北京地区围绝经期妇女激素替代疗法(HRT)使用情况调查及疗效分析

目的:了解北京地区围绝经期妇女激素替代治疗的使用情况和疗效.方法:采用分层整群概率比率的流行病学方法在北京地区抽取城区、郊区两层的10个样本群中40～65岁围绝经期妇女进行问卷调查,部分妇女进行血脂、骨密度测定.结果:激素替代治疗明显减少各种更年期症状(P＜0.01),减少高血压的发生率(P＜0.05),明显减少糖尿病、肝病、甲亢、肾病等内科疾病的发生率(P＜0.01),而胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白却极显著增高(P＜0.01).结论:激素替代疗法可以有效地减轻各种更年期症状,减少高血压、糖尿病、肝病、甲亢、肾病等内科疾病的发生.但在使用过程中应密切观察血脂变化,防止血栓形成.     

妇女围绝经期健康状况调查研究

目的:通过对兰州市享受居民最低生活保障(低保)妇女围绝经期健康状况和保健需求的调查,了解该人群围绝经期存在的健康问题,为进一步做好围绝经期妇女的疾病预防、健康促进提供科学依据。方法:采用随机整群抽样方法,选取兰州市城关区2 187例35～60岁、享受居民低保的围绝经期妇女进行统一问卷调查。结果:①兰州市城关区享受居民低保妇女平均绝经年龄为47.43岁。②围绝经期综合征发生率为70.23%,主要相关症状发生率依次为:头痛(36.99%)、失眠(33.47%)、疲乏(32.74%)、眩晕(32.60%)、骨关节痛(29.13%)、情绪波动(26.25%)等。围绝经期综合征发生率各年龄组间比较差异有统计学意义(P<0.01),随着年龄的增大,其发生率增高。③各系统疾病或症状的发生率为63.88%,顺位依次是腰腿痛(36.99%)、关节痛(30.27%)、偏头痛(20.67%)、更年期症状(19.94%)、胆囊炎(13.35%)和高血压(11.06%)等,其发生率在各年龄组间比较差异有统计学意义(P<0.01)。随着年龄的增长,疾病或症状的发生率逐渐升高。④高血压、高脂血症、冠心病、糖尿病等慢性病检出率分别为11.06%、6.77%、4.85%、2.97%,各年龄组高血压检出率均高于其他三类慢性病。⑤围绝经期保健需求主要为定期全面体格检查和政府经济补贴,分别占60.22%和58.34%。结论:兰州市享受居民低保妇女围绝经期综合征发生率较高,围绝经期保健需求迫切,相关部门应高度重视,指导并采取积极有效的措施使中老年妇女的生活质量得到提高。     

周口市围绝经期及绝经后妇女健康状况研究

目的:探讨周口市45～60岁围绝经期及绝经后妇女健康状况。方法:选择周口市2008年2月～2009年2月45～60岁围绝经期及绝经后妇女300例,参考有关资料自行设计《周口市围绝经期及绝经后妇女健康状况调查表》逐个进行问卷调查。结果:300例围绝经期及绝经后妇女,月经正常67例(22.33%),月经紊乱135例(45.00%),自然绝经92例(30.67%),人工绝经(子宫切除)6例(2.00%),平均绝经年龄48.6岁。随着年龄的增大,高血压、冠心病、糖尿病及其他慢性病的发生几率明显升高,无统计学意义(P>0.05)。随着年龄的增大,阴道炎、宫颈糜烂、子宫肌瘤、卵巢囊肿及乳腺增生这几种疾病的发生几率明显升高,但经统计学分析,亦无统计学意义(P>0.05)。随着年龄的增长,更年期症状的严重程度不断加重,经统计学分析,51～55岁年龄组和56～60岁年龄组的更年期症状较45～50岁年龄组妇女的症状明显加重,P<0.01,具有统计学意义。结论:对围绝经期及绝经后妇女应进行医疗干预,严重的可进行激素替代治疗,在治疗过程中不只是生物治疗和心理治疗,更为重要的是广泛群体宣教,提高保健意识和自我保健能力,自动减压,调节心理平衡,特别是可以把文化水平低的高发人群作为重点的对象,积极提高这部分人群的健康水平。     

求医信箱

自《中老年保健》刊出《更年期妇女的激素替代治疗》一文后,我陆续收到湖南、湖北、云南等地多位读者的来信,现就信中一些共性问题回答如下: 问:围绝经期妇女能否使用激素替代治疗? 答:围绝经期是指40岁后的妇女出现更年期症状或月经紊乱至停经1年内的阶段。为了缓解更年期症状,保护心脏及预防骨质疏松症,围绝经期妇女及早使用激素替代治疗可以受到最大限度的保护。 问:药品种类很多,如何选择?     

