[Analyze of obesity indicators and effect of fertility preservation treatment in patients with endometrial atypical hyperplasia and early endometrial cancer].

Objective: To investigate the clinical features of obesity indicators in patients with endometrial atypical hyperplasia (EAH) and early endometrial cancer (EC) and analyze the relationship between these indexes and effect of fertility preservation therapy. Methods: The clinical data of patients with EAH, EC and endometrial benign lesions treated in Peking University People's Hospital from January 1, 2018 to June 30, 2021 who required fertility-sparing treatment were collected, and obesity indicators were calculated and analyzed retrospectively. Results: (1) Obesity indicators: the obesity [body mass index (BMI) ≥28 kg/m2] rate of patients with fertility preservation treatment was 40% (32/80), and abdominal obesity [waist circumference (WC) ≥80 cm] rate was 79% (63/80), and obesity indicators [BMI, WC, waist-hip ratio (WHR), weight height ratio (WHTR), body roundness index (BRI), lipid accumulation index (LAP), visceral adiposity index (VAI)] were higher than those with endometrial benign lesions (all P<0.001). (2) Related factors affecting the efficacy of fertility preservation treatment and their predictive value: EC, higher BMI, WC, WHR, WHTR and BRI were risk factors for lower complete remission rate after nine months' treatment (all P<0.05). The predictive values of BRI and WHTR combined with pathological type were superior to other indicators [area under the curve (AUC)=0.716; AUC=0.714]. (3) Relation of obesity indicators and glucolipid indicators:BMI, WC, WHR, WHTR, BRI, LAP and VAI were positively correlated with homeostasis model assessment-insulin resistance index, glycosylated hemoglobin, and triacylglycerol (all P<0.05); while VAI was negatively correlated with high density lipoprotein cholesterol (P<0.001). Conclusions: For patients with EAH and EC treated with fertility preservation therapy, abnormal obesity indexes affect the treatment effect. BRI and WHTR combined pathology have good predictive value for effect of fertility preservation treatment. In clinical practice, appropriate indicators could be selected to evaluate body shape, glucolipid metabolism and predict efficacy.目的： 探讨子宫内膜非典型增生（EAH）和早期子宫内膜癌（EC）保留生育功能治疗患者的肥胖指标特征，并分析肥胖指标与疗效的关系。 方法： 选择2018年1月1日至2021年6月30日就诊于北京大学人民医院行保留生育功能治疗的EAH和早期EC患者各40例（分别为EAH组和EC组），收集同期收治的子宫内膜良性病变患者40例作为对照（对照组）。回顾性分析3组患者的临床病理资料并计算肥胖指标，分析肥胖指标与保留生育功能治疗疗效及糖脂代谢指标的关系。 结果： （1）肥胖指标：80例保留生育功能治疗的EAH和早期EC患者中，肥胖［体质指数（BMI）≥28 kg/m2］的发生率为40%（32/80），腹型肥胖（腰围≥80 cm）的发生率为79%（63/80）。EAH组、EC组患者的肥胖指标包括BMI、腰围、腰臀比、腰高比、身体圆度指数（BRI）、脂质蓄积指数（LAP）、内脏脂肪指数（VAI）均显著高于对照组（P均<0.001）。（2）影响保留生育功能治疗疗效的相关因素及其预测疗效的价值：病理类型为EC及BMI、腰围、腰臀比、腰高比、BRI 5项肥胖指标高是保留生育功能治疗9个月后完全缓解（CR）率低的危险因素（P均<0.05），BRI和腰高比分别联合病理类型对保留生育功能治疗疗效的预测价值中等［曲线下面积（AUC）分别为0.716、0.714］。（3）肥胖指标与糖脂代谢指标的相关性：BMI、腰围、腰臀比、腰高比、BRI、LAP和VAI与稳态模型的胰岛素抵抗指数、糖化血红蛋白、三酰甘油水平均呈显著正相关（P均<0.05），VAI与高密度脂蛋白胆固醇呈显著负相关（P<0.001）。 结论： 对于保留生育功能治疗的EAH和EC患者，肥胖指标异常影响疗效，BRI和腰高比联合病理类型对保留生育功能治疗疗效的预测价值较好，临床中可选择适当的指标评估体型、预测疗效和评估糖脂代谢。.