2025 年第 8 期 第 20 卷

绝经后异常子宫出血的病理及临床特征分析

Analysis of pathological and clinical characteristics of postmenopausal abnormal uterine bleeding

作者：张才志1黄锦源2曹雨停1巫剑红1代荫梅1

英文作者：Zhang Caizhi1 Huang Jinyuan2 Cao Yuting1 Wu Jianhong1 Dai Yinmei1

单位：1首都医科大学附属北京妇产医院北京妇幼保健院妇科，北京100026；2北京大学第三医院妇产科/生殖医学中心女性生育力促进全国重点实验室国家妇产疾病临床医学研究中心（北京大学第三医院）辅助生殖教育部重点实验室（北京大学）生殖内分泌与辅助生殖技术北京市重点实验室，北京100191

英文单位：1Department of Gynecology Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing Maternal and Child Health Care Hospital Beijing 100026 China; 2Department of Obstetrics and Gynaecology Center for Reproductive Medicine Peking University Third Hospital State Key Laboratory of Female Fertility Promotion National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Key Laboratory of Assisted Reproduction (Peking University) Ministry of Education Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology Beijing 100191 China

关键词：绝经后异常子宫出血；子宫内膜恶性病变；高危因素；临床特征

英文关键词：Abnormaluterinebleedingaftermenopause;Endometrialmalignantlesions;High-riskfactors;Clinicalfeatures

• 摘要：

• 目的 观察绝经后异常子宫出血的病理类型及其分布情况，分析不同病理类型与临床特征的关系，探讨绝经后异常子宫出血患者子宫内膜恶性及癌前病变的危险因素。方法 回顾性分析首都医科大学附属北京妇产医院2018年5月1日至2023年5月1日收治的因绝经后异常子宫出血行宫腔镜检查+子宫内膜定位活检的894例患者的临床资料，总结患者的病理和临床特征，采用多因素Logistic回归方法分析绝经后异常子宫出血患者子宫内膜恶性及癌前病变发生的危险因素。结果  894例绝经后异常子宫出血患者中病理类型以良性病变为主、为710例（79.4%），其中子宫内膜息肉占比最多、269例（30.1%），恶性及癌前病变184例（20.6%），以子宫内膜癌最多见、为151例（16.9%）。良性病变组和恶性及癌前病变组在年龄、绝经年限、已生育、合并糖尿病、子宫内膜回声均匀、子宫内膜厚度≥0.5 cm、异常子宫出血持续时间、凝血功能正常及肿瘤标志物正常比例方面差异均有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示，绝经年限长（6～10年、＞10年）、未生育、子宫内膜厚度≥0.5 cm、肿瘤标志物异常是绝经后患者发生子宫内膜恶性及癌前病变的危险因素（均P<0.05）。结论  绝经后异常子宫出血主要原因是良性病变，恶性及癌前病变的发生与绝经年限、是否生育、子宫内膜厚度、肿瘤标志物相关。

• Objective To observe the pathological types and distribution of abnormal uterine bleeding in postmenopausal women, analyze the relationship between different pathological types and clinical characteristics, and explore the risk factors of endometrial malignant and precancerous lesions in postmenopausal women with abnormal uterine bleeding. Methods The clinical data of 894 patients with postmenopausal abnormal uterine bleeding who underwent hysteroscopy and endometrial localization biopsy in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from May 1, 2018 to May 1, 2023 were retrospectively analyzed. The pathological and clinical characteristics of the patients were summarized. Multivariate Logistic regression was used to analyze the risk factors of endometrial malignant and precancerous lesions in postmenopausal women with abnormal uterine bleeding. Results Among 894 patients with abnormal uterine bleeding after menopause, the pathological types were mainly benign lesions, accounting for 710 cases (79.4%), of which endometrial polyps accounted for the largest proportion, 269 cases (30.1%), malignant and precancerous lesions accounted for 184 cases (20.6%), and endometrial cancer was the most common, accounting for 151 cases (16.9%). There were significant differences between the two groups in age, menopausal years, fertility, diabetes mellitus, endometrial echo uniformity, endometrial thickness ≥0.5 cm, duration of abnormal uterine bleeding, normal coagulation function and normal proportion of tumor markers (all P<0.05). Multivariate Logistic regression analysis showed that long menopausal years (6-10 years, >10 years), non-childbearing, endometrial thickness ≥0.5 cm, abnormal tumor markers were the risk factors for endometrial malignant and precancerous lesions in postmenopausal patients (all P<0.05). Conclusion The main cause of abnormal uterine bleeding after menopause is benign lesions, and the occurrence of malignant and precancerous lesions is related to the years of menopause, fertility, endometrial thickness and tumor markers.