子宫切除术对围绝经期症状出现的影响

目的:探讨子宫切除术后更年期症状出现的情况,了解子宫切除术对女性卵巢功能的影响。方法:选择本院2003～2006年因子宫良性病变行全子宫切除术的妇女125例作为观察组,年龄40～45岁;选择同年龄段正常妇女100例作为对照组,以电话随访和问卷调查的形式了解其围绝经期症状。结果:术后1年观察组围绝经期综合征出现率为46.4%,对照组为13.0%,两组比较差异有显著性(P<0.01);观察组出现中、重度更年期症状23例(18.4%),对照组出现中、重度更年期症状1例(1.0%),差异有显著性(P<0.01);观察组性功能减退32例(25.6%),对照组性功能减退2例(2.0%),差异有显著性(P<0.01)。结论:子宫切除术后妇女围绝经期症状出现早、症状重,可能影响性功能。     

妇女更年期症状及保健行为调查

目的:了解围绝经期妇女有关更年期症状和更年期保健行为,为开展围绝经期妇女健康教育提供参考依据.方法:用随机整群抽样的方法,以问卷形式调查297名45～55岁妇女.结果:平均绝经年龄为46.47±3.87岁,更年期症状发生率为51.5%,其中重度仅占5.7%;农村妇女血管舒缩症状和一般症状的发生率低于城市妇女(P<0.05);58.9%的妇女知道有关的更年期保健知识,农村妇女的知晓率明显低于城市妇女(P<0.01);在有症状的妇女中,仅有20.8%的人去医院就医;调查期间采用雌激素替代疗法的占1.3%.结论:大多数妇女在围绝经期表现出较轻的更年期症状,农村妇女的更年期症状发生率低于城市妇女,围绝经期妇女缺乏更年期保健知识和意识,存在不健康的生活方式,亟需加强有关更年期保健的健康教育.     

深港两地围绝经期妇女健康状况调查

目的:了解深港两地妇女围绝经期综合征的患病情况及其相关因素。方法:在深圳市罗湖区、香港各随机整群抽取一个社区,采用统一的调查问卷,对40～60岁围绝经期妇女进行调查。结果:在418例被调查者中,出现围绝经期综合征者225例,发生率为53.83%,其中以骨关节痛、失眠、烦躁易怒、潮热出汗、容易疲劳或乏力、性欲下降等症状表现较为突出;血管舒缩症状、骨质疏松症状深圳妇女高于香港妇女(P<0.01),而精神神经症状香港妇女高于深圳妇女(P<0.01);随着绝经的来临和年龄增长,围绝经期症状的发生率呈增高趋势(P<0.01)。结论:围绝经期妇女的健康问题不容忽视,应加强围绝经期妇女的保健工作,缓解症状,改善生活质量。     

动态血压监测在妇女围绝经期疑诊高血压中的应用

目的:探讨动态血压监测(ABPM)对围绝经期妇女疑诊高血压的诊断价值。方法:将42例疑诊高血压的围绝经期妇女分为两组:绝经过度期组23例,绝经期组19例,测定动态血压参数、血脂、血糖等生化指标进行比较。结果:①两组除血脂外生化指标比较差异无统计学意义(P>0.05);②绝经期和绝经过度期ABPM参数比较分别为24 h平均收缩压(148.2±10.3)比(136.5±9.3)mmHg,白昼平均收缩压(149.9±11.4)比(130.1±10.5)mmHg,夜间平均收缩压(128.0±11.3)比(116.4±6.7)mmHg,24 h收缩压变异系数(8.1±1.8)比(7.0±1.5),24 h舒张压变异系数(9.0±2.1)比(7.3±1.9),非勺型昼夜节律发生率31.6%比8.7%,差异有统计学意义(P<0.01);③高血压患病率31.6%比17.4%,差异有统计学意义(P<0.01)。结论:疑诊高血压的围绝经期妇女应用ABPM能筛查高血压病,绝经后高血压患病率增加,围绝经期血压波动以收缩压增高为主。     

