Blood lead concentration, blood pressure, and renal function

Blood lead concentrations were related to blood pressure and indicators of renal function in a clinical survey of 7735 middle aged men from 24 British towns. There was no overall evidence that blood lead concentrations were associated with systolic or diastolic blood pressure (r = +0.03 and +0.01, respectively). In the 74 men with a blood lead concentration of 1.8 mumol/l (37.3 micrograms/100 ml) or more there was some suggestion of increased hypertension, but this did not reach significance. Blood lead concentration did not have any relation with serum creatinine concentration. Moderate increases in blood lead concentration were associated with small increases in mean serum urate concentration and small decreases in mean serum urea concentration; these associations were both reduced when alcohol consumption was taken into account. There is no indication that exposure to lead at concentrations commonly encountered in British men is responsible for impaired renal function or increased blood pressure.     

劳务女工孕期血铅水平与血压相关性研究

目的 探讨劳务女工孕期血铅水平与其血压的关系,为改善围生期工作,促进孕妇健康提供参考.方法 对2008年3月至2009年11月在深圳市宝安区妇幼保健院产前门诊建卡的劳务女工孕妇进行问卷调查、血压及血微量元素浓度测定.随机选取其中897例资料完整并在深圳居住满2年者作为研究对象,采用简相关和回归方法评价血铅与血压的关系.结果 孕妇血铅均值为(45±23)μg/L;家族史、体质量指数(BMI)、血铅浓度对血压升高有预测作用;在血铅56 μg/L分界点时,两组舒张压比较差异有统计学意义(P＜0.05);高铅组(血铅浓度≥100 μg/L)收缩压、舒张压均显著高于低铅组(P＜0.05).结论 低铅暴露是致孕妇血压升高的危险因素之一,铅对血压的影响以舒张压更为敏感. Abstract： Objective To observe the degree of blood lead in pregant women and the influence of different levels of blood lead on blood pressure under environmental lead exposure, in order to previde basic evidences for taking the further measures. Methods A quesionnaire survey was administed, blood pressure and the serum of microelements were tested for the pregnant women who took the prenatal examinationin the Maternal and Child Care Service Centre of Baoan between March 2008 and November 2009, gathered 897 pregnant women whose materials were complete and stayed in Shenzhen more than one year as the study objects. Compare the differences between groups distributed by quartileand carried out the pair matching study. Correlation, stepwise regression analysis and T test were usedto statistic. Results The average of blood lead was (45±23)μg/L;The Bivriate correlations showed the association between blood lead and blood pressure was positive. Stepwise regression analysis indicated family history, BMI,blood lead were predictors of increasing blood pressure. After excluding the confounding factors, on the 56 μg/L the diastolic pressure(DBP) with statistical significance (P＜0.05);Blood pressure of case group was higher than that of control group with significant difference (P＜0.05). Blood calcium of case group was lower than that of control group without statistical significance (P＞0.05). Conclusions The results indicate the degree of blood lead of pregnant women in Shenzhen is low. Environmental lead exposure is one of the dangerous factors of increasing blood pressure .DBP is more sensitive to lead.     

Noncontraceptive hormones and rheumatoid arthritis in perimenopausal and postmenopausal women

The use of noncontraceptive hormones before onset of joint disease was compared between 490 perimenopausal and postmenopausal women with rheumatoid arthritis and a control group of 659 women with soft-tissue rheumatologic disorders and/or osteoarthritis. Both groups were sampled randomly from the attendees of five rheumatologic clinics. A negative association was found between the onset of rheumatoid arthritis and the previous use of noncontraceptive hormones (odds ratio, 0.32; 95% confidence interval, 0.16 to 0.64). This association persisted on univariate and multivariate control of potentially confounding variables and on subgroup analysis. The protective effect of oral contraceptives on the development of rheumatoid arthritis was confirmed.     

