Effects Of Different Interventions And Disease Cognition On The Long-term Prognosis Of Endometrial Hyperplasia

Objective : To analyze the relationship between different interventions,disease cognition and prognosis and to investigate the factors affecting the long-term outcomes in endometrial hyperplasia patients through the follow-up.Methods: A total of 197 cases pathologically diagnosed with endometrial hyperplasia after D&C or hysteroscopy in the department of obstetrics and gynecology of the General Hospital of Tianjin Medical University from July 2002 to December 2016 were collected.The patients were followed up for 3-17 years(median 9 years).The follow-up contents included the general condition(age,gravidity,parity,height,weight),the previous history(history of DM or IR,HBP,dyslipidemia,PCOS),treatment modes(oral progesterone,oral progesterone+LNG-IUS,oral progesterone+endometrial lesion resection),metformin/weight loss,disease cognition(lower,higher),prognosis(recovery,persistence,progression,relapse)and pregnancy outcomes of young women with desire for fertility.According to different intervention patterns and disease cognition,the patients were divided into different groups and analyzed statistically.Results:1.Of the 197 cases,the average age was(37.82±9.05)years old;overweight patients accounted for 64.5%(127/197);patients with hypertension accounted for 12.7%(25/197);patients with DM or IR accounted for 21.3%(42/197);patients with dyslipidemia accounted for 4.1%(8/197);for education level junior high school or below accounted for 23.9%(47/197),technical secondary school or senior high school accounted for 21.3%(42/197),college and above accounted for 54.8%(108/197);EH accounted for 73.6%(145/197)and AH accounted for 29.7%(52/175).22 were untreated and the rate of recovery was 90.9%(20/22),1 was persistence,1 was progression.2.Progesterone combined with LNG-IUS or endometrial lesion resection could improve the cure rate compared with progesterone only(93.8%/85.7%vs53.5%),the difference was statistically significant(P = 0.000).The cure rate of patients with weight loss was significantly higher than that of patients without weight loss(80.0%vs58.7%),the difference was statistically significant(P = 0.025).The cure rate of patients with better disease cognition was higher than that of poor cognition(73.9% vs 57.0%),the difference was statistically significant(P = 0.013)3.To analyze the impact of multiple clinical indicators such as treatment modes,metformin treatment/weight loss and disease cognition on the prognosis of endometrial hyperplasia.The Chi-square test showed that diabetes or insulin resistance(χ~2 = 5.671,P = 0.017),treatment mode(χ~2 = 21.175,P = 0.000),disease cognition(χ~2 = 10.643,P = 0.001)were statistically significant.Multivariate logistic regression analysis showed that patients without diabetes or insulin resistance(OR 0.326,95%CI:0.143-0.747,P=0.008),with the treatment mode of progesterone combined with LNG-IUS or endometrial lesion resection and(OR 0.110,95%CI:0.025-0.496,P=0.004;OR 0.185,95%CI:0.037-0.922,P=0.039)and with better disease cognition(OR 0.394,95%CI:0.192-0.810,P=0.011)can improve the prognosis of endometrial hyperplasia.4.According to the analysis of the characteristics of patients with different degrees of disease cognition,it was found that people with younger age(χ~2=4.226,P=0.000),no hypertension(χ~2=6.899,P=0.009),no diabetes or insulin resistance(χ~2=6.619,P=0.010),higher Education(χ~2=25.579,P=0.000),and severe hyperplasia(χ~2=8.041,P=0.005)had better cognition of disease.Binary logistic regression analysis showed that the high education level had better disease cognition(OR=3.911,95%CI:1.684～9.082,P=0.002).5.After conservative treatment of 74 patients with desire for fertility,the total pregnancy rate was 60.8%(45/74)and the total live birth rate was 52.7%(39/74).Among 49 cases of endometrial hyperplasia without atypia,the pregnancy rate was 65.3%(32/49)and the live birth rate was 59.2%(29/49);25 cases of atypical hyperplasia,the pregnancy rate was 52.0%(13/25)and the live birth rate was 40.0%(10/25).Multivariate logistic regression analysis showed that BMI < 28 kg / m2 and assisted reproductive technology could improve the pregnancy rate of patients with endometrial hyperplasia(OR=5.227,95%CI:1.478-18.480,P=0.010;OR=4.503,95%CI:1.454-13.948,P=0.009).Conclusion:1.No diabetes or insulin resistance,progesterone combined with LNG-IUS or endometrial lesion resection,and better disease cognition can improve the prognosis of endometrial hyperplasia.2.Weight loss can significantly improve the cure rate of endometrial hyperplasia patients in overweight or obese.3.The patients with high education level have better disease cognition.4.The patients with BMI<28 kg/m2 can improve the pregnancy rate by assisted reproductive technology.