敏感度、特异度、阳性预测值、阴性
预测值分别为 80％、90．5％、80％、90．5％，提高 T M卉的特异件．
结论：1．绝经后子宫内膜增生及子宫内膜癌病人血清EZ水平较
正常妇女高，但不能作为绝经后无症状妇女子宫内膜癌的筛查手
段。2．PCT对绝经后妇女子宫内膜增殖、增生、子宫内腆癌的筛
查具有较高特异度，但敏感度较低，可能导致假阴性结果。3．TVS
对子宫内膜增殖、增生、子宫内膜癌的筛查具有较高敏感度，们
特异度较低，可能导致不必要的诊刮。4．二者联合应用，不仅有
利于早期诊断子宫内膜增殖、增生等子宫内膜癌的高危囚素，以
及于宫内膜非典型增生和于宫内腴癌，且可碱少不必玫的诊刮，
并对可疑病人进行随访。我们建议用TVS作为绝经后妇女的常规
筛查工具，选择出子宫内膜癌的高危人群。这部分人中如果子宫
内膜厚度 3 smm，则需行 PCT。如 PCT 为阳性，则行进一步检查
（诊刮或宫腔镜检查），其余的PCT阴性者，必须在随后的1 年
内每3－6个月复查TVS，如发现子宫内膜明显增厚，则须行诊刮
或宫腔镜检查。阴道超声与孕激素刺激实验联合运用，是一种简
单，安全，可靠，容易耐受的绝经后无症状妇女子宫内膜癌的筛
查方法。
ObjcctivcrTo evaluate the use of progesterone challenge test(PCT) and transvaginal ultrosonography (TVS) in postmenopausal asymptomatic women to detect endometrial pathology. Methods:E2,P,FSH,LH,T were assayed in 106 postmenopausal asymptomatic women,then they were examined by TVS. Endometrial thickness 5mm was considered pathological .All women underwent PCT after TVS.Whether PCT was positive or negative ,all women underwent curettage. E2,P,FSH,LH,T were also assayed in 31 postmenopausal patients with endometrial carcinoma. Result: Eleven cases showed a positive PCT, and the sensitivity,specificity, positive predictive value, negtive predictive value of PCT were 81.8%,97.9%,8 1.8%,97.9%.There is a significant elevation in E2 concentrations in cases with endometrial carcinoma and PCT positive compared with PCT negtive group.Th
irty-one women had endometrial thickness 5mm , and ten of them had abnormal endometrium.The sensitivity, specificity,positive predictive value, negtive predictive value of TVS for detecting endometrial pathology were 90.9%,77.9%,32.3%, 98.7% ,respectively,if the cut-off of 5mm was used. The sensitivity,specificity,positive predictive
value, negtive predictive value of TVS combined with PCT were
80%, 90. 5%, 80%, 90. 5% in the patients with endometrial thickness
5mm. The sensitivity improved. Conclusion:1. There is a
significant elevation in E2 concentrations in cases with
proliferative endometrium, endometrial hyperplasia or endometrial
carcinoma compared with atrophic endometrium. 2. PCT is
specific, but not sensitive to detect proliferative endometrium,
endometrial hyperplasia or endometrial carcinoma. 3. TVS is
sensitive, but not specific to detect proliferative endometrium,
endometrial hyperplasia or endometrial carcinoma. 4. TVS
combined with PCT can decrease curretage,and the suspected
patients can be supervised. We recommend routine TVS as a
screening test in all postmenopausal women. If the endometrium is
5mm, a PCT must be carried out and if it is positive, curettage
or hysteroscopy is obligatory. In the remaining cases with
negative PCT, TVS must be performed every 3-6 months within
the following 1 year. If the endometrium become thicker, curettage
or hysteroscopy must be carried out. TVS combined with PCT is a
simple, well-tolerated, safe and reliable method for identifying
pathology in postmenopausal women.
引文
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