Oguz S, Sargin A, Kelekci S, Aytan H, Tapisiz O L, Mollamahmutoglu L
Zekai Tahir Burak Woman Health, Education and Research Hospital, Ankara, Turkey.
Maturitas. 2005 Mar 14;50(3):231-6. doi: 10.1016/j.maturitas.2004.06.002.
To evaluate the iatrogenic effect of different protocols of hormone replacement therapy (HRT) on endometrial polyp formation adjusting for the confounding effects of other factors such as age, parity, weight and menopausal status at menopause.
Out of 2685 menopause patients 375 (13.9%) eligible patients were enrolled. Patients were randomized to three HRT types and three equal groups were formed. The first group received Premelle 2.5 mg (Group-I) (0.625 mg conjugated estrogen + 2.5 mg medroxyprogestorone), the second received Kliogest (Group-II) (2 mg estradiol + 1 mg norethisterone) and the last received Livial (Group-III) (2.5 mg tibolone) at least for 36 months without giving a break. After the first 18 months patients had their first office hysteroscopy and it was repeated in every 6 months until the end of third year to find out new and recurrent endometrial polyps.
Multiple regression analysis revealed that the type of HRT, late menopause and obesity increased the occurrence of endometrial polyps. In Group-I five polyps, in Group-II ten polyps and in Group-III two polyps were detected. There were significant differences between G-II and G-I and G-II and G-III (P < 0.05), but there was no significant difference between G-I and G-III (P > 0.05). 82.3% of the polyps were detected in the third and fourth hysteroscopic examinations. Endometrial polyp recurrence was encountered in 4 (23.5%) patients, 1 in G-I and 3 in G-II without a significant difference (P > 0.05). No malignancy was detected in any of the specimen.
We observed that endometrial polyp formation may be dependent on the type and dosage of the estrogen and progestogen. Especially a progestogen with high antiestrogenic activity may play an important preventive role in the development of endometrial polyps.
评估不同激素替代疗法（HRT）方案对子宫内膜息肉形成的医源性影响，并对年龄、产次、体重和绝经时的绝经状态等其他因素的混杂效应进行校正。
在2685例绝经患者中，375例（13.9%）符合条件的患者被纳入研究。患者被随机分为三种HRT类型，形成三个相等的组。第一组接受倍美力2.5毫克（第一组）（0.625毫克结合雌激素+2.5毫克甲羟孕酮），第二组接受克龄蒙（第二组）（2毫克雌二醇+1毫克炔诺酮），最后一组接受利维爱（第三组）（2.5毫克替勃龙），至少服用36个月且不间断。在最初的18个月后，患者进行首次门诊宫腔镜检查，并每6个月重复一次，直至第三年末，以发现新的和复发性子宫内膜息肉。
多元回归分析显示，HRT类型、绝经晚和肥胖会增加子宫内膜息肉的发生率。在第一组中检测到5个息肉，第二组中检测到10个息肉，第三组中检测到2个息肉。第二组与第一组以及第二组与第三组之间存在显著差异（P < 0.05），但第一组与第三组之间无显著差异（P > 0.05）。82.3%的息肉在第三次和第四次宫腔镜检查中被检测到。4例（23.5%）患者出现子宫内膜息肉复发，第一组1例，第二组3例，无显著差异（P > 0.05）。在任何标本中均未检测到恶性肿瘤。
我们观察到子宫内膜息肉的形成可能取决于雌激素和孕激素的类型及剂量。特别是具有高抗雌激素活性的孕激素可能在子宫内膜息肉的发生发展中起重要的预防作用。
