-
摘要:
目的 了解北京社区女性在生殖衰老过程中子宫大小的变化。 方法 对北京市某社区418名年龄30~68岁、符合STRAW+10分期标准的健康女性, 前瞻性随访5年。随访期间每天记录月经日记, 每年做一次盆腔超声检查以测量子宫大小, 并进行血清雌二醇(estradiol, E2)水平测定。 结果 基线时, 绝经后期早期+1a阶段起子宫各径线和体积开始缩小, +1c阶段继续缩小(P < 0.05), 绝经后期晚期无明显变化; 子宫内膜厚度从绝经后期早期+1a阶段开始变薄(P < 0.05), 此后并无明显变化; E2在绝经过渡期和绝经后2年内变异度较大, 与生育期相比, 差异均无统计学意义(P>0.05), 从+1c阶段才开始明显下降(P < 0.05), 绝经后期晚期虽有下降, 但与+1c阶段比较差异无统计学意义(P>0.05)。经过5年随访分期未改变者, 子宫仅部分径线在绝经后期早期+1c阶段和绝经后期晚期缩小(P < 0.05), 子宫内膜厚度均无明显变化, E2仅在绝经后期晚期进一步降低(P < 0.01), 余无明显变化。经过5年随访分期发生改变者, 子宫各径线和体积的显著变化发生于从各期转换至绝经后期早期+1a/+1b阶段, 或者从绝经过渡期转换至后续各阶段中; 内膜厚度的明显变化仅见于从绝经过渡期转换至后续阶段者; E2变化主要见于从绝经过渡期起的后续各阶段转换。子宫肌瘤从生育期转换到绝经过渡期有所增大(P < 0.01), 从绝经后期开始缩小, 但差异无统计学意义(P>0.05)。有子宫肌瘤者子宫体积的缩小主要发生于绝经后期早期, 此后无明显变化。 结论 子宫大小、子宫内膜厚度及E2的变化并不完全同步。子宫大小从绝经开始逐渐缩小, 变化时间较长; 子宫内膜厚度变薄主要发生在绝经后的起始阶段; E2在绝经过渡期和绝经2年内变异度较大, 直至绝经2年后才明显降低。 -
关键词:
- STRAW+10分期系统 /
- 子宫大小 /
- 子宫体积 /
- 子宫内膜厚度 /
- 子宫肌瘤
Abstract:Objective To investigate the change of uterine size in ovarian aging in women living in a Beijing community. Methods A total of 418 healthy women aged 30 to 68 years who could be staged by STRAW+10 staging system were recruited from a Beijing community and prospectively followed up for 5 years. Menstrual dairy was recorded daily by every woman during the research. Transvaginal ultrasonography was performed for measurement of uterine size at baseline and each year during the 5 years. Serum estradiol (E2) was tested as well. Results At baseline, various diameters and volume of uterus began to shrink significantly since the early post-menopausal stage+1a and shrank further at stage+1c (P < 0.05), while not changed much at late post-meno-pausal stage. The thickness of endometrium decreased from stage+1a (P < 0.05) and showed no significant change after that (P>0.05). E2 in menopausal transition and the first 2 years after menopause had a large variation that no significant difference was found comparing with reproductive stage (P>0.05). E2 level decreased significantly at stage+1c(P < 0.05) and kept at a low level at late postmenopausal stage, with no statistically significant difference compared with stage+1c (P>0.05). For women still at the same STRAW+10 stages after 5-year's follow-up, there was only decline in some diameters at early and late postmenopausal stages and no obvious change in endometrial thickness. E2 level only decreased in the late postmenopausal stage(P < 0.01). For women with stage progress after 5-year's follow-up, each line diameter and volume of the uterus changed