上海地区中年女性健康体检者健康状况及与绝经状态关系研究-现代医学

上海地区中年女性健康体检者健康状况及与绝经状态关系研究

单位：1. 上海市保健医疗中心医务处, 江苏无锡 214065;
2. 上海市保健医疗中心妇女保健科, 江苏无锡 214065;
3. 上海市保健医疗中心科教处, 江苏无锡 214065

分类号：R173

出版年·卷·期（页码）：2024·52·第十一期（1736-1743）

摘要：

目的: 了解上海地区中年女性健康体检人群的健康状况，并探讨绝经状态对其健康的影响。方法: 以2021年1月至12月上海市保健医疗中心40～60岁女性健康体检者为研究对象，随机抽取30%体检者，收集其健康体检数据，根据绝经状态将其分为绝经前、围绝经期和绝经后3组,比较不同绝经状态下女性生活方式、健康指标和慢性病患病率的差异；采用Logistic回归模型分析绝经状态与女性常见慢性病患病情况相关性。结果: 共计纳入9 094例40～60岁女性健康体检者进行研究。不同绝经状态女性饮酒、饮食和运动情况均不同(均P<0.05)；体质指数(BMI)、舒张压、收缩压、甘油三酯、胆固醇、低密度脂蛋白、空腹血糖、尿酸、肌酐等指标水平均不相同(均P<0.05)。幽门螺旋杆菌感染、宫颈疾病、乳腺结节和贫血检出率在围绝经期或绝经后下降(均P<0.05)；各系统其他疾病(肺部结节除外)检出率在围绝经期或绝经后均有不同程度的升高(均P<0.05)。调整吸烟、饮酒、饮食和运动等因素后，在40~49岁女性中，绝经后是2型糖尿病[OR=2.327，95%CI:(1.096，4.938)]的危险因素(P<0.05)；围绝经期和绝经后是血脂异常[OR=1.574，95%CI:(1.279，1.937)；OR=2.668，95%CI:(2.005，3.549)]、高尿酸血症[OR=1.828，95%CI:(1.075，3.109)；OR=3.751，95%CI:(2.207，6.375)]和脂肪肝[OR=1.552，95%CI:(1.213，1.985)；OR=1.540，95%CI:(1.110，2.136)]的危险因素(均P<0.05)。在50～60岁女性中，围绝经期和绝经后是2型糖尿病[OR=2.656，95%CI:(1.397，5.053)；OR=3.163，95%CI:(1.756，5.698)]、血脂异常[OR=1.669，95%CI:(1.337，2.083)；OR=1.799，95%CI:(1.496，2.164)]、高尿酸血症[OR=2.326，95%CI:(1.379，3.924)；OR=2.029，95%CI:(1.259，3.269)]和脂肪肝[OR=1.907，95%CI:(1.488，2.445)；OR=2.012，95%CI:(1.623，2.494)]的危险因素(均P<0.05)。结论: 不同绝经状态女性的健康状况存在一定差异；绝经状态是2型糖尿病、血脂异常、高尿酸血症、脂肪肝的影响因素，应加强生活方式干预，改善中年女性健康状况。

