Growth of uterine leiomyomata among premenopausal black and white women
Growth of uterine leiomyomata among premenopausal black and white women
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DOI：
10.1073/pnas.0808188105
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发表时间：
2008-12-16
影响因子：
11.1
通讯作者：
Baird, Donna Day
中科院分区：
文献类型：
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作者：
Peddada, Shyamal D.;Laughlin, Shannon K.;Baird, Donna Day
子宫肌瘤(肌瘤)是美国子宫切除术的主要原因。黑人女性的肌瘤负担比白人更重，但还没有研究系统地评估黑人和白人的肌瘤生长情况。我们前瞻性地跟踪了72名绝经前参与者(38名黑人和34名白人)262个肌瘤(大小范围：1-13厘米)的生长情况。肌瘤体积是通过计算机分析在12个月内最多四次MRI扫描来测量的。我们使用混合效应模型来确定与生长相关的因素，并将结果转换为每6个月临床相关性的百分比变化。中位数增长率为9%(范围：-89%至+138%)。7%的肌瘤消退(缩水20%)。同一女性的肿瘤以不同的速率增长(女性内部变异成分是女性变异成分的两倍；两者都很显著，P<；0.001)。年龄在35岁以下的黑人和白人女性的肌瘤生长速度相似。然而，白人的增长率随着年龄的增长而下降，而黑人的增长率则没有下降(P=0.05)。6个月内肿瘤生长超过20%的几率在白人中也随着年龄的增长而降低，但在黑人中则不是(P<；0.01)。生长速度不受肿瘤大小、位置、体重指数或胎次的影响。我们得出的结论是：(I)肌瘤的自发消退发生；(Ii)同一女性的肌瘤生长速度不同，尽管激素环境相同；(Iii)肌瘤大小不能预测生长速度；以及(Iv)黑人和白人之间肌瘤生长的年龄差异可能导致黑人女性的症状负担更高。
Uterine leiomyomata (fibroids) are the leading cause of hysterectomy in the United States. Black women have a greater fibroid burden than whites, yet no study has systematically evaluated the growth of fibroids in blacks and whites. We prospectively tracked growth for 262 fibroids (size range: 1-13 cm in diameter) from 72 premenopausal participants (38 blacks and 34 whites). Fibroid volume was measured by computerized analysis of up to four MRI scans over 12 months. We used mixed effects models to identify factors that are associated with growth, and results were converted to percent change per 6 months for clinical relevance. The median growth rate was 9% (range: -89% to +138%). Seven percent of fibroids regressed (> 20% shrinkage). Tumors from the same woman grew at different rates (within-woman component of variation was twice the component among women; both were significant, P < 0.001). Black and white women less than 35 years of age had similar fibroid growth rates. However, growth rates declined with age for whites but not for blacks (P = 0.05). The odds of a tumor growing more than 20% in 6 months also decreased with age for whites but not for blacks (P < 0.01). Growth rates were not influenced by tumor size, location, body mass index, or parity. We conclude that (i) spontaneous regression of fibroids occurs; (ii) fibroids from the same woman grow at different rates, despite a uniform hormonal milieu; (iii) fibroid size does not predict growth rate; and (iv) age-related differences in fibroid growth between blacks and whites may contribute to the higher symptom burden for black women.