北京社区妇女卵巢功能衰退过程中心血管疾病危险因素的变化及生活方式干预效果研究
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摘要
背景心血管疾病(CVD)是威胁妇女健康的主要疾病之一。绝经是妇女生命进程中必然发生的生理过程,绝经提示卵巢功能衰退,生殖能力终止。国外研究CVD危险因素的变化与妇女年龄及绝经均有关系,国内研究提示妇女绝经与CVD危险因素是值得关注的问题,但缺乏长期随访研究的结果。对绝经过渡期妇女CVD危险因素最理想的干预方式是生活方式的调整。生活方式干预对CVD危险因素的效果在国外多项研究中已证实,但国内对围绝经期妇女生活方式干预的研究很少。
第一部分研究：北京社区妇女卵巢功能衰退过程中随访5年CVD危险因素的变化
一、研究目的
描述北京社区妇女基线CVD危险因素及随访5年CVD危险因素的变化。
二、研究方法
采用前瞻性队列研究。本研究是北京协和医院妇泌中心从2005年开始的社区妇女队列研究的一部分,根据研究目的,在北京市某街道办事处所辖8个居委会选取30-54岁在过去12个月中有月经来潮的妇女,以入组的社区资料作为研究的基线,共追踪随访5年。每年进行问卷调查、体格检查(身高、体重、腰围、臀围、血压)、实验室检查(雌二醇E2、卵泡刺激素FSH、空腹血糖和血脂)、体成分测定,并记录月经日记。按照STRAW+10分期标准划分生殖衰老分期(生育期、绝经过渡期早期、绝经过渡期晚期、绝经早期),分析生殖衰老分期和随访5年CVD危险因素变化的关系。
三、结果
1.基线妇女CVD危险因素
本研究基线入组426人,平均年龄43.23±4.89岁(极差30-54),按照STRAW+10分期标准,基线时有217人(51.0%)处于生育期,有148人(34.7%)处于绝经过渡期早期,另有61人(14.3%)处于绝经过渡期晚期。调整年龄和体重指数(BMI)后,腰围和腰臀比(WHR)在绝经过渡期早期比生育期和绝经过渡期晚期高,总胆固醇(TC)在绝经过渡期晚期比生育期和绝经过渡期早期高。
2.基线妇女随访5年CVD危险因素的变化
基线入组426人,共随访5年,平均随访2.87年,完成每年1次随访的研究对象是260人。第5年随访时生育期有37人(14.2%),绝经过渡期早期87人(33.4%),绝经过渡期晚期68人(26.2%),绝经早期68人(26.2%)。
对随访5年的CVD危险因素进行重复测量方差分析发现,在调整年龄后,随访5年过程中不同随访时间的BMI差异无统计学意义,不同生殖衰老分期间差异也无统计学意义。在调整年龄和BMI后,不同随访时间的腰围、WHR、腹部／臀部脂肪比(A/G)、全身脂肪百分比差异有显著的统计学意义(P<0.05),但不同生殖衰老分期间差异无统计学意义。在调整年龄和BMI后,不同随访时间的收缩压、舒张压、躯干大腿脂肪比、血糖、血脂的差异没有统计学意义,不同生殖衰老分期间差异也无统计学意义。
以CVD危险因素各指标随访过程中变化百分比作因变量,将基线年龄、文化程度、日常运动强度,生殖衰老分期(以生育期为参照)作为自变量进行多元线性回归分析发现,在随访第1年,第3-5年,腰围和腰臀比与生殖衰老分期有关(P<0.05)；在随访第3年和随访第5年TC与生殖衰老分期有关(P<0.05)；在随访第2年,全身脂肪百分比与生殖衰老分期有关(P<0.05)；在随访第5年,A/G与生殖衰老分期有关(P<0.05)。
四、结论和建议
1.北京社区妇女CVD危险因素随年龄增长而变化。
2.年龄和卵巢衰退对腰围、腰臀比、A/G、全身脂肪百分比、TC的变化都有影响。BMI、血压、血糖、TG、HDL-C、LDL-C与卵巢衰退的关系还需进一步研究。
3.建议继续完成每年社区妇女的随访,观察卵巢衰退与CVD危险因素的关系,观察心血管疾病在随访妇女中的发生情况。
第二部分研究：生活方式干预对北京社区绝经过渡期和绝经早期妇女CVD危险因素的效果评价
一、研究目的评价生活方式干预对北京社区绝经过渡期和绝经早期妇女CVD危险因素的效果。
二、研究方法
采用类实验性研究,2011年12月-2012年5月在社区随访的妇女中,按照STRAW+10分期标准,选取绝经过渡期和绝经早期妇女100人(平均年龄49.89±4.16岁),按照所在居委会整群分组分为干预组(n=53)和对照组(n=47)。干预组采用生活方式干预,发放并讲解生活方式干预手册,组织参加社区健康讲座,并定期进行随访；对照组不进行生活方式干预。在基线、干预后3个月、6个月和1年分别进行体格检查、空腹血糖、血脂和体成分测定。
三、结果
干预后3个月与基线相比,干预组收缩压降低；对照组体重、BMI、腰围、腰臀比升高。干预组与对照组相比,干预后3个月与基线差值的差异有显著统计学意义的指标有体重(-0.28vs0.68,P=0.002)、BMI(-0.06vs0.44,P=0.003)、腰围(-0.28vs1.43,P=0.001)和腰臀比(-0.01vs0.01,P=0.045)。
干预后6个月与基线相比,干预组体重、腰臀比、收缩压、TC、LDL-C降低；对照组身体测量、血糖血脂无变化。干预组与对照组相比,干预后6个月与基线差值的差异有显著统计学意义的指标有腰围(-0.73vs1.02,P=0.012)、腰臀比(-0.02vs-0.003,P=0.020)和收缩压(-7.52vs-0.63,P=0.012)。
干预后1年与基线相比,干预组各指标无差异；对照组腰围增加。干预组与对照组相比,干预后1年与基线差值的差异有显著性统计学意义的指标有TC(-0.07vs0.03,P=0.045)和LDL-C(-0.13vs0.01, P=0.022)。
四、结论与建议
1.生活方式干预可有效降低北京社区绝经过渡期和绝经早期妇女的体重、BMi、WC、WHR、收缩压、TC(?)LDL-C,对舒张压、TG、HDL-C和体成分的效果还有待进一步研究。
2.继续随访观察生活方式干预在社区妇女中的长期效果。考虑在社区中全面推广生活方式干预项目,对肥胖和超重或血脂异常妇女单独分析生活方式干预的效果,并注重干预效果的持续性。
Background
