Ash S J, Farrell S A, Flowerdew G
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.
J Reprod Med. 1996 Dec;41(12):892-6.
To determine the incidence of abnormal endometrial histology in women with dysfunctional uterine bleeding and to evaluate the predictive value of risk factors for endometrial cancer in women with dysfunctional uterine bleeding (DUB).
We conducted a retrospective review of 310 women with DUB who underwent endometrial biopsy. The risk factors for abnormal endometrial histology included menstrual cycle irregularity, diabetes, nulliparity, hypertension, weight > or = 100 kg and age > or = 40 years. The incidence of endometrial abnormalities was determined, and the predictive value of combinations of risk factors was assessed using stepwise logistic regression.
Twenty-one patients (6.7%) had abnormal endometrial biopsies. Menstrual cycle irregularity (P = .0001), age > or = 40 years (p = .022) and hypertension (P = .058) were independently significant risk factors for abnormal endometrial histology. The probability of abnormal endometrial histology in a premenopausal woman with DUB whose cycle was regular was < 1%. The presence of menstrual cycle irregularity increased the probability of abnormal endometrial histology to 14.3%.
The patient who presents with DUB and a history of menstrual cycle irregularity warrants an endometrial biopsy, regardless of age. The current clinical emphasis on age (especially > or = 40 years) as justification for endometrial biopsy is unwarranted in patients with DUB. More careful selection of patients for endometrial biopsy will mean that fewer women are unnecessarily exposed to the discomfort and risk of complications associated with endometrial biopsy.
确定功能失调性子宫出血女性子宫内膜组织学异常的发生率，并评估功能失调性子宫出血（DUB）女性子宫内膜癌风险因素的预测价值。
我们对310例行子宫内膜活检的DUB女性进行了回顾性研究。子宫内膜组织学异常的风险因素包括月经周期不规律、糖尿病、未生育、高血压、体重≥100 kg和年龄≥40岁。确定子宫内膜异常的发生率，并使用逐步逻辑回归评估风险因素组合的预测价值。
21例患者（6.7%）子宫内膜活检异常。月经周期不规律（P = .0001）、年龄≥40岁（P = .022）和高血压（P = .058）是子宫内膜组织学异常的独立显著风险因素。月经周期规律的绝经前DUB女性子宫内膜组织学异常的概率<1%。月经周期不规律会使子宫内膜组织学异常的概率增加到14.3%。
有DUB且有月经周期不规律病史的患者，无论年龄大小，均需进行子宫内膜活检。目前临床上将年龄（尤其是≥40岁）作为子宫内膜活检依据的做法，对于DUB患者是没有必要的。更谨慎地选择子宫内膜活检患者意味着更少的女性会不必要地遭受与子宫内膜活检相关的不适和并发症风险。