significantly during transition to early postmenopausal stage +1a/+1b, or from menopausal transition stage to ensuing stages. Change in endometrial thickness was only found in those transformed since menopausal transition stage. E2 level changed mainly after menopausal transition stage. Uterine fibroids increased significantly during the transition from the reproductive stage to the menopausal transition stage (P < 0.01) and began to shrink after menopause but with no statistically significant difference(P>0.05). The decline in uterine volume in women with uterine fibroid was mainly observed at early postmenopausal stage, with no obvious change afterwards. Conclusions Uterine size, endometrial thickness, and E2 level do not change in synchronization. Uterine size shrinks during a rather long time since menopause, endometrial thickness begins to reduce mainly in the early stage after menopause. E2 in menopausal transition and the first 2 years after menopause has a big variation which does not decrease obviously until 2 years after menopause. -
Key words:
- STRAW+10 staging system /
- uterine size /
- uterine volume /
- thickness of endometrium /
- uterine fibroids
-
表 1 北京市某社区女性基线时不同年龄段STRAW+10分期
年龄段(岁) 生育期
-4/-3期绝经过渡期
-2/-1期绝经后期早期 绝经后期晚期
+2期合计 +1a阶段 +1b阶段 +1c阶段 30~34 4 1 0 0 0 0 5 35~39 24 8 0 0 0 0 32 40~44 30 33 0 0 0 0 63 45~49 37 59 3 1 5 0 105 50~54 3 40 23 15 33 6 120 55~59 0 2 1 1 24 22 50 ≥60 0 0 0 0 3 40 43 合计 98 143 27 17 65 68 418 STRAW:生殖衰老分期系统 表 2 北京市某社区女性基线时各期子宫径线与雌二醇水平x±s
分组 分期 例数 年龄
(岁)雌二醇
(pmol/L)子宫 纵径(cm) 横径(cm) 前后径(cm) 体积(cm3) 内膜厚度(cm) 总体 -4/-3 98 41.89±6.09 239.25±195.92 5.33±0.62 5.10±0.79 4.44±0.71 65.70±28.87 0.51±0.18 -2/-1 143 46.83±4.33 269.34±246.32 5.28±0.70 5.02±0.68 4.49±0.66 64.76±26.11 0.51±0.25 +1a 27 51.30±2.05 205.80±290.27 4.55±0.63* 4.37±0.54* 3.84±0.62* 41.07±16.50* 0.41±0.14* +1b 17 52.50±2.09 175.24±181.21 4.76±0.47* 4.53±0.44* 3.68±0.58* 42.31±13.50* 0.40±0.14* +1c 65 53.70±3.21 92.85±135.02*$^\dagger $ 3.98±0.72*$^\dagger $ 4.05±0.65* 3.00±0.76*$^\dagger $ 27.06±14.69*$^\dagger $ 0.35±0.25* +2 68 60.41±4.57 54.79±25.62*$^\dagger $ 3.75±0.66*$^\dagger $ 3.66±0.59*§ 2.71±0.60*$^\dagger $ 20.54±10.37*$^\dagger $ 0.33±0.20* A组 -4/-3 33 42.76±4.51 187.76±81.51 5.46±0.73 5.47±0.98 4.77±0.86 78.84±38.85 0.53±0.20 -2/-1 60 46.97±4.19 253.34±252.54 5.43±0.63 5.26±0.68 4.68±0.66 72.01±26.46 0.51±0.31 +1a 7 52.14±2.61 180.18±276.84 4.31±0.31* 4.07±0.28* 3.93±0.54* 40.25±7.72* 0.39±0.05* +1b 3 52.67±1.15 