Cardiovascular diseases (CVD) are one of major threats to women's health. Epidemiological studies suggest that menopause is associated with increase in CVD risk factors. However, whether changes in these risk factors were related to ovarian aging and chronological aging remains controversial. Meanwhile, there are few prospective studies mainly on the relationship between aging of ovarian function and risk factors for CVD in China. In this study, we investigated changes of risk factors for CVD during the aging of ovarian function in Chinese women and the effect of lifestyle intervention.
The following sections were included in this study: Section one:Investigation on changes of risk factors for CVD during the aging of ovarain function in Chinese women
Section two:The effects of lifestyle intervention improve cardiovascular disease risk factors in menopausal transition and early-postmenopausal women in China
Section one:Investigation on changes of risk factors for CVD during the aging of ovarian function in Chinese women
Objective Investigate the changes of risk factors for CVD during aging of ovarian function in Chinese women.
Methods Prospective study. To recruit women30-54years in eight communities in western Beijing from June to December2005, and from April to July2007. A total of426community-based healthy premenopausal or perimenopausal women were followed annually for up to5years. Measured CVD risk factors included body measurement variables(BMI, waist circumference, ratio of waist circumference to hip circumference, systolic pressure, diastolic pressure), fasting blood glucose, lipids (TC, TG, HDL-C and LDL-C) and body composition. Those risk factors were assessed in six annual serial measures.Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop+10.
Results
1.CVD risk factors at baseline among premenopausal women
At baseline, there were217(51.0%) women in reproductive phase,148(34.7%) women in early menopausal transition,61(14.3%) women in late menopausal transition. After adjusting for age and BMI, WC and WHR were higher among women in early menopausal transition than women in reproductive phase or late menopausal transition. And TC was higher among women in late menopausal transition than those in reproductive phase or early menopausal transition. There were no significant differences for other risk factors for CVD between different stages of STRAW+10.
2. Changes of CVD risk factors during5years follow up
There are260women who had finished5years follow up. After average2.87years follow-up,37(14.2%) women were still in reproductive phase,87(33.4%) women in early menopausal transition,68(26.2%) women in late menopausal transition and68(26.2%) women reached early postmenopause.
After adjusting for age and BMI, there were significant in WC, WHR, A/G, total fat mass ratio over the time period. But there were no significance in systolic blood pressure, diastolic blood pressure, fasting blood glucose, lipids (TC, TG, HDL-C, LDL-C), and trunk-leg fat mass ratio over the follow-up period. There was no significance for all CVD risk factors in different staging of STRAW+10.
