2022 年第 5 期 第 17 卷

子宫内膜癌分型分期与代谢综合征和同型半胱氨酸的相关性研究

Relationship of typing and stage of endometrial carcinoma with metabolic syndrome and homocysteine

作者：张丽张军

英文作者：Zhang Li Zhang Jun

单位：首都医科大学附属北京安贞医院妇产科，北京100029

英文单位：Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：子宫内膜癌；代谢综合征；同型半胱氨酸

英文关键词：Endometrialcarcinoma;Metabolicsyndrome;Homocysteine

• 摘要：

• 目的 分析子宫内膜癌（EC）Bokhman分型与代谢综合征（MS）、同型半胱氨酸（Hcy）的相关性，以及MS、Hcy对EC病理分期的影响。方法  回顾性收集2018年1月至2022年1月就诊于首都医科大学附属北京安贞医院的149例EC患者的临床资料。其中Ⅰ型EC 125例，病理分期：Ⅰ期97例、Ⅱ期13例、Ⅲ期14例、Ⅳ期1例；Ⅱ型EC 24例，病理分期：Ⅰ期10例、Ⅱ期3例、Ⅲ期7例、Ⅳ期4例。记录患者月经初潮年龄、发病年龄、体重指数、血压、空腹血糖、血脂及Hcy水平。比较不同Bokhman分型患者以及各分型内不同病理分期患者上述指标差异。同时比较不同分型患者MS发生率及绝经比例。结果 Ⅱ型EC患者月经初潮年龄、体重指数及三酰甘油、高密度脂蛋白胆固醇（HDL-C）水平均小于/低于Ⅰ型EC患者［（13.1±1.5）岁比（14.8±1.9）岁、（25±4）kg/m2比（27±4）kg/m2、（1.4±0.4）mmol/L比（1.7±1.0）mmol/L、（1.05±0.32）mmol/L比（1.28±0.36）mmol/L］，Hcy水平高于Ⅰ型EC患者［（17±5）μmol/L比（13±5）μmol/L］，差异均有统计学意义（均P＜0.05）。Ⅰ型EC患者中MS发生率高于Ⅱ型EC患者［63.2%（79/125）比45.8%（11/24）］，绝经比例低于Ⅱ型EC患者［68.8%（86/125）比91.7%（22/24）］，差异均有统计学意义（均P＜0.05）。Ⅰ型或Ⅱ型ECⅠ期患者与Ⅱ~Ⅳ期患者月经初潮年龄、发病年龄、体重指数、血压、空腹血糖、三酰甘油、总胆固醇、HDL-C、低密度脂蛋白胆固醇、Hcy水平比较，差异均无统计学意义（均P＞0.05）。结论  月经初潮年龄、体重指数、三酰甘油、HDL-C、Hcy、MS及绝经状态与EC Bokhman分型有关。而上述指标均与相同分型EC的不同病理分期无关。

• Objective  To analyze the relationship of Bokhman typing of endometrial carcinoma (EC) with metabolic syndrome (MS) and homocysteine (Hcy), and to analyze the impact of MS and Hcy on pathological stage of EC. Methods Data of 149 patients with EC admitted to Beijing Ahzhen Hospital, Capital Medical University from January 2018 to January 2022 were retrospectively analyzed. There were 125 cases with EC typing Ⅰ, including 97 cases in pathological stage Ⅰ, 13 cases in pathological stage Ⅱ, 14 cases in pathological stage Ⅲ, and 1 case in pathological stage Ⅳ; there were 24 cases with EC typing Ⅱ, including 10 cases in pathological stage Ⅰ, 3 cases in pathological stage Ⅱ, 7 cases in pathological stage Ⅱ, and 4 cases in pathological stage Ⅳ. The menarche age, age of onset, body mass index, blood pressure, fasting blood glucose, blood lipid and Hcy of patients were recorded and were compared in different Bokhman typing and different pathological stages. The incidences of MS and menopause were compared between patients with different typing. Results  The menarche age, body mass index, serum levels of triacylglycerol and high-density lipoprotein cholesterol (HDL-C) in patients with EC typing Ⅱ were younger/lower than those in patients with EC typing Ⅰ ［（13.1±1.5）years vs （14.8±1.9）years,（25±4）kg/m2 vs （27±4）kg/m2,（1.4±0.4）mmol/L vs （1.7±1.0）mmol/L,（1.05±0.32）mmol/L vs （1.28±0.36）mmol/L］, and level of Hcy in patients with EC typing Ⅱ was higher than that in patients with EC typing Ⅰ ［（17±5）μmol/L vs （13±5）μmol/L］(all P<0.05). The incidence of MS in patients with EC typing Ⅰ was higher than that in patients with EC typing Ⅱ ［63.2%（79/125） vs 45.8%（11/24）］, and the incidence of menopause was lower than that in patients with EC typing Ⅱ ［68.8%（86/125） vs 91.7%（22/24）］(both P<0.05). There were no significant differences in menarche age, age of onset, body mass index, blood pressure, fasting blood glucose, triacylglycerol, total cholesterol, HDL-C, low-density lipoprotein cholesterol, and Hcy between pathological stage Ⅰ and stage Ⅱ-Ⅳ in patients with EC typing Ⅰ or typing Ⅱ respectively (all P>0.05). Conclusion The menarche age, body mass index, triacylglycerol, HDL-C, Hcy, MS, and menopausal state are correlated with EC Bokhman typing. However, those are not related to the different pathological stages of the same type of EC.