92.38± 9.92* 4.87±0.80 4.37±0.60* 3.97±0.60 45.42±19.86 0.31±0.23* +1c 10 53.60±3.53 67.12±31.04*$^\dagger $ 4.62±0.59* 4.60±0.62* 3.68±0.66* 41.73±16.10* 0.38±0.16* +2 6 58.50±1.64 40.33±35.43*$^\dagger $ 4.47±0.66* 4.32±0.48* 3.80±0.59* 34.70±11.77* 0.33±0.04* B组 -4/-3 65 42.23±4.71 263.12±234.46 5.26±0.55 4.90±0.58 4.27±0.54 58.79±18.79 0.50±0.17 -2/-1 83 46.21±4.30 287.16±254.44 5.16±0.74 4.83±0.62 4.33±0.62 58.72±24.38 0.51±0.19 +1a 20 51.31±0.75 196.32±307.87 4.68±0.73* 4.53±0.59* 4.85±0.68* 44.20±19.25* 0.42±0.17 +1b 14 53.57±1.90 159.03± 1.28 4.71±0.63* 4.60±0.39 3.56±0.58* 40.98±11.63* 0.43±0.10 +1c 55 52.57±2.66 90.04±113.68*$^\dagger $ 3.74±0.63*$^\dagger $ 3.85±0.55* 2.75±0.64*$^\dagger $ 21.63±9.77*$^\dagger $ 0.35±0.28* +2 62 59.45±4.23 57.32±29.35*$^\dagger $ 3.62±0.56*$^\dagger $ 3.54±0.53* 2.58±0.52*$\dagger $ 19.97±7.84*$^\dagger $ 0.33±0.23* A组:有子宫肌瘤者;B组:无子宫肌瘤者;与-4/-3期比较,*P < 0.05;与+1a/+1b阶段比较,$^\dagger $P < 0.05;与+1c阶段比较,§P < 0.05 表 3 北京市某社区女性基线和5年后随访时STRAW+10分期情况
基线时分期 随访时分期 合计 -4/-3 -2/-1 +1a/+1b +1c +2 -4/-3 16 67 10 5 0 98 -2/-1 0 53 35 55 0 143 +1a/+1b 0 0 0 40 0 40 +1c 0 0 0 22 47 69 +2 0 0 0 0 68 68 合计 16 120 45 122 115 418 STRAW:同表 1 表 4 随访5年分期未发生改变女性子宫各径线及雌二醇水平变化(n=159,x±s)
分期 例数 数据 雌二醇
(pmol/L)子宫 纵径(cm) 横径(cm) 前后径(cm) 体积(cm3) 内膜厚度(cm) -4/-3 16 基线 187.61±74.15 5.10±0.48 4.92±0.58 4.21±0.48 56.46±19.66 0.52±0.11 随访 264.03±266.07 5.08±0.42 4.74±0.42 4.33±0.50 55.33±16.37 0.56±0.11 差值 66.61±149.98 -0.01±0.27 0.15±0.49 0.17±0.35 -0.04±0.14 0.04±0.11 -2/-1 53 基线 262.20±206.09 5.29±0.63 4.98±0.54 4.40±0.51 62.01±19.83 0.51±0.15 随访 251.29±325.67 5.32±0.73 5.04±0.72 4.62±0.78* 69.23±33.02 0.53±0.12 差值 -10.91±244.09 0.03±0.61 0.05±0.67 0.22±0.70 6.92±29.81 0.02±0.18 +1c 22 基线 128.87±204.26 4.25±0.67 3.98±0.61 3.12±0.76 29.36±13.65 0.42±0.33 随访 32.68±28.44 3.61±0.50* 3.54±0.50* 2.97±0.49 20.69±8.09* 0.37±0.18 差值 -96.00±208.62 -0.65±0.58 -0.44±0.49 -0.19±0.66 -9.05±10.06 -0.04±0.16 +2 68 基线 54.82±25.66 3.75±0.67 3.66±0.59 2.71±0.60 20.54±10.37 0.33±0.20 随访 21.99±26.54** 3.32±0.49** 3.35±0.53** 2.75±0.50 17.04±8.37 0.32±0.09 差值 -32.17±26.86 -0.37±0.53 -0.22±0.47 0.04±0.53 -1.92±7.31 -0.01±0.23 与基线数据比较,*P < 0.05,* *P < 0.01;各项指标差值为随访检查结果减去基线检查结果的数值 表 5 随访5年后分期发生改变女性子宫的变化(n=259,x±s)
分期 例数 数据 雌二醇
