绝经妇女代谢综合征干预措施的研究

doi:10.3969/j.issn.1006-7795.2013.04.008

摘要/Abstract

摘要：

目的探讨激素治疗及生活方式干预对防治绝经妇女代谢综合征的有效性。方法自然绝经妇女121名,分为激素治疗组和生活方式干预组。激素治疗组:给予戊酸雌二醇配伍地屈孕酮周期序贯治疗6个周期,同时给予生活方式干预,个体化饮食营养指导以及精神心理辅导;对生活方式干预组:只进行个体化饮食营养指导以及精神心理辅导。分别于干预前后对两组研究对象各进行一次改良Kupperman评分、一般指标、血清学指标,以及全身脂肪含量(body fat,BF)的测定。分别对激素治疗组、生活方式干预组干预前后各项指标测量值进行配对样本检验,对激素治疗组和生活方式干预组干预后各项指标的变化进行独立样本检验。结果 121人全部完成了该项研究,激素治疗组64人,生活方式干预组57人。干预6个月,激素治疗组研究对象的改良Kupperman评分,体质量指数(body mass index,BMI),腰围(waist circumference,WC),全身脂肪含量,血清卵泡刺激素(follicle stimulating hormone,FSH),三酰甘油(triglyceride,TG),低密度脂蛋白胆固醇(light density lipoprotein cholesterol,LDL-C)浓度下降程度以及血清雌二醇(estradiol,E2),高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)浓度升高程度均明显大于生活方式干预组,差异具有统计学意义(P<0.05)。激素治疗组研究对象的血清总胆固醇(total cholesterol,TC),空腹血清血糖(fasting plasma glucose,FPG)浓度下降程度也稍大于生活方式干预组,但差异无统计学意义(P>0.05)。结论干预6个周期,激素治疗和个体化生活方式干预方案均能明显降低绝经妇女代谢综合征(metabolic syndrome,MS)的患病率,有效防治绝经妇女代谢综合征的发生发展。但激素治疗方案在改善绝经妇女绝经相关症状,减少绝经妇女体质量以及全身脂肪含量增加,防治绝经妇女代谢综合征血清学组分异常发生发展方面的效果均显著优于单纯生活方式干预组。

关键词: 更年期, 代谢综合征, 激素治疗, 生活方式干预

Abstract:

Objective To explore the efficacy of hormone therapy and lifestyle intervention in metabolic syndrome of postmenopausal women.Methods A total of 121 voluntary participants were recruited, divided into hormone therapy group which contained 64 persons and lifestyle intervention group which contained 57 persons. Hormone therapy group was treated with estradiol valerate combined with dydrogesterone for 6 months plus lifestyle intervention. Lifestyle intervention group was intervened with dietary nutrition guidance and psychological counseling for 6 months. The Kupperman score, anthropometric indicators, serological indicators and the body fat% were measured before and after the interventions. The paired sample test was conducted between the measurements before and after the intervention in hormone therapy group and lifestyle intervention group respectively. The independent samples test was conducted between the measurements after the intervention in hormone therapy group and lifestyle intervention group.Results All the 121 subjects completed the study, including 64 cases of hormone treatment group and 57 cases of lifestyle intervention group. After 6 months of hormone therapy, Kupperman score, body mass index, waist circumference, body fat, serum follicle-stimulating hormone(FSH), triglycerides(TG), low density lipoprotein cholesterol(LDL-C) of hormone therapy group subjects were significantly decreased, and the estradiol(E2), high density lipoprotein cholesterol(HDL-C) levels were significantly increased compared with lifestyle intervention group subjects, the difference between the two groups was statistically significant. But the total cholesterol(TC), fasting plasma glucose(FPG) level, prevalence of metabolic syndrome(MS) were not significantly different compared with the lifestyle intervention group subjects.Conclusion Both hormone therapy and lifestyle intervention could significantly reduce the prevalence of the MS in menopausal women after 6 months intervention. But the hormone therapy plus lifestyle intervention was better than the lifestyle intervention only in improving the menopausal symptoms, decreasing the weight and the body fat increases, prevention of the occurrence and development of metabolic syndrome components in postmenopausal women.

Key words: menopause, metabolic syndrome, hormone therapy, lifestyle intervention

中图分类号:

阮祥燕, 闫丹, 张俊丽, 卢永军, 柳顺玉, 王娟, 殷冬梅, 刘玉兰, 甄洁. 绝经妇女代谢综合征干预措施的研究[J]. 首都医科大学学报, 2013, 34(4): 519-524.

RUAN Xiangyan, YAN Dan, ZHANG Junli, LU Yongjun, LIU Shunyu, WANG Juan, YIN Dongmei, LIU Yulan, ZHEN Jie. Interventions on metabolic syndrome in postmenopausal women[J]. Journal of Capital Medical University, 2013, 34(4): 519-524.

参考文献

[1] 宋秀霞.国际糖尿病联盟代谢综合征全球共识定义[J].中华糖尿病杂志,2005,13(3):178-180.

[2] Alberti K G, Zimmet P, Shaw J. The metabolic syndrome a new world-wide definition[J]. Lancent, 2005,366(9491):1059-1062.

[3] Mathieu P, Despres J P, Pibarot P. The ‘valvulo-metabolic' risk in calcific aortic valve disease[J]. Can J Cardiol, 2007,23(Suppl B):32B-39B.

[4] Leuzzi C, Marzullo R, Modena M G. Is meno pause a risk factor for ischemic heart disease in women?[J]. G Ital Cardiol, 2012,13(6):401-406.

[5] Ijuin H, Douchi T, Oki T, et al. The contribution of menopause to changes in body-fat distribution[J]. J Obstet Gynaecol Res,1999,25(5):367-372.

[6] Bittner V. Menopause, age, and cardiovascular risk: a complex relationship[J]. Am Coll Cardiol, 2009,54(25):2374-2375.

[7] Coylewright M, Reckelhoff J F, Ouyang P. Menopause and hypertension: an age-old debate[J]. Hypertension, 2008,51(4):952-959.

[8] Kim E S, Menon V. Status of women in cardiovascular clinical trials[J]. Arterioscler Thromb Vasc Biol, 2009,29(3):279-283.

[9] Reckelhoff J F, Maric C. Sex and gender differences in cardiovascular-renal physiology and pathophysiology[J]. Steroids, 2010,75(11):745-746.

[10] Siegel R D, Cupples A, Schaefer E J, et al. Lipoproteins, apolipoproteins, and low-density lipoprotein size among diabetics in the Framingham offspring study[J]. Metabolism, 1996,45(10):1267-1272.

[11] Lee S W, Jo H H, Kim M R, et al. Association between metabolic syndrome and serum leptin levels in postmenopausal women[J]. J Obstet Gynaecol, 2012,32(1):73-77.

[12] Chu F L, Hsc C H, Jeng C. Low predictability of anthropometric