有机溶剂暴露条件下子宫内膜增生的特征

I. Marinkin, L. Shpagina, E. S. Lisova, I. Shpagin, O. Kotova, G. Kuznetsova, E. Loktin, S. Karmanovskaya
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摘要

目的:探讨肥胖患者有机溶剂暴露条件下子宫内膜增生的临床及分子特征。材料和方法:将绝经后子宫内膜增生(形态学标准)的妇女纳入观察性横断面研究。主要组包括140名职业性有机溶剂暴露者,年龄57,5(46;64)岁,其中肥胖70人,体重正常70人。对照组:140名无职业健康风险的妇女,年龄56,5(46;65)岁,68名有肥胖,72名无肥胖。调查对象为机械制造行业油漆工,服务年限在10年以上,接触后持续1 ~ 5年的29人(20.7%)。工作场所的有机溶剂浓度是职业接触限值的1.5-5.5倍。使用线性和逻辑回归来探索关系。显著性水平p<0.05。结果:接触有机溶剂的工人不典型子宫内膜增生比例最高:肥胖组34.3%,非肥胖组18.6%;对照组肥胖组10.3%,非肥胖组6.9%,p=0.004。肥胖中毒亚组Ki-67表达最高(分别为55、9±2、51、51、4±4、95、41、5±3、29和30、1±2、18分),子宫出血率、m回声厚度、血白细胞介素1β浓度较高。不典型子宫内膜增生与工作年限(OR 1.80)、甲苯最大短期暴露浓度(OR 2.51)、腰围(OR 1.68)、Ki-67 (OR 2.1)、上皮雌激素受体(OR 1.92)相关。结论:有机溶剂暴露于绝经后子宫内膜增生的妇女有助于不典型增生、全身性炎症、Ki-67表达的发展,肥胖受试者的程度更高。
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Endometrial hyperplasia features in conditions of organic solvents exposure
Objective: to establish clinical and molecular features of endometrial hyperplasia in conditions of organic solvents exposure in patients with obesity. Materials and methods: postmenopausal women with endometrial hyperplasia (morphological criteria) were included to observational cross-sectional study. The main group included 140 subjects with occupational organic solvents exposure, aged 57,5 (46;64) years, of whom 70 had obesity and 70 had normal weight. Comparison group — 140 women without of occupational health risks, aged 56,5 (46;65) years, 68 with and 72 without obesity. Investigated workers were painters in machine building industry with length of service above 10 years, in post-contact period lasted for 1-5 years were 29 (20.7%) of participants. Organic solvents concentrations at the workplace’s areas were 1.5-5.5 times above occupational exposure limits. Linear and logistic regression were used to explore relationships. Level of significance p<0.05. Results: workers exposed to organic solvents had maximal percent of atypical endometrial hyperplasia: 34.3% in obesity subjects and 18.6% in those without obesity, in the comparison group 10.3% in subjects with and 6.9% in those without obesity, p=0.004. Subgroup with toxicant exposure with obesity characterized by maximal expression of Ki-67 (55,9±2,51, 51,4±4,95, 41,5±3,29 and 30,1±2,18 scores respectively), higher rate of uterine bleeding, M-echo thickness, blood interleukin 1β concentration. Atypical endometrial hyperplasia was associated with length of service (OR 1.80), maximal short-term exposure concentration of toluene (OR 2.51), waist circumference (OR 1.68), Ki-67 (OR 2,01), estrogen receptors on epithelium (OR 1.92). Conclusions: organic solvents exposure in postmenopausal women with endometrial hyperplasia contributes to development of atypical hyperplasia, systemic inflammation, Ki-67 expression, higher grades in subjects with obesity.
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