杭州地区围绝经期及绝经后女性代谢综合征的调查研究

目的调查杭州地区40~70岁女性代谢综合征（Mets）的发病情况,了解Mets与年龄、绝经的关系。方法收集1425例40~70岁的女性,按照年龄进行分组,根据中华医学会制定的Mets诊断标准,分析围绝经期女性Mets的患病率及与年龄、绝经的关系。结果研究对象总体平均年龄为（52.38±7.79）岁;各年龄组比较,年龄、身高、体重及BMI均有统计学差异（P＜0.05或0.01）;与40~45岁组相比,其他年龄组的BMI显著上升（均P＜0.01）。研究对象Mets总体患病率为17.89%,随着年龄的增长,患病率呈显著上升趋势（字2=159.1,P＜0.01）;且Mets各组分肥胖、高血糖、高血压、血脂紊乱的发生率均显著升高（字2=59.239、10.707、158.4、143.7,P＜0.05或0.01）。各年龄组SBP、DBP、FBG、TG、TC、LDL-C组间比较均有统计学差异（P＜0.05或0.01）,HDL-C组间比较无统计学差异（P＞0.05）;与40~45岁组比较,其他年龄组的SBP、DBP、TG、TC、LDL-C均显著升高（P＜0.05或0.01）;56~60岁组及60岁以上组FBG显著高于年龄较低的各组（P＜0.05或0.01）。结论Mets的患病率随着年龄的增长呈显著上升趋势,围绝经期和绝经后女性是Mets的高危人群,在围绝经期及绝经早期及时进行个体化生活方式干预、临床激素补充治疗（HRT）,可以显著降低绝经后女性Mets和心血管疾病的发生风险,从而提高围绝经期和绝经后女性的健康水平及生活质量。     

Compliance and blood pressure control in women with hypertension

Compliance with treatment is a fundamental prerequisite for therapeutic benefit. The aim of this study is to determine the level of knowledge of hypertension, compliance with recommended antihypertensive therapy, and current blood pressure status in women with hypertension attending a Type V health centre. A pre-tested questionnaire with 37 in-depth items was administered to 30 (37.5%) women, selected by quota sampling, from a population of 80 women with hypertension, on four consecutive regular clinic days in May/June 2001. Weights and the mean of two blood pressure measurements were recorded. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 7.5. The median age and weight of the respondents was 57 years (range 36-85 years) and 80.3 kg (range 66.8-150 kg). Median duration of hypertension was five years. Fifty per cent of the sample were diabetic. The longer the patient had been hypertensive, the greater the compliance with medication (p < 0.05). Twenty per cent of non-diabetics were controlled to blood pressure < or = 140/90 mmHg and 13% of the diabetics were controlled to blood pressure < or = 135/85 mmHg. Twenty per cent reported ill effects from medication; 60% used "folk remedies" such as garlic. Only 27% of patients were fully compliant with medication. Sixty per cent did no exercise, 73% did less than one hour of exercise per week. Diabetics took more exercise than non-diabetics (Z = -2.1, p < 0.05) and were more compliant with medication than non-diabetics (Z = -2.3, p < 0.05). All respondents included salt in their diets and consumed fruits and vegetables only "sometimes". One third believed that hypertension could be "cured". The overall median knowledge score and median compliance score were 50% (range 16.7%-100%) and 31% (range 13%-60%) respectively. This group had inadequate knowledge of hypertension, poor compliance with recommended antihypertensive therapy (JNCVI) and limited BP control. Counselling of these patients in the areas of medication, diet, exercise and weight control is recommended. Further research, using randomized samples, to inform interventions to improve the knowledge, compliance and self-care management of patients with hypertension is indicated.     

围绝经期及绝经后妇女心血管疾病危险因素的变化

心血管疾病是危害绝经后妇女健康的常见疾病,预防绝经后妇女心血管疾病的发生,首先要了解绝经过程中妇女心血管疾病危险因素的发生及变化。心血管疾病危险因素分为不可改变和可改变的两大类,不可改变因素包括年龄、性别和家族史,可改变因素包括高血压、血脂异常、肥胖、糖耐量减低、吸烟、糖尿病和久坐。本文就围绝经期和绝经后妇女心血管疾病可改变危险因素的变化做一系统综述。     

腹腔镜检查对围绝经和绝经后妇女盆腔肿块的诊断价值

目的 评价腹腔镜检查对围绝经和绝经后妇女盆腔肿块的诊断价值。方法 对1983年1月~2002年12月在我科就诊的117例围绝经期和绝经后妇女患盆腔肿块患者的腹腔镜检查结果进行回顾性分析。结果 117例盆腔肿块经腹腔镜检查,诊断出卵巢恶性肿瘤17例,输卵管癌2例;其余为良性肿瘤,并在腹腔镜下做了相应处理。结论 对围绝经和绝经后妇女,腹腔镜检查是一种安全、诊断准确率高的检查方法,可及早明确肿块存在及其性质,有利于早期诊断、早期治疗。     