农村妇女围绝经期症状的影响因素与健康行为的干预研究

目的:对农村40～55岁妇女更年期症状出现情况以及她们所采取的相应医疗保健行为进行干预。方法:通过3年的行为干预,对1573名40～55岁妇女进行现场一对一、面对面的调查。采用SPSS13.0进行统计。结果:以询问法获得围绝经期症状发生率(至少有1项与围绝经期有关)93.32%,高于干预前(48.59%)。干预后出现围绝经期症状后到一级医院就诊、更年期专科就医的比例增加;出现症状后使用药物比例为16.96%,使用激素替代疗法比例为3.81%;干预后主要从医务人员而对照组主要从媒体接受知识。结论:加强农村更年期保健,普及小剂量的激素补充的知识;发挥三级网络作用,在村里建立更年期咨询点,社区和二级医院建立更年期保健门诊;根据农村的特点,通过多种形式开展更年期健康教育,提高更年期妇女的身心健康。     

围绝经期妇女就诊及激素替代治疗态度调查

目的了解广东省围绝经期妇女的医疗保健行为，为有针对性地开展更年期预防保健工作提供依据。方法对广东省珠江三角地区、山区、东西两翼地区的地市级、县级的围绝经期妇女4489人进行问卷调查，用SPSS软件进行分析。结果我省围绝经期妇女有更年期症状的比例较高，但自我保健意识薄弱，就诊率仅为19．9％，其中36．2％的妇女就诊于内科，34.1％的妇女就诊于中医科，仅20．3％的妇女就诊于妇产科；在被调查人群中使用激素替代(HRT)治疗的比例仅1．496；围绝经期妇女的医疗保健行为受文化程度、职业、经济发展、是否绝经及不同地域等因素的影响。结论需要进一步提高围绝经期妇女的自我保健意识，尤其要加强对农村、山区等地围绝经期妇女健康教育。     

妊娠高血压综合征与血脂、载脂蛋白及脂蛋白(a)的关系

目的探讨妊娠高血压综合征(简称妊高征)患者血脂代谢水平的变化及其临床意义。方法测定正常孕妇及妊高征患者的血清甘油三脂(TG)、总胆固醇(TC)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及脂蛋白(a)水平。结果妊高征组血清TG(P<0.01)、ApoB(P<0.01)、LDL-C(P<0.05)及LP(a)(P<0.05)较正常孕妇显著升高,ApoAI、HDL-C则显著降低(P<0.05),TC在两组间差别无显著性意义(P>0.05)。在轻、中、重妊高征患者之间,ApoAI(P<0.05)及HDL-C(P<0.01)依次降低,组间比较有显著性意义,LDL-C(P<0.01)及LP(a)(P<0.01)依次升高,组间有极显著性差异。TG、TC和ApoB组间比较,差别无显著性意义。结论血脂代谢异常可能在妊娠高血压疾病的发病中起一定作用。     

轮叶党参对大鼠血脂的影响

为了探讨食用植物对高脂血症及动脉粥样硬化的预防作用,选用轮叶党参(Codonopsis Lanceolata)水提取液对实验性大鼠高脂血症进行预防实验.结果显示,给予高脂饲料的同时按4g/kg和8g/kg给予轮叶党参水提液的大鼠,其血清胆固醇、甘油三酯、低密度脂蛋白胆固醇及动脉硬化指数明显低于只给高脂饲料的大鼠(P<0.05或P<0.01),高密度脂蛋白的含量明显高于只给高脂饲料的大鼠.说明轮叶党参有明显的调理血脂蛋白的作用,可预防血脂升高.     

Effect of a fish-oil concentrate on serum lipids in postmenopausal women receiving and not receiving hormone replacement therapy in a placebo-controlled, double-blind trial

BACKGROUND: n-3 Fatty acid supplementation lowered serum triacylglycerol concentrations in studies in which most of the subjects were male. The effects of n-3 fatty acid supplementation in postmenopausal women receiving and not receiving hormone replacement therapy (HRT) have received little attention. OBJECTIVE: We sought to determine the effects of a fish-oil-derived n-3 fatty acid concentrate on serum lipid and lipoprotein risk factors for cardiovascular disease in postmenopausal women receiving and not receiving HRT, with an emphasis on serum triacylglycerol concentrations and the ratio of triacylglycerol to HDL cholesterol. DESIGN: Postmenopausal women (n = 36) were grouped according to exogenous hormone use and were randomly allocated to receive 8 capsules/d of either placebo oil (control) or n-3 fatty acid-enriched oil (supplement). The supplement provided 2.4 g eicosapentaenoic acid (EPA) plus 1.6 g docosahexaenoic acid (DHA) daily. Serum lipids and the fatty acid composition of serum phospholipids were determined on days 0 and 28. RESULTS: Supplementation with n-3 fatty acids was associated with 26% lower serum triacylglycerol concentrations (P < 0.0001), a 28% lower overall ratio of serum triacylglycerol to HDL cholesterol (P < 0.01), and markedly greater EPA and DHA concentrations in serum phospholipids (P < 0.05). CONCLUSIONS: These results show that supplementation with a fish-oil-derived concentrate can favorably influence selected cardiovascular disease risk factors, particularly by achieving marked reductions in serum triacylglycerol concentrations and triacylglycerol:HDL cholesterol in postmenopausal women receiving and not receiving HRT. This approach could potentially reduce the risk of coronary heart disease by 27% in postmenopausal women.     

