| Objective:To analyse the pathological and clinical features of perimenopausal abnormal uterine bleeding and Chinese medicine patterns,to explore the utility of endometrial thickness in assessing endometrial pathological types and the influencing factors of endometrial lesions and the distribution characteristics of Chinese medicine patterns,with a view to providing theoretical references for the prevention and diagnosis and treatment of perimenopausal abnormal uterine bleeding with endometrial malignant lesions.Method:One hundred and twenty patients with perimenopausal abnormal uterine bleeding who were admitted to the inpatient gynecology department of Hebei Provincial Hospital of Traditional Chinese Medicine from September 2020 to September 2021 were selected,and were divided into 54 cases in Group A(normal endometrium)and 66 cases in Group B(abnormal endometrium)according to the type of endometrial pathology.Group B was subdivided into53 cases in group B1(non-precancerous and non-cancerous)and 13 cases in group B2(precancerous and cancerous)according to the presence or absence of precancerous and cancerous lesions.Clinical data such as age,pregnancy,delivery,BMI,vaginal ultrasonography results(including endometrial thickness and endometrial echogenicity),pathological results,and Chinese medicine certificates were counted in each group.SPSS23.0 statistical software was used for data analysis.Measurement data that conformed to normal distribution were described by mean ± standard deviation and t-test was used;those that did not conform to normal distribution were expressed by median and rank sum test was used.Count data were described by constitutive ratios,using the chi-square test or Fisher’s exact probability method.Diagnostic tests were used to derive ROC curves,cut-off values,sensitivity and specificity of endometrial thickness for predicting endometrial pathology.Result:1 Distribution of pathology in groups A and B:1.1 Group A had 54 cases(45%)of 38(31.7%)proliferative endometrium,14(11.7%)secretory endometrium and 2(1.6%)atrophic endometrium.1.2 Group B consisted of 66 cases(55%)of 27 cases(22.5%)without atypical endometrial hyperplasia,16 cases(13.3%)of endometrial polyps,9cases(7.5%)of endometrial carcinoma,7 cases(5.8%)of submucosal leiomyoma,4 cases(3.4%)of atypical endometrial hyperplasia and 3 cases(2.5%)of endometritis.2 Diagnostic value of endometrial thickness in predicting the type of endometrial pathology using group A as the reference population:2.1 The working curve for the subjects showed that the area under the curve for endometrial thickness to assess the type of abnormal endometrial pathology was 0.705(95% CI = 0.615-0.785;P<0.05).2.2 An endometrial thickness of 0.8 cm was the best cut-off value for assessing abnormal endometrium,corresponding to a sensitivity and specificity of 86.3 per cent and 55.6 per cent,respectively.3 Comparison of clinical characteristics between groups B1 and B2:A one-way comparison of age,number of pregnancies,BMI and vaginal ultrasound results between the two groups showed that the mean age was higher in group B2 compared with group B1(49.46 vs 45.36;P<0.05);the mean number of pregnancies was less in group B2(1 vs 3;P<0.05);the mean BMI was higher in group B2(25.66 kg/m2 vs 22.88 kg/m2;P <0.05);the mean endometrial thickness was higher in group B2(1.13 cm vs 0.94 cm;P<0.05);and the rate of endometrial echogenicity was higher in group B2(61.53% vs 22.64%;P<0.05).Statistical differences existed in the above indicators between the two groups.4 Distribution and comparison of TCM evidence types in groups B1 and B2:4.1 Distribution of Chinese medicine types in group B1: 20 cases(37.7%)with spleen deficiency,18 cases(34.0%)with kidney deficiency,10 cases(18.9%)with blood-heat syndrome and 5 cases(9.4%)with blood stasis syndrome.4.2 Distribution of TCM patterns in Group B2: 6 cases(46.1%)with spleen deficiency,5 cases(38.5%)with blood stasis,1 case(7.7%)with kidney deficiency and 1 case(7.7%)with blood heat.4.3 There was a statistical difference in the distribution of TCM evidence in groups B1 and B2(X2 =8.166;P<0.05). |
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