Objective: To analyze the health status of middle-aged women in Shanghai and explore the impact of menopausal status on health. Methods: The physical examination data of 30% physical examination women aged 40 to 60 years from January to December 2021 were collected, and the subjects were divided into pre-menopause, perimenopause and postmenopause groups according to menopausal status. The differences in lifestyle, clinical indicators and prevalence of chronic diseases among middle-aged women under different menopausal status were compared. Logistic regression was used to analyze the correlation between menopausal status and common chronic diseases in women. Results: Totally 9 094 female health examination subjects aged 40 to 60 years were included in the study. Drinking, diet and exercise were different in different menopausal women(P<0.05). The levels of body mass index, diastolic blood pressure, systolic blood pressure, triglyceride, cholesterol,low density lipoprotein, fasting blood glucose, uric acid, creatinine were different in different menopausal women(all P<0.05). The prevalence of Helicobacter pylori infection, cervical diseases, breast nodules, and anemia decreased in perimenopause or postmenopause(all P<0.05). Except for pulmonary nodules, the prevalence of other diseases increased in perimenopause or postmenopause(all P<0.05). After adjusting for smoking, drinking, diet and exercise, postmenopause was risk factor for type 2 diabetes[OR=2.327, 95%CI:(1.096, 4.938)] in women aged 40 to 49 years(P<0.05), perimenopause and postmenopause were risk factors for dyslipidemia[OR=1.574, 95%CI:(1.279, 1.937); OR=2.668, 95%CI:(2.005, 3.549)], hyperuricemia[OR=1.828, 95%CI:(1.075, 3.109); OR=3.751, 95%CI:(2.207, 6.375)] and fatty liver[OR=1.552, 95%CI:(1.213, 1.985); OR=1.540, 95%CI:(1.110, 2.136)] (all P<0.05); perimenopause and postmenopause were risk factors for type 2 diabetes[OR=2.656, 95%CI:(1.397, 5.053); OR=3.163, 95%CI:(1.756, 5.698)], dyslipidemia[OR=1.669, 95%CI:(1.337, 2.083); OR=1.799, 95%CI:(1.496, 2.164)], hyperuricemia[OR=2.326, 95%CI:(1.379, 3.924); OR=2.029, 95%CI: (1.259, 3.269)] and fatty liver[OR=1.907, 95%CI:(1.488, 2.445); OR=2.012, 95%CI:(1.623, 2.494)]in women aged 50 to 60 years(all P<0.05). Conclusion: There are some differences in the health condition of women with different menopausal status; menopausal status are the risk factors of type 2 diabetes mellitus, dyslipidemia, hyperuricemia and fatty liver in middle-aged women；lifestyle intervention should be strengthened to improve the health status of middle-aged women.