利维爱治疗女性更年期综合征70例疗效观察

目的:探讨利维爱治疗女性更年期综合征的临床疗效。方法:对70例女性更年期综合征患者采用利维爱治疗。结果:随访发现显效61例,占87.14%(61/70);有效7例,占11.43%(8/70);无效1例,占1.43%(1/70),总有效率达98.57%(69/70)。对70例更年期患者各项激素与生化指标进行检查发现,雌二醇(E2)、孕激素(P)与治疗前相比明显升高,而促卯泡成熟激素(FSH)、黄体生成激素(LH)、碱性磷酸酶(AKP)、总胆固醇(TC)及甘油三酯(TG)等指标与治疗前相比均明显降低(P<0.05)。结论:利维爱治疗更年期综合征的疗效是肯定的,且达到预防疾病,提高更年期妇女生活质量的目的,值得在临床上推广应用。     

Prediction of metabolic syndrome among postmenopausal Ghanaian women using obesity and atherogenic markers

ABSTRACT: BACKGROUND: Metabolic syndrome (MetS) is an important health problem which puts individuals at risk for cardiovascular diseases and type 2 diabetes as well as obesity-related cancers such as colon and renal cell in men, and endometrial and oesophageal in women. OBJECTIVE: This study was aimed at examining how obesity indicators and related determinants influence metabolic syndrome, and how the factors can be used to predict the syndrome and its cut-offs in postmenopausal Ghanaian women. METHODS: Two hundred and fifty (250) Ghanaian subjects were involved in the study with one hundred and forty-three (143) being premenopausal women and one hundred and seven (107) postmenopausal women. The influence of traditional metabolic risk factors including high blood pressure, dyslipidemia and glucose intolerance on obesity and atherogenic indices i.e. body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Waist-to-thigh ratio (WTR), waist-to-height ratio (WHtR), high density lipoprotein cholesterol to total cholesterol ratio (HDL-C/TC), high density lipoprotein cholesterol to low density lipoprotein ratio (HDL-C/LDL-C) and triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) were identified according to the Harmonization (H_MS) criterion. RESULTS: The most significant anthropometric marker that significantly influence metabolic risk factors among the pre- and postmenopausal women was waist-to-hip ratio (premenopausal: p- 0.004, 0.026 and 0.002 for systolic blood pressure (SBP), fasting blood glucose (FBG) and HDL-C; postmenopausal: p-0.012, 0.048, 0.007 and 0.0061 for diastolic blood pressure (DBP), FBG, triglyceride (TG) and high density lipoprotein cholesterol (HDL-C) respectively). Using the receiver operating characteristic (ROC) analysis, the area under the curve for WC, WHR, TG/HDL-C and HDL-C/TC among postmenopausal women were estimated at 0.6, 0.6, 0.8 and 0.8 respectively. The appropriate cut-off values for WC, WHR, TG/HDL-C and HDL-C/TC that predicted the presence of metabolic syndrome were 80.5 cm, 0.84, 0.61 and 0.34 respectively. CONCLUSION: The presence of metabolic syndrome among Ghanaian postmenopausal women can be predicted using WC, WHR, TG/HDL-C and HDL-C/TC.     

吸烟与急性心肌梗死患者血脂及冠状动脉病变程度的相关性研究

目的 观察吸烟与急性心肌梗死患者血脂水平和冠状动脉病变程度的相关性。 方法 选取129例急性心肌梗死患者为研究对象,参照国际公认的吸烟指数分级法将上述患者分为0级(43例)、1级(33例)、2级(31例)、3级(22例)四类患者,比较不同吸烟指数患者甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平变化,同时以Judkins法经股动脉进行选择性冠状动脉造影,观察不同吸烟指数患者冠状动脉病变支数情况。 结果 0~3级吸烟患者TC、TG、LDL-C水平呈上升趋势(r=0.747、0.914、0.833,P<0.05),其中吸烟3级指数患者TG高于0、1级,而LDL-C高于0级,差异有统计学意义(P<0.05);吸烟指数1、2、3级指数患者三支病变发生率高于0级,差异有统计学意义(P<0.05/6);三支病变发生率随吸烟指数级别上升呈上升趋势(r=0.863,P<0.05)。 结论 吸烟可影响急性心肌梗死患者血脂水平,且吸烟指数越高,病变程度越严重,需引起临床重视。     