(pmol/L)子宫 纵径(cm) 横径(cm) 前后径(cm) 体积(cm3) 内膜厚度(cm) -4/-3到-2/-1 67 基线 253.49±32.35 5.41±0.61 5.14±0.86 4.50±0.74 68.07±30.70 0.52±0.17 随访 302.90±373.39 5.47±0.83 5.16±0.95 4.77±0.95* 76.39±43.65 0.56±0.15 差值 49.37±413.76 0.07±0.70 -0.00±0.72 0.27±0.65 7.60±32.18 0.04±0.19 -4/-3到+1a/+1b 10 基线 230.54±132.20 5.49±0.79 4.99±0.68 4.68±0.67 68.94±27.58 0.51±0.31 随访 196.27±350.55 4.57±0.42* 4.24±0.51* 3.77±0.43* 38.86±10.31* 0.52±0.19 差值 -34.37±368.56 -0.82±0.82 -0.63±0.66 -0.80±0.60 -27.68±25.56 -0.03±0.42 -4/-3到+1c 5 基线 485.90±531.83 4.70±0.61 5.35±0.49 3.77±0.35 47.34±9.94 0.55±0.92 随访 35.76±30.96 3.83±0.35 3.53±0.45* 2.80±0.35 20.20±6.92 0.28±0.02* 差值 -450.8±510.86 -0.87±0.95 -1.80±0.14 -0.97±0.68 -26.03±19.33 -0.27±0.12 -2/-1到+1a/+1b 35 基线 296.50±235.81 5.39±0.83 5.16±0.70 4.57±0.68 69.37±30.12 0.53±0.26 随访 77.33±134.91* 4.53±0.69* 4.25±0.65* 3.81±0.58* 40.35±18.12* 0.45±0.14* 差值 -219.16±279.40 -0.86±0.70 -0.91±0.55 -0.77±0.48 -29.02±22.12 -0.08±0.26 -2/-1到+1c 55 基线 256.57±78.15 5.17±0.68 4.97±0.79 4.51±0.80 63.71±28.62 0.49±0.33 随访 36.01±54.39* 4.01±0.70* 3.87±0.87* 3.36±0.82* 30.74±26.18* 0.36±0.06* 差值 -220.55±276.55 -1.11±0.58 -1.06±0.61 -1.06±0.56 -30.56±16.82 -0.07±0.13 +1a/+1b到+1c 40 基线 196.76±252.39 4.60±0.58 4.40±0.50 3.77±0.60 40.87±15.23 0.43±0.14 随访 30.30±29.10* 3.76±0.49* 3.61±0.40* 3.03±0.44* 22.32±8.63* 0.32±0.05* 差值 -166.46±242.18 -0.88±0.51 -0.84±0.41 -0.77±0.47 -19.68±11.39 -0.10±0.15 +1c到+2 47 基线 76.86±87.36 3.80±0.72 4.10±0.69 2.92±0.77 25.50±15.46 0.31±0.16 随访 25.80±22.40* 3.46±0.46* 3.46±0.50* 2.87±0.44 18.65±7.37* 0.31±0.07 差值 -51.06±93.91 -0.31±0.66 -0.65±0.50 -0.01±0.58 -6.46±10.87 -0.00±0.15 与基线数据比较,*P < 0.05;各项指标差值为随访检查结果减去基线检查结果的数值 表 6 随访5年后分期发生改变女性子宫肌瘤的变化(n=119,x±s)
分期转变 例数 数据 雌二醇(pmol/L) 子宫 纵径(cm) 横径(cm) -4/-3到-2/-1 67 基线 253.49±221.14 2.11 ±1.00 1.80 ±0.91 随访 302.90±373.39 2.33±1.09* 2.10±1.05* 差值 >43.74±413.76 0.76±1.04 0.81±0.98 -4/-3到+1 7 基线 117.56±157.02 2.15±0.85 1.73±0.79 随访 68.26±96.95 1.80±0.47 1.63±0.50 差值 -49.30±118.07 -0.35±0.52 -0.10±0.47 -2/-1到+1 39 基线 250.56±212.94 2.08±1.18 1.90±1.16 随访 37.73±59.22* 2.01±1.23 1.82±1.28 差值 -212.87±228.53 -0.21±0.94 -0.15±0.88 +1到+2 6 基线 51.53±25.77 2.30±1.20 2.43±0.55 随访 23.72±27.60 1.77±0.21 1.70±0.20 差值 -27.82±44.18 -0.53±0.84 -0.73±0.49 与基线数据比较,*P < 0.01;各项指标差值为随访检查结果减去基线检查结果的数值 -
[1] Wong JY, Gold EB, Johnson WO, et al. Circulating Sex Hormones and Risk of Uterine Fibroids:Study of Women's Health Across the Nation (SWAN)[J]. J Clin Endocrinol Metab, 2016, 101:123-130. doi: 10.1210/jc.2015-2935 [2] Szoeke CE, Robertson JS, Rowe CC, et al. The Women's Healthy Ageing Project:fertile ground for investigation of healthy participants 'at risk' for dementia[J]. Int Rev Psychiatry, 2013, 25:726-737. doi: 10.3109/09540261.2013.873394 [3] Freeman EW, Sammel MD, Sanders RJ. Risk of long-term hot flashes after natural menopause:evidence from the Penn Ovarian Aging Study cohort[J]. Menopause, 2014, 21:924-932. doi: 10.1097/GME.0000000000000196 [4] 王亚平, 陈蓉, 林守清.