摘要
目的探讨亚高原地区异常子宫出血(abnormal uterine bleeding,AUB)住院患者的临床特点,并分析影响其治疗方法的因素。方法选取2018年1月1日至2022年12月31日期间,在云南省永平县人民医院(平均海拔1620米的亚高原地区)住院治疗的AUB患者。总结患者的一般临床特征,将患者按FIGO推荐的病因分类指南分为2大类(有或无子宫结构性病变)9个亚型(PALM-COEIN),在此基础上,分别针对汉族和少数民族、药物保守治疗和手术治疗、有输血和未输血,采用二元Logistic回归分析影响治疗方法的因素。结果共纳入481例AUB患者,延迟就诊率高达80.46%,超重及肥胖比例为49.90%,高于我国女性平均水平。病因以异常子宫出血-排卵障碍(AUB-ovulatory dysfunction,AUB-O)最为常见(78.59%),延迟就诊患者手术治疗比例高于未延迟就诊患者(82.17%vs.74.47%),输血患者的年龄、血红蛋白(hemoglobin,HGB)水平、妊娠次数和BMI均显著低于未输血患者(P<0.05)。单因素分析显示,手术治疗组的年龄、发病时间、HGB水平、孕次/产次、BMI、汉族患者比例、无输血比例、高血压患病率和子宫结构性病变比例均高于药物保守治疗组。多因素回归分析发现,有输血治疗降低了手术治疗的概率。年龄和子宫结构性病变是需要手术治疗的高危因素,回归分析显示患者年龄每增加1岁,进行手术治疗的风险增加10%。患者有子宫结构性病变需要手术治疗的风险是无子宫结构性病变的2.987倍。结论该亚高原地区AUB患者的延迟就诊率高,超重及肥胖比例高,AUB-O为主要病因,年龄较大和存在子宫结构性病变的患者是需要手术治疗的高危因素。
Objective To investigate the clinical characteristics of women with abnormal uterine bleeding(AUB)in sub-plateau regions and analyze the factors affecting their treatment methods.Methods AUB patients who were hospitalized from Jan 1,2018 to Dec 31,2022,in a sub-plateau region(Yongping County People’s Hospital of Yunnan Province)with an average altitude of 1620 meters were selected.The general clinical characteristics of the patients were summarized,and patients were classified into two categories(with or without uterine structural lesion)and nine subtypes(PALM-COEIN)according to the FIGO recommended etiological classification guidelines.Then the patients were divided into groups based on the presence or absence of uterine structural lesions,ethnic group(Han and minority),conservative drug treatment and surgical treatment groups,blood transfusion and non-blood transfusion groups.Binary Logistic regression analysis was used to identify factors affecting treatment methods.Results A total of 481 AUB patients enrolled,and the delayed consultation rate was as high as 80.46%,and the proportion of overweight and obese patients was 49.90%,which was higher than the average level among Chinese women.The main cause was AUB-O(AUB-ovulatory dysfunction),accounting for 78.59%of cases,the proportion of patients with delayed medical treatment was higher than those without delayed medical treatment(82.17%vs.74.47%).Patients who received blood transfusion were significantly younger,had lower hemoglobin(HGB)levels,fewer pregnancies,and lower BMI compared to those in the non-blood transfusion group(P<0.05).Univariate analysis showed that the surgical treatment group had older age,longer onset time,higher HGB levels,more pregnancies and deliveries,higher BMI,a higher proportion of Han ethnicity patients,lower rates of non-blood transfusion,higher rates of hypertension,and more uterine structural lesions compared to the conservative drug treatment group.Multivariate regression analysis revealed that blood transfusion treatment reduced the probability of surgical treatment.Age and uterine structural lesions were risk factors for requiring surgical treatment,for each additional year of age,the risk of undergoing surgical treatment increased by 10%.The risk of requiring surgical treatment for patients with uterine structural lesions was 2.987 times higher than for those without.Conclusion AUB patients in this sub-plateau regions have a high rate of delayed consultation and a high proportion of overweight and obesity,with AUB-O being the primary cause.Older age and the presence of uterine structural lesions were risk factors for requiring surgical treatment.
作者
杜丹峰
王茹娟
茶荣裙
蒋萍
王李芹
陈希
杨丽娜
吴志勇
DU Dan-feng;WANG Ru-juan;CHA Rong-qun;JIANG Ping;WANG Li-qin;CHEN Xi;YANG Li-na;WU Zhi-yong(Department of Gynecology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Department of Obstetrics and Gynecology,Yongping County People’s Hospital,Dali Bai Autonomous Prefecture 672600,Yunnan Province,China;Department of Gynecology,Obstetrics and Gynecology Hospital,Fudan University,Yangtze River Delta Integration Demonstration Zone(Qingpu),Shanghai 201713,China)
出处
《复旦学报(医学版)》
北大核心
2025年第3期408-415,423,共9页
Fudan University Journal of Medical Sciences
基金
云南省永平县人民医院吴志勇专家基层科研工作站项目(2022.11-2025.11)
上海市青浦区卫健委第五轮学科人才专项-高峰学科项目(GF2023-3)
名医项目(MY2023-3)。
关键词
异常子宫出血(AUB)
亚高原
延迟就诊
治疗
abnormal uterine bleeding(AUB)
sub-plateau
delayed consultation
treatment
