高胰岛素血症与子宫内膜增生和子宫内膜增生紊乱有关：一项前瞻性横断面研究。

Hyperinsulinemia is associated with endometrial hyperplasia and disordered proliferative endometrium: a prospective cross-sectional study.

机构信息

Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China.

Department of Gynecology, Shanghai First People's Hospital Affiliated to Shanghai Jiao tong University, Shanghai 200081, China.

出版信息

Gynecol Oncol. 2014 Mar;132(3):606-10. doi: 10.1016/j.ygyno.2014.01.004. Epub 2014 Jan 10.

DOI:10.1016/j.ygyno.2014.01.004

PMID:24418201

Abstract

OBJECTIVE

To explore the relationship between metabolic abnormalities and DPE (disordered proliferative endometrium), EH (endometrial hyperplasia) and type I EC (endometrial cancer).

METHODS

We conducted a prospective cross-sectional study that lasted from September 2011 to September 2012 at the Obstetrics and Gynecology Hospital of Fudan University. 314 cases were enrolled, including 56 cases of DPE, 194 cases of EH and 25 cases of type I EC. 39 healthy female cases were collected as a control group. General information was collected, and blood tests, including blood lipids, OGTT (75-g oral glucose tolerance test) and insulin release tests were examined. Statistical analysis was performed using SPSS 19.0 (Chicago, USA), and 0.05 was chosen as the significance test level.

RESULTS

The median (inter-quartile) age of the 314 study subjects was 44 (12) years, with the ages ranging from 21 to 75 years. Elevated insulin level was correlated with DPE, EH without/with atypia and EC. The risk increased when HOMA-IR (homeostasis model assessment-insulin resistance)≥ 2.95 (the lower limit of the top quartile of HOMA-IR distribution in non-diabetic patients); the OR (odds ratio) for DPE was 9.973 (95% CI (coefficient interval): 2.038-48.789, P=0.005), that for EH without atypia was 8.481 (95% CI:1.860-38.672, P=0.006), that for EH with atypia was 18.716 (95% CI: 3.091-113.335, P=0.001) and that for type I EC was 45.199 (95% CI: 5.886-347.065, P<0.001). Opposite trends were observed for the QUICKI (Quantitative Insulin Sensitivity Check Index).

CONCLUSIONS

Hyperinsulinemia is associated with DPE and EH without/with atypia, not only with type I EC, and it might be a key factor that initiates and promotes endometrial hyperplastic lesions.

摘要

目的

探讨代谢异常与 DPE（增生性子宫内膜不典型增生）、EH（子宫内膜增生）和 I 型 EC（子宫内膜癌）的关系。

方法

本研究为前瞻性病例对照研究，于 2011 年 9 月至 2012 年 9 月在复旦大学妇产科医院进行。共纳入 314 例患者，包括 56 例 DPE、194 例 EH 和 25 例 I 型 EC，另选择 39 例健康女性作为对照组。收集一般资料，检测血脂、75g 口服葡萄糖耐量试验（OGTT）及胰岛素释放试验等。采用 SPSS 19.0（美国芝加哥）统计软件进行分析，以 P<0.05 为差异有统计学意义。

结果

314 例研究对象的中位（四分位数间距）年龄为 44（12）岁，年龄 2175 岁。高胰岛素血症与 DPE、无/伴不典型增生的 EH 和 EC 相关。HOMA-IR≥2.95（非糖尿病患者中 HOMA-IR 分布上四分位数的下限）时，风险增加；DPE 的 OR 值为 9.973（95%CI：2.03848.789，P=0.005），无不典型增生的 EH 的 OR 值为 8.481（95%CI：1.860~~38.672，P=0.006），有不典型增生的 EH 的 OR 值为 18.716（95%CI：3.091~~113.335，P=0.001），I 型 EC 的 OR 值为 45.199（95%CI：5.886~347.065，P<0.001）。QUICKI（定量胰岛素敏感指数）则呈相反趋势。