腹腔镜检查对围绝经和绝经后妇女盆腔肿块的诊断价值

目的 评价腹腔镜检查对围绝经和绝经后妇女盆腔肿块的诊断价值。方法 对1983年1月～2002年12月在我科就诊的117例围绝经期和绝经后妇女患盆腔肿块患者的腹腔镜检查结果进行回顾性分析。结果 117例盆腔肿块经腹腔镜检查，诊断出卵巢恶性肿瘤17例，输卵管癌2例；其余为良性肿瘤，并在腹腔镜下做了相应处理。结论 对围绝经和绝经后妇女，腹腔镜检查是一种安全、诊断准确率高的检查方法，可及早明确肿块存在及其性质．有利于早期诊断、早期治疗。     

上海市部分地区40~65岁女性骨健康认知度调查研究

目的探讨上海市部分地区40~65岁围绝经期和绝经后女性对绝经后骨质疏松的认知度及其影响因素。方法2021年10月—2022年4期间上海市5个社区年龄在40~65岁的常住女性,采用方便抽样的方法纳入调查对象。采用自行设计的问卷进行调查,由专业人员开展面对面问卷调查,调查内容包括人口学特征、运动健身情况、骨质疏松症知识等。采用SPSS 20.0对数据进行处理和分析。结果发放调查问卷520份,回收502份,回收率96.54%。其中排除明显错误或信息不全者41份,获取有效问卷共计461份,有效回收率为91.83%。调查对象平均年龄（50.6±1.57）岁;调查对象中接受过骨质疏松科普培训的占比为69.63%(321/461);正在或曾经接受绝经激素补充治疗(menopausal hormone replacement therapy, MHT)的占比为13.67%(63/461);接受过双能X线骨密度检测（dual energy X-ray absorptiometry, DEXA）占比为26.68%(123/461)。认为知晓骨质疏松知识(很了解+了解)的占比为46.86%,对骨质疏松6个危险因素的知晓率在2.17%~26.03%。对骨质疏松的3个主要危害的知晓率在21.04%~39.91%。有骨质疏松家族史,对绝经后骨质疏松防治相关知识知晓程度为82.2%（P＜0.05）。受教育程度、生育次数、职业状态、有少量饮酒史、有家族骨质疏松史等与绝经后骨质疏松知识的知晓率相关（P＜0.05）。结论上海市部分地区围绝经期和绝经后女性对骨质疏松认知度较低,尤其是对导致骨质疏松的危险因素和由骨质疏松所带来的健康的危害认知度低。围绝经期和绝经后妇女对骨质疏松基本知识的认知度受多种因素影响。围绝经期及绝经期女性普遍缺乏骨密度监测。进一步加强骨健康相关知识的科学普及十分必要。     

Blood lead and blood pressure. Relationship in the adolescent and adult US population

Heavy lead exposure has been connected to cardiovascular disease, but modest exposures encountered in the general environment have not been associated previously with disease risk. The relationship between blood lead levels and blood pressures was examined using data from the second National Health and Nutrition Examination Survey. A direct relationship was found between blood lead levels and systolic and diastolic pressures for men and women and for white and black persons aged 12 to 74 years. Blood lead levels were significantly higher in younger men and women (aged 21 to 55 years) with high blood pressure, but not in older men or women (aged 56 to 74 years). In multiple regression analyses, the relationship of blood lead to blood pressure was independent of other variables for men, but not for women. Dietary calcium and serum zinc levels were inversely related to blood pressure.     

围绝经期及绝经女性睡眠质量与代谢的相关性分析

目的探讨围绝经期及绝经女性的睡眠质量对代谢的影响。方法回顾性分析2015年1月～2018年1月于我院妇科内分泌门诊就诊的1657例(围)绝经期患者病历资料并对其进行匹兹堡睡眠质量问卷(PSQI)调查,根据PSQI≥8分作为判断睡眠质量的好与差,比较分析睡眠质量与代谢的关系。结果年龄、文化程度、经济收入、职业在不同睡眠质量患者中有显著性差异(P0.05);睡眠质量差组患者低密度脂蛋白(LDL)、总胆固醇(TC)、甘油三酯(TG)、体重指数(BMI)、空腹血糖(FBG)水平高于睡眠质量好组(P0.05),高密度脂蛋白(HDL)低于睡眠质量好组(P0.05)。年龄、代谢水平等为影响围绝经期女性睡眠质量的独立危险因素(均P0.05)。结论围绝经期及绝经女性睡眠状态受代谢水平影响,为临床改善睡眠质量提供理论支持。     