Adjusted for the important predictors--age, BMI, education level, and physicial activity, menopausal status was a significant and independent predictor of the increase in WC, WHR, TC, percent of body fat and A/G.
Conclusions Both time (chronological aging) and ovarian aging contributed to substantial changes in WC, WHR, A/G, percent of body fat and TC in Chinese Women. But we need more research to investigate the relationship between BMI, blood pressure, blood glucose, TG, HDL-C, LDL-C with menopause.
Section two:The effects of lifestyle intervention improve cardiovascular disease risk factors in menopausal transition and early-postmenopausal women in China
Objective The purpose of this study was to test the efficacy of a12months lifestyle intervention on CVD risk factors in menopausal transition and early-postmenopausal women in China.
Methods One hundred healthy menopausal transition and early-postmenopausal women aged40-60years were randomly assigned to receive either lifestyle change (intervention group, n=53) or usual care (control group, n=47). Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop+10based on the prospective menstrual calendars.
Women in the intervention group were provided with a booklet and interview one by one at which time biophysical cardiovascular risk measures were taken in Women Health Center. Women were encouraged to followed healthy eating pattern and increased their aerobic activity (moderate,3day/week,40min/d). Women in the control group continued their normal activities.
Weight, Body Mass Index (BMI), waist circumference(WC), Waist circumference to hip circumference ratio (WHR), body composition, blood pressure (BP), blood glucose and blood lipids were assessed at baseline and12-month. At3-month, Weight, BMI, WC, WHR, and BP were assessed. At6-month, Weight, BMI, WC, WHR, BP, blood glucose and blood lipids were assessed.
Results The data from five biophysical outcome measures supported the efficacy of the intervention, with significant decreases seen in the women's weight, BMI, WC, and WHR. At3-month, there were significant changes in weight(-0.28vs0.68, P=0.002), BMI(-0.06vs0.44, P=0.003), WC (-0.28vs1.43, P=0.001), WHR(-0.01vs0.01, P=0.045) between intervention group and control group. At6-month, there were significant changes in WC(-0.73vs1.02, P=0.012), WHR (-0.02vs-0.003, P=0.020) and Systolic blood pressure(SBP)(-7.52vs-0.63, P=0.012) between intervention group and control group. At12-month, there were significant changes in TC(-0.07vs0.03, P=0.045) and LDL-C (-0.13vs0.01, P=0.022) between intervention group and control group.
Conclusions Lifestyle intervention may be an effective means for reducing cardiovascular risk in menopausal transition and early-postmenopausal women in China.
第一部分研究：北京社区妇女卵巢功能衰退过程中随访5年CVD危险因素的变化
一、研究目的
