Bortoletto C de C, Baracat E C, Gonçalves W J, Stávalle J N, de Lima G R, Novo N F
Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
Sao Paulo Med J. 1996 May-Jun;114(3):1166-72. doi: 10.1590/s1516-31801996000300005.
The clinical aspects and anatomopathological patterns of 150 postmenopausal women were studied using the progestogen challenge test. An endometrial biopsy was obtained and submitted to the progestogen test. A histopathological analysis of the uterine mucosa from women with a positive progestogen test revealed that the endometrium was active in 44 percent of cases and atrophic or inactive in 56 percent. In contrast, among women with a negative response, the endometrium was atrophic in 94 percent of cases and active in 6 percent. Analysis of clinical aspects did not show significant differences between groups in terms of age; age at menarche and at menopause; fasting blood glucose levels; or body mass. However, postmenopausal time was significantly shorter for women with a positive test, with a correlation between postmenopausal time of one to two years and test positivity. The progestogen challenge test for the detection of atrophic endometrium presented 78.57 percent sensitivity, 77.05 percent specificity, 44 percent positive predictive value, and 94 percent negative predictive value. Thus, when negative, the test is highly valuable, indicating the presence of atrophic endometrium in 94 percent of cases. False-negative results occurred in only 6 percent of the subjects, with no case of hyperplasia detected. However, when the response to the test was positive, the endometrium was atrophic in 56 percent of the cases. We suggest that, in order to avoid invasive procedures, the progestogen challenge test be combined with other methods such as transvaginal ultrasonography.
采用孕激素激发试验对150名绝经后女性的临床情况和解剖病理学模式进行了研究。获取子宫内膜活检样本并进行孕激素试验。对孕激素试验呈阳性的女性的子宫黏膜进行组织病理学分析发现，44%的病例子宫内膜呈活跃状态，56%呈萎缩或不活跃状态。相比之下，在反应呈阴性的女性中，94%的病例子宫内膜呈萎缩状态，6%呈活跃状态。临床情况分析显示，两组在年龄、初潮年龄和绝经年龄、空腹血糖水平或体重方面无显著差异。然而，试验呈阳性的女性绝经时间明显较短，绝经时间在1至2年与试验阳性之间存在相关性。用于检测萎缩性子宫内膜的孕激素激发试验的灵敏度为78.57%，特异度为77.05%，阳性预测值为44%，阴性预测值为94%。因此，当试验结果为阴性时，该试验具有很高的价值，表明94%的病例存在萎缩性子宫内膜。仅6%的受试者出现假阴性结果，未检测到增生病例。然而，当试验反应为阳性时，56%的病例子宫内膜呈萎缩状态。我们建议，为避免侵入性操作，孕激素激发试验应与经阴道超声检查等其他方法联合使用。