绝经后女性高血压患者24 h动态血压变异性研究

目的研究绝经后女性高血压患者24 h动态血压变异性。方法选取2015年6月~2017年6月于我院就诊的163例绝经后女性原发性高血压患者为研究对象。根据动态血压监测结果,按血压昼夜节律划分为勺型组(n=18)、非勺型组(n=87)和反勺型组(n=58)。收集两组患者临床基线资料,并进行24 h动态血压监测。结果反勺型组患者的绝经年龄显著早于勺型组(P0.05);多因素Logistic回归分析结果显示,绝经年龄是反勺型血压形成的独立危险因素(OR=1.148;95%CI=1.020~1.292;P=0.020);通过更进一步的发现,绝经年龄与夜间血压下降率成负相关(收缩压r=-0.159,P0.05;舒张压r=-0.161,P0.05)。结论女性绝经后高血压患者中,绝经年龄是反勺型高血压的独立危险因素。     

更年期妇女对激素补充治疗的知晓率和接受程度调查

目的:了解更年期妇女月经改变、绝经相关症状发生时间,对激素补充治疗(HRT)的知晓、使用及相关知识需求情况,为中老年妇女生殖保健提供依据.方法:对年龄≥40岁、至少有一侧卵巢、有月经周期改变或更年期症状的妇女进行有关问卷调查.结果:共纳入326例妇女,平均年龄49.49岁,绝经年龄49.1岁,月经改变年龄45.6岁,出现更年期症状年龄46.6岁;38.6％知晓HRT的相关知识,44.2％认为更年期综合征有必要治疗,42.1％愿意接受HRT但有诸多担心顾虑,96.7％希望得到更多围绝经期保健知识;HRT使用率为5.83％.结论:更年期妇女对HRT与更年期保健知识的知晓率低,获取渠道主要为妇产科医生,应注重宣传教育,提供方便的医学支持服务,进一步提高中老年妇女的健康水平和生活质量.     

铅暴露区产妇血铅、脐血铅及初乳铅测定的意义

目的确定铅暴露环境中产妇血铅、脐血铅及乳汁铅测定的意义。方法前瞻性选择45名电子垃圾拆解场周围产妇作为观察组,对其分娩时母血铅、脐血铅及乳汁铅进行测定,同时随机选取非铅高暴露环境的40名产妇作为对照组。比较2组产妇血铅、脐血铅及乳汁铅测定值和新生儿出生情况。结果观察组39名、对照组38名完成研究。观察组新生儿体质量较对照组降低（P < 0.05）,观察组新生儿身长与对照组差异无统计学意义（P>0.05）,观察组产妇血铅、脐血铅、初乳铅水平均明显高于对照组（P < 0.01）。结论电子垃圾拆解场周围产妇妊娠期暴露在铅高环境中,可导致胎儿宫内铅暴露,且较高初乳铅亦可能导致哺乳期铅暴露,建议加强铅暴露环境中妇女孕期的防铅工作。     

运动对围绝经期症状、抑郁症状的影响

目的探讨运动对围绝经期症状和抑郁症状的影响。方法选取更年期门诊就诊的634例围绝经期妇女,采用问卷方式调查妇女基本情况,采用改良Kupperman评分量表评估妇女围绝经期症状,采用HAMD评分量表评估妇女抑郁症状。结果不同运动频率妇女在情绪波动、抑郁疑心、眩晕、心悸、皮肤蚁行感、抑郁情绪、自杀、入睡困难、睡眠不深、早醒、激越、自知力等方面比较,差异均有统计学意义（均P＜0.05）。运动频率越高,改良Kupperman评分和HAMD评分总分越低（均P＜0.05）。运动频率与改良Kupperman评分和HAMD评分均呈负相关（r=-0.135和-0.125,均P＜0.01）,改良Kupperman评分与HAMD评分呈正相关（r=0.606,P＜0.01）。结论运动可以有效改善妇女围绝经期症状和抑郁症状,推荐每周超过3次的运动作为改善围绝经期症状、抑郁症状的非药物治疗的方法之一。     

血压晨峰对绝经后妇女靶器官的影响

目的研究绝经后妇女的血压晨峰,明确其对靶器官的影响。方法采用动态血压监测仪分析70例绝经后妇女的血压,分为晨峰组及非晨峰组,常规检查空腹血糖、血脂及动态心电图等;并计算体重指数(BMI)和左室质量指数(LVMI)、QT离散度(QTcd)等。结果晨峰组的日夜平均收缩压均高于非晨峰组的动态血压监测水平;晨峰组的左室质量指数等均高于非晨峰组。结论绝经后妇女的血压晨峰有显著的靶器官损害加重等表现。因此,应根据血压的变化调整治疗方案,从而减少血压晨峰对其靶器官的损害。