卵巢衰老过程中血清性激素和卵巢大小的变化[J].协和医学杂志, 2016, 3:161-167. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xhyx201603001 [5] Harlow SD, Gass M, Hall JE, et al. Executive summary of the stages reproductive aging Workshop+10:addressing unfinished agenda of staging reproductive aging[J]. Menopause, 2012, 19:387-395. doi: 10.1097/gme.0b013e31824d8f40 [6] 陈蓉, 林守清.构建中的生殖衰老分期——生殖衰老分期+10专题研讨会总结摘译[J].中国实用妇科与产科杂志, 2012, 28:713-715. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyfkyckzz201209024 [7] Pirhonen JP, Vuento MH, Mäkinen JI, et al. Long-term effects of hormone replacement therapy on the uterus and on uterine circulation[J]. Am J Obstet Gynecol, 1993, 168:620-630. doi: 10.1016/0002-9378(93)90506-E [8] 林守清, 林萍, 姜玉新.绝经后卵巢和子宫萎缩及血雌二醇降低的观察[J].中国妇产科杂志, 1997, 32:524-527. http://www.cnki.com.cn/Article/CJFDTotal-ZHDB199719019.htm [9] 吴鸣, 沈铿, 郎景和.绝经后子宫出血与子宫内膜癌的相关因素分析[J].中华妇产科杂志, 2005, 40:487-488. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfck200507017 [10] Committee on Gynecologic Practice, Society of Gynecologic Oncology. The American College of Obstetricians and Gynecologists Committee Opinon no.631:endometrial intraepithelial neoplasia[J]. Obstet Gynecol, 2015, 125:1272-1278. doi: 10.1097/01.AOG.0000465189.50026.20 [11] 王良岸, 杨冬梓, 谢梅青.测量子宫内膜厚度对HRT中不规则出血的检测作用[J].实用医学杂志, 2003, 19:986-988. http://www.cnki.com.cn/Article/CJFDTotal-SYYZ200309023.htm [12] El Khoudary SR, McClure CK, VoPham T, et al. Longitudinal assessment of the menopausal transition, endogenous sex hormones, and perception of physical functioning:the Study of Women's Health Across the Nation[J].J Gerontol A Biol Med Sci, 2014, 69:1011-1017. doi: 10.1093/gerona/glt285 [13] Duhan N. Current and emerging treatments for uterine myoma-an update[J]. Int J Womens Health, 2011, 3:231-241. http://www.dovepress.com/current-and-emerging-treatments-for-uterine-myoma-ndash-an-update-peer-reviewed-article-IJWH [14] Sabry M, Al-Hendy A. Medical treatment of uterine leiomyoma[J]. Reprod Sci, 2012, 19:339-353. doi: 10.1177/1933719111432867 [15] Parker WH. Etiology, symptomatology, and diagnosis of ute-rine myomas[J]. Fertil Steril, 2007, 87:725-736. doi: 10.1016/j.fertnstert.2007.01.093
计量
- 文章访问数: 280
- HTML全文浏览量: 75
- PDF下载量: 8
- 被引次数: 0