参考文献：

[1] 中华医学会健康管理学分会,《中华健康管理学杂志》编辑委员会.健康体检基本项目专家共识(2022)[J].中华健康管理学杂志，2023，17(9)：649-660.
[2] 骆梅雪.体检中心健康教育的意义[J].中国社区医师(医学专业)，2012，14(20):343.
[3] 徐书贤.把健康融入所有政策——“健康中国2030”规划纲要出台[J].中国医院院长，2016(22)：30-31.
[4] 徐畅.基于灰色综合评价法的《“健康中国2030”规划纲要》实施效果研究[D].北京：北京协和医学院，2021.
[5] 李建新，李毅.性别视角下中国老年人健康差异分析[J].人口研究，2009，33(2)：48-57.
[6] 伍芸,江东帆,喻姗,等.基于互联网+妇女健康管理模式在妇女体检中的应用探究[J].成都医学院学报，2023，18(6)：795-798.
[7] 文念驰，刘玉萍，杨华，等.医院体检中心健康管理一体化服务模式要点和实施方法探讨[J].中国卫生事业管理，2020，37(3)：184-185，189.
[8] 杨琦,宋波.妇幼全生命周期健康教育基本信息(女性篇)[M].北京：中国人口出版社，2023：153-167.
[9] VERDONK P,BENDIEN E,APPELMAN Y.Menopause and work:a narrative literature review about menopause,work and health[J].Work,2022,72(2):483-496.
[10] 吴迪，张钏沨，张庆洋，等.围绝经期综合征妇女患病情况及影响因素分析[J].中国妇幼保健，2022，37(1)：158-161.
[11] 李娜，倪敏.社区围绝经期女性绝经症状健康管理服务认知与需求状况及相关性[J].中国妇幼保健，2022，37(24)：4745-4748.
[12] 中华人民共和国卫生部疾病控制司.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社，2006.
[13] 诸骏仁，高润霖，赵水平，等.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志，2016，44(10)：833-853.
[14] EL KHOUDARY S R,GREENDALE G,CRAWFORD S L,et al.The menopause transition and women's health at midlife:a progress report from the study of women's health across the nation(SWAN)[J].Menopause,2019,26(10):1213-1227.
[15] 何柳，唐迅，胡永华.绝经与心血管疾病及相关代谢紊乱的关联[J].北京大学学报(医学版)，2016，48(3)：448-453.
[16] 张帅，俞峰，郑毅敏，等.围绝经期高血压患者心血管结构功能特点及相关影响因素分析[J].中国妇幼保健，2023，38(17)：3358-3361.
[17] CHIKWATI R P,CHIKOWORE T,MAHYOODEEN N G,et al.The association of menopause with cardiometabolic disease risk factors in low-and middle-income countries:a systematic review and Meta-analyses[J].Menopause,2024,31(1):77-85.
[18] WU Q,GUAN Y,XU C,et al.Association of serum uric acid with diabetes in premenopausal and postmenopausal women—a prospective cohort study in Shanghai,China[J].Int J Environ Res Public Health,2022,19(23):16137.
[19] 贾潇湘，邵素君，白文佩，等.年龄和绝经对围绝经期女性血糖的影响[J].中国临床研究，2020，33(3)：308-311.
[20] SALZBERG L.Risk Factors and lifestyle interventions[J].Prim Care,2022,49(2):201-212.
[21] WAHID A,MANEK N,NICHOLS M,et al.Quantifying the association between physical activity and cardiovascular disease and diabetes:a systematic review and Meta-analysis[J].J Am Heart Assoc,2016,5(9):e002495.
[22] PARK J,SON M K,PARK H Y.Substantial lipid increases during menopausal transition in Korean middle-aged women[J].J Korean Med Sci,2023,38(31):e238.
[23] KO S H,KIM H S.Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women[J].Nutrients,2020,12(1):202.
[24] 加孜热亚·再依拿提，罗蕴芝，李素丽，等.新疆乌鲁木齐女性绝经状态与血脂变化相关性及影响因素[J].国际老年医学杂志，2022，43(2)：149-153.
[25] KARVINEN S,JERGENSON M J,HYVÄRINEN M,et al.Menopausal status and physical activity are independently associated with cardiovascular risk factors of healthy middle-aged women:cross-sectional and longitudinal evidence[J].Front Endocrinol(Lausanne),2019,10:589.
[26] TERAMURA S,SANKAI T,YAMAGISHI K,et al.Changes in cardiovascular disease risk factors during menopausal transition in Japanese women:the circulatory risk in communities study(CIRCS)[J].Menopause,2023,30(1):88-94.
[27] 杨慕坤，贾潇湘，任正洪，等.绝经还是年龄增长的影响？——一项针对中年女性冠心病高危因素的前瞻性队列研究[J].中国全科医学，2024，27(3)：280-285.
[28] 纪晓菁，王巍.女性生殖衰老分期与高尿酸血症的相关性[J].中国妇幼保健，2022，37(10)：1842-1844.
[29] YI K,CUI S,TANG M,et al.Adherence to DASH dietary pattern and its association with incident hyperuricemia risk:a prospective study in Chinese community residents[J].Nutrients,2022,14(22):4853.
[30] PIAO W,ZHAO L,YANG Y,et al.The prevalence of hyperuricemia and its correlates among adults in China:results from CNHS 2015-2017[J].Nutrients,2022,14(19):4095.
[31] 董嘉慧，庞慧，赵灵燕.2018—2020年内蒙古蒙古族成年人高尿酸血症现状及相关因素[J].卫生研究，2022，51(6)：940-946.
[32] XU X,ZHOU X,TIAN T,et al.Comparison of clinical characteristics and outcomes of MAFLD and NAFLD in Chinese health examination populations[J].J Clin Transl Hepatol,2023,11(4):777-786.
[33] CHEN K L,MADAK-ERDOGAN Z.Estrogens and female liver health[J].Steroids,2018,133:38-43.
[34] VENETSANAKI V,POLYZOS S A.Menopause and non-alcoholic fatty liver disease:a review focusing on therapeutic perspectives[J].Curr Vasc Pharmacol,2019,17(6):546-555.
[35] JEONG H G,PARK H.Metabolic disorders in menopause[J].Metabolites,2022,12(10):954.
[36] ROBEVA R,MLADENOVI D,VESKOVI M,et al.The interplay between metabolic dysregulations and non-alcoholic fatty liver disease in women after menopause[J].Maturitas,2021,151:22-30.
[37] MOLINA-MOLINA E,FURTADO G E,JONES J G,et al.The advantages of physical exercise as a preventive strategy against NAFLD in postmenopausal women[J].Eur J Clin Invest,2022,52(3):e13731.
[38] VAN EEKELEN E,GEELEN A,ALSSEMA M,et al.Sweet snacks are positively and fruits and vegetables are negatively associated with visceral or liver fat content in middle-aged men and women[J].J Nutr,2019,149(2):304-313.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录