描述北京社区妇女基线CVD危险因素及随访5年CVD危险因素的变化。
二、研究方法
采用前瞻性队列研究。本研究是北京协和医院妇泌中心从2005年开始的社区妇女队列研究的一部分,根据研究目的,在北京市某街道办事处所辖8个居委会选取30-54岁在过去12个月中有月经来潮的妇女,以入组的社区资料作为研究的基线,共追踪随访5年。每年进行问卷调查、体格检查(身高、体重、腰围、臀围、血压)、实验室检查(雌二醇E2、卵泡刺激素FSH、空腹血糖和血脂)、体成分测定,并记录月经日记。按照STRAW+10分期标准划分生殖衰老分期(生育期、绝经过渡期早期、绝经过渡期晚期、绝经早期),分析生殖衰老分期和随访5年CVD危险因素变化的关系。
三、结果
1.基线妇女CVD危险因素
本研究基线入组426人,平均年龄43.23±4.89岁(极差30-54),按照STRAW+10分期标准,基线时有217人(51.0%)处于生育期,有148人(34.7%)处于绝经过渡期早期,另有61人(14.3%)处于绝经过渡期晚期。调整年龄和体重指数(BMI)后,腰围和腰臀比(WHR)在绝经过渡期早期比生育期和绝经过渡期晚期高,总胆固醇(TC)在绝经过渡期晚期比生育期和绝经过渡期早期高。
2.基线妇女随访5年CVD危险因素的变化
基线入组426人,共随访5年,平均随访2.87年,完成每年1次随访的研究对象是260人。第5年随访时生育期有37人(14.2%),绝经过渡期早期87人(33.4%),绝经过渡期晚期68人(26.2%),绝经早期68人(26.2%)。
对随访5年的CVD危险因素进行重复测量方差分析发现,在调整年龄后,随访5年过程中不同随访时间的BMI差异无统计学意义,不同生殖衰老分期间差异也无统计学意义。在调整年龄和BMI后,不同随访时间的腰围、WHR、腹部／臀部脂肪比(A/G)、全身脂肪百分比差异有显著的统计学意义(P<0.05),但不同生殖衰老分期间差异无统计学意义。在调整年龄和BMI后,不同随访时间的收缩压、舒张压、躯干大腿脂肪比、血糖、血脂的差异没有统计学意义,不同生殖衰老分期间差异也无统计学意义。
以CVD危险因素各指标随访过程中变化百分比作因变量,将基线年龄、文化程度、日常运动强度,生殖衰老分期(以生育期为参照)作为自变量进行多元线性回归分析发现,在随访第1年,第3-5年,腰围和腰臀比与生殖衰老分期有关(P<0.05)；在随访第3年和随访第5年TC与生殖衰老分期有关(P<0.05)；在随访第2年,全身脂肪百分比与生殖衰老分期有关(P<0.05)；在随访第5年,A/G与生殖衰老分期有关(P<0.05)。
四、结论和建议
1.北京社区妇女CVD危险因素随年龄增长而变化。
2.年龄和卵巢衰退对腰围、腰臀比、A/G、全身脂肪百分比、TC的变化都有影响。BMI、血压、血糖、TG、HDL-C、LDL-C与卵巢衰退的关系还需进一步研究。
3.建议继续完成每年社区妇女的随访,观察卵巢衰退与CVD危险因素的关系,观察心血管疾病在随访妇女中的发生情况。
第二部分研究：生活方式干预对北京社区绝经过渡期和绝经早期妇女CVD危险因素的效果评价
一、研究目的评价生活方式干预对北京社区绝经过渡期和绝经早期妇女CVD危险因素的效果。
二、研究方法
采用类实验性研究,2011年12月-2012年5月在社区随访的妇女中,按照STRAW+10分期标准,选取绝经过渡期和绝经早期妇女100人(平均年龄49.89±4.16岁),按照所在居委会整群分组分为干预组(n=53)和对照组(n=47)。干预组采用生活方式干预,发放并讲解生活方式干预手册,组织参加社区健康讲座,并定期进行随访；对照组不进行生活方式干预。在基线、干预后3个月、6个月和1年分别进行体格检查、空腹血糖、血脂和体成分测定。
三、结果
干预后3个月与基线相比,干预组收缩压降低；对照组体重、BMI、腰围、腰臀比升高。干预组与对照组相比,干预后3个月与基线差值的差异有显著统计学意义的指标有体重(-0.28vs0.68,P=0.002)、BMI(-0.06vs0.44,P=0.003)、腰围(-0.28vs1.43,P=0.001)和腰臀比(-0.01vs0.01,P=0.045)。
干预后6个月与基线相比,干预组体重、腰臀比、收缩压、TC、LDL-C降低；对照组身体测量、血糖血脂无变化。干预组与对照组相比,干预后6个月与基线差值的差异有显著统计学意义的指标有腰围(-0.73vs1.02,P=0.012)、腰臀比(-0.02vs-0.003,P=0.020)和收缩压(-7.52vs-0.63,P=0.012)。
干预后1年与基线相比,干预组各指标无差异；对照组腰围增加。干预组与对照组相比,干预后1年与基线差值的差异有显著性统计学意义的指标有TC(-0.07vs0.03,P=0.045)和LDL-C(-0.13vs0.01, P=0.022)。
四、结论与建议
1.生活方式干预可有效降低北京社区绝经过渡期和绝经早期妇女的体重、BMi、WC、WHR、收缩压、TC(?)LDL-C,对舒张压、TG、HDL-C和体成分的效果还有待进一步研究。
2.继续随访观察生活方式干预在社区妇女中的长期效果。考虑在社区中全面推广生活方式干预项目,对肥胖和超重或血脂异常妇女单独分析生活方式干预的效果,并注重干预效果的持续性。
Background
Cardiovascular diseases (CVD) are one of major threats to women's health. Epidemiological studies suggest that menopause is associated with increase in CVD risk factors. However, whether changes in these risk factors were related to ovarian aging and chronological aging remains controversial. Meanwhile, there are few prospective studies mainly on the relationship between aging of ovarian function and risk factors for CVD in China. In this study, we investigated changes of risk factors for CVD during the aging of ovarian function in Chinese women and the effect of lifestyle intervention.
