摘要
目的分析低雌激素妇女心血管疾病高危因素及骨密度状况。方法回顾性分析2011年7月至2013年4月就诊于山西医科大学第一医院妇产科门诊的低雌激素妇女256例，分为绝经后组（133例）、卵巢早衰组（25例）、绝经过渡期组（67例）、卵巢早衰过渡期组（31例）。比较4组患者绝经年限（仅包括绝经后组和卵巢早衰组）、绝经症状程度、心血管疾病高危因素（体质指数、血压、腰围、腰臀比、血脂和血糖水平）、骨密度等指标。结果（1）绝经后组和卵巢早衰组中位绝经年限分别为3．4和3．6年，两组间比较，差异无统计学意义（P〉0．05）；绝经症状程度的中位Kupperman评分绝经后组、卵巢早衰组、绝经过渡期组、卵巢早衰过渡期组分别为12、9、9、8分，4组问比较，差异有统计学意义（P〈0．05）。（2）4组间体质指数、腰围、腰臀比、舒张压比较，差异无统计学意义（P〉0．05）；中位收缩压绝经后组、卵巢早衰组、绝经过渡期组、卵巢早衰过渡期组分别为120、110、110、110mmHg（1mmHg=0．133kPa），4组问比较，差异有统计学意义（P〈0．05）；绝经后组中位高密度脂蛋白（1．6mmol／L）高于卵巢早衰组（1．3mmol／L），差异有统计学意义（P〈0．05）；4组间空腹血糖比较，差异无统计学意义（P〉0．05）。（3）绝经后组、卵巢早衰组、绝经过渡期组、卵巢早衰过渡期组（4组进行骨密度相关指标检测的患者分别为81、15、28、19例）腰椎骨量低下比例分别为57％（46／81）、8／15、32％（9／28）、12／19，骨质疏松症比例分别为9％（7／81）、3／15、11％（3／28）、0，2项指标4组问分别比较，差异均有统计学意义（P〈0．05）；左侧髋骨、腰椎骨密度异常率卵巢早衰组（分别为11／15、12／16）高于绝经后组[均为65％（53／81）]，卵巢早衰过渡期组（分别为12／19、10／20）高于绝经过渡期组[43％（12／28）、39％（12／31）]，分别比较，差异均有统计学意义（P〈0．05）。结论自然绝经后妇女因低雌激素引发的绝经症状最明显；绝经后骨密度的降低腰椎比左侧髋骨明显。早绝经比正常绝经妇女易发生血脂改变和骨密度异常，尤以高密度脂蛋白的降低明显，更易导致心血管疾病和骨质疏松症。
Objective To study risk factors of cardiovascular disease （CVD） and status of bone mineral density （BMD） in women with hypoestrogenism. Methods From Jul 2011 to April 2013, a total of 256 women with hypoestrogenism in the First Affiliated Hospital of Shanxi Medical University were enrolled in this retrospective study, which were divided into four groups：133 women in ppausal group, 25 women in premature ovarian failure （POF） group, 67 women in menopausal transition group and 31 women in premature ovarian failure transition group. General statue, CVD risk factors and BMD were compared among four groups. General statue include menopausal period, menopausal symptoms （ Kupperman Index） , CVD risk factors include body mass index, blood pressure, waist circumference, waist-hip ratio, blood lipids and glucose, BMD include left hip, lumbar spine bone mineral density and T or Z value. Results （ 1 ） The median menopausal period were 3.4 years in postmenopausal group and 3.6 years in premature ovarian failure group, which did not show no statistical difference （P 〉 0. 05 ）. Kupperman Index in four groups were 12 in postmenopausal group, 9 in POF group, 9 in menopausal transition group and 8 in premature ovarian failure transition group, which reached statistical difference （ P 〈 O. 05 ）. （2） The difference of body mass index （BMI） , waist circumference, waist-hip ratio, diastolic blood pressure were no statistically significant among four groups（ P 〉 0.05 ） ; the systolic blood pressure in four groups were 120, 110, 110, 110 mm Hg （1 mm Hg = O. 133 kPa）, their differences were statistically significance （P 〈 0. 05 ）; the high-density lipoprotein （HDL-C） was 1.6 mmol/L in postmenopausal group, and 1.3 mmol/L in premature ovarian failure transition group, their differences were all statistically significance （ P 〈 0. 05 ） ; the difference of the fasting plasma glucose （FPG） was not statistically different in 4 groups （ P 〉 O. 05 ）. （ 3 ） The abnormal rate of lower bone mass in lumbar spine were 57% （46/81）postmenopausal group, 8/15 in POF group, 32% （9/28） in menopausal transition group, 12/19 in premature ovarian failure transition group, and osteoporosis was 9 % （7/81 ）, 3/15, 1% （ 3/28 ） and 0 respectively , their differences were statistically different （ P 〈 0. 05 ） ; the abnormal rate of BMD of left hip and lumbar spine of 11/15 and 12/16 in POF group was higher than 65% （53/81） in postmenopausal group. In the mean time, the abnormal rate of BMD of left hip and lumbar spine were, 12/19 and 10/20 in premature ovarian failure transition group, which were significantly higher than 43% （ 12/28 ） and 39% （ 12/31 ） in the menopausal transition group. Conclusions The menopausal symptoms resulting from hypoestrogenism in natural postmenopausal women are mostly remarkable. The decrease of BMD in lumbar spine is more significant than that of left hip among postmenopausal women. Women with earlier menopause was prone to cause the changes of blood fat and abnormal of BMD, especially HDL-C decreased significantly compared with those natural postmenopause, it is more likely to cause CVD and osteoporosis.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2013年第10期734-739,共6页
Chinese Journal of Obstetrics and Gynecology
关键词
绝经期
雌激素类
卵巢功能早衰
心血管疾病
骨密度
危险因素
Menopause
Estrogens
Ovarian failure, premature
Cardiovascular diseases
Bone density
Risk factors
