摘要目的 分析醋酸甲地孕酮治疗子宫内膜不典型增生(EAH)的临床效果及患者妊娠结局.方法 选取2011年1月至2017年1月于郑州大学第一附属医院治疗的EAH患者93例,回顾性分析其临床资料.93例EAH患者中轻度45例,中度28例,重度20例,治疗期间每3个月行宫腔镜检查+诊刮术复查,随访2年,评估其临床疗效及有生育要求的患者妊娠情况,分析妊娠的相关因素.结果 治疗后,93例EAH患者中85例有效,总有效率为91.3％(85/93),轻度和中度者总有效率高于重度者(χ2=14.87、4.38,P均<0.05).2年内试孕或采用辅助生殖技术的65例患者中,30例成功妊娠,妊娠率为46.15％(30/65),22例获得活产儿,生育率为33.84％(22/65).患者妊娠结局与年龄、不孕症史、多囊卵巢综合史、治疗时间、子宫内膜病理分级、胰岛素抵抗、肿瘤家族史无关(P>0.05),体质指数(BMI)、辅助生殖技术是妊娠结局的影响因素(P<0.05).结论 醋酸甲地孕酮保守治疗子宫内膜不典型增生效果可靠,妊娠率较高,而采用辅助生殖技术及BMI<30 kg/m2可提高妊娠率,获得较满意的妊娠结局.

abstractsObjective To analyze the clinical effect of megestrol acetate in the treatment of endometrial atypical hyperplasia ( EAH) and the pregnancy outcome of patients .Methods Ninety-three patients with EAH who were treated at the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2017 were retrospectively analyzed .Of the 93 patients with EAH , 45 cases were mild , 28 cases were moderate , and 20 cases were severe .During the treatment , hysteroscopy and diagnosis were performed every 3 months.After 2 years of follow-up, the clinical efficacy and pregnancy status of patients with fertility requirements were evaluated , and the factors related to pregnancy were analyzed . Results After treatment, 85 of 93 patients with EAH were effective , with a total effective rate of 91.3％(85/93).The total effective rate were higher in mild and moderate patients than that in severe cases (χ2 =14.87, 4.38, P<0.05).Of the 65 patients who were pregnant or who used assisted reproductive technology within 2 years, 30 cases had a successful pregnancy , the pregnancy rate was 46.15％(30/65), and 22 patients were born alive.The fertility rate was 33.84％ (22/65).The pregnancy outcome was not related to age , history of infertility , comprehensive history of polycystic ovary , treatment time, endometrial pathological grade, insulin resistance, and family history of tumor (P>0.05), but body mass index ( BMI ) and assisted reproductive technology were the influencing factors of pregnancy outcome ( P<0.05 ) .Conclusions The preventive treatment of endometrial atypical hyperplasia with megestrol acetate is reliable and the pregnancy rate is high .The use of assisted reproductive technology and BMI <30 kg/m2 can improve the pregnancy rate and pregnancy outcome .