The following sections were included in this study: Section one:Investigation on changes of risk factors for CVD during the aging of ovarain function in Chinese women
Section two:The effects of lifestyle intervention improve cardiovascular disease risk factors in menopausal transition and early-postmenopausal women in China
Section one:Investigation on changes of risk factors for CVD during the aging of ovarian function in Chinese women
Objective Investigate the changes of risk factors for CVD during aging of ovarian function in Chinese women.
Methods Prospective study. To recruit women30-54years in eight communities in western Beijing from June to December2005, and from April to July2007. A total of426community-based healthy premenopausal or perimenopausal women were followed annually for up to5years. Measured CVD risk factors included body measurement variables(BMI, waist circumference, ratio of waist circumference to hip circumference, systolic pressure, diastolic pressure), fasting blood glucose, lipids (TC, TG, HDL-C and LDL-C) and body composition. Those risk factors were assessed in six annual serial measures.Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop+10.
Results
1.CVD risk factors at baseline among premenopausal women
At baseline, there were217(51.0%) women in reproductive phase,148(34.7%) women in early menopausal transition,61(14.3%) women in late menopausal transition. After adjusting for age and BMI, WC and WHR were higher among women in early menopausal transition than women in reproductive phase or late menopausal transition. And TC was higher among women in late menopausal transition than those in reproductive phase or early menopausal transition. There were no significant differences for other risk factors for CVD between different stages of STRAW+10.
2. Changes of CVD risk factors during5years follow up
There are260women who had finished5years follow up. After average2.87years follow-up,37(14.2%) women were still in reproductive phase,87(33.4%) women in early menopausal transition,68(26.2%) women in late menopausal transition and68(26.2%) women reached early postmenopause.
After adjusting for age and BMI, there were significant in WC, WHR, A/G, total fat mass ratio over the time period. But there were no significance in systolic blood pressure, diastolic blood pressure, fasting blood glucose, lipids (TC, TG, HDL-C, LDL-C), and trunk-leg fat mass ratio over the follow-up period. There was no significance for all CVD risk factors in different staging of STRAW+10.
Adjusted for the important predictors--age, BMI, education level, and physicial activity, menopausal status was a significant and independent predictor of the increase in WC, WHR, TC, percent of body fat and A/G.
Conclusions Both time (chronological aging) and ovarian aging contributed to substantial changes in WC, WHR, A/G, percent of body fat and TC in Chinese Women. But we need more research to investigate the relationship between BMI, blood pressure, blood glucose, TG, HDL-C, LDL-C with menopause.
Section two:The effects of lifestyle intervention improve cardiovascular disease risk factors in menopausal transition and early-postmenopausal women in China
Objective The purpose of this study was to test the efficacy of a12months lifestyle intervention on CVD risk factors in menopausal transition and early-postmenopausal women in China.
Methods One hundred healthy menopausal transition and early-postmenopausal women aged40-60years were randomly assigned to receive either lifestyle change (intervention group, n=53) or usual care (control group, n=47). Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop+10based on the prospective menstrual calendars.
Women in the intervention group were provided with a booklet and interview one by one at which time biophysical cardiovascular risk measures were taken in Women Health Center. Women were encouraged to followed healthy eating pattern and increased their aerobic activity (moderate,3day/week,40min/d). Women in the control group continued their normal activities.
Weight, Body Mass Index (BMI), waist circumference(WC), Waist circumference to hip circumference ratio (WHR), body composition, blood pressure (BP), blood glucose and blood lipids were assessed at baseline and12-month. At3-month, Weight, BMI, WC, WHR, and BP were assessed. At6-month, Weight, BMI, WC, WHR, BP, blood glucose and blood lipids were assessed.
Results The data from five biophysical outcome measures supported the efficacy of the intervention, with significant decreases seen in the women's weight, BMI, WC, and WHR. At3-month, there were significant changes in weight(-0.28vs0.68, P=0.002), BMI(-0.06vs0.44, P=0.003), WC (-0.28vs1.43, P=0.001), WHR(-0.01vs0.01, P=0.045) between intervention group and control group. At6-month, there were significant changes in WC(-0.73vs1.02, P=0.012), WHR (-0.02vs-0.003, P=0.020) and Systolic blood pressure(SBP)(-7.52vs-0.63, P=0.012) between intervention group and control group. At12-month, there were significant changes in TC(-0.07vs0.03, P=0.045) and LDL-C (-0.13vs0.01, P=0.022) between intervention group and control group.
Conclusions Lifestyle intervention may be an effective means for reducing cardiovascular risk in menopausal transition and early-postmenopausal women in China.
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