Improved iron status parameters may be a benefit of hormone replacement therapy

One of the benefits of hormone replacement therapy (HRT) is to decrease cardiovascular disease. A mechanism whereby HRT may play a role in reducing cardiovascular risk is through improved iron status parameters. High serum ferritin has been related to increased risk of coronary heart disease, whereas low iron-binding capacity has been identified as an important risk factor for myocardial infarction. This study examined iron status parameters in a group of postmenopausal women taking oral HRT (n = 27) and those not taking oral HRT (n = 27) at two times 1 year apart. Women were compared on the following serum measures: estradiol, lipids, iron, total iron-binding capacity, and ferritin. Women taking HRT had higher levels of estradiol (p < 0.001) and improved lipid profiles (p < 0.001) (lower total and low-density lipoprotein [LDL] cholesterol and higher levels of high-density lipoprotein [HDL] cholesterol). In addition, women on HRT had better iron status parameters than those not on HRT (p = 0.002). Total iron-binding capacity was greater for women on HRT compared with women not on HRT, and serum ferritin levels were lower in women on HRT than those not on HRT. The groups were comparable in age, body mass index, and physical activity. Our results confirm previous findings and indicate that women taking HRT have higher serum levels of estradiol and improved lipid profiles compared with those not taking HRT. In addition, we have found that iron status parameters are better in women taking HRT, suggesting the need to further examine this effect as it relates to decreased cardiovascular risk in postmenopausal women.     

美藤果油对高脂血症大鼠血脂及Apo AI、Apo B的影响

摘要:目的　研究美藤果油的调血脂作用及对载脂蛋白的影响机制。方法　建立高脂血症大鼠模型,通过给予不同剂量的美藤果油,观察其对高脂血症大鼠血脂4项及载脂蛋白含量的影响。结果　美藤果油能降低高脂血症大鼠血清总胆固醇（TG）、甘油三酯（TC）、低密度脂蛋白胆固醇（LDL-C）浓度（P＜0.05,P＜0.01）,升高高密度脂蛋白胆固醇（HDL-C）浓度（P＜0.05）;降低载脂蛋白B（Apo B）浓度（P＜0.05）,升高载脂蛋白AI（Apo AI）浓度（P＜0.05）。结论　美藤果油能明显调节高脂血症大鼠脂质代谢紊乱,其作用通过调控Apo B、Apo AI水平而实现。     

Association of body fat distribution with plasma lipids, lipoproteins, apolipoproteins AI and B in postmenopausal women

Associations between the distribution of body fat, measured by the waist/hip circumference ratio (WHR), and plasma lipid fractions were examined in 84 postmenopausal women. WHR was correlated r = 0.39 with body mass index (BMI). After adjustment for BMI and other covariates, WHR was positively and significantly associated with concentrations of triglycerides, apolipoprotein B, low-density lipoprotein cholesterol, and the total cholesterol/high density lipoprotein cholesterol ratio. WHR was negatively and significantly associated with concentrations of high density lipoprotein cholesterol and apolipoprotein AI. These results indicate that in postmenopausal women abdominal fat preponderance is associated with an atherogenic plasma lipid profile, independent of its association with BMI.     

低剂量辛伐他汀对急性冠状动脉综合征患者血脂、C-反应蛋白及纤维蛋白原的影响

目的观察低剂量辛伐他汀治疗前后急性冠状动脉综合征(ACS)患者血脂、C-反应蛋白(CRP)及纤维蛋白原(FIB)的变化。方法120例ACS患者被随机分为治疗组和对照组,每组60例;对照组予常规治疗,治疗组在常规治疗基础上每日加用辛伐他汀20 mg,疗程2月。结果治疗组总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)较治疗前明显降低(P<0.05),高密度脂蛋白F胆固醇(HDL-C)较治疗前明显升高(P<0.05),CRP及纤维蛋白原较治疗前明显降低(P<0.05);对照组各观察指标治疗前后无明显变化(P>0.05)。结论低剂量辛伐他汀能有效调节急性冠状动脉综合征患者血浆中血脂、降低CRP及FIB水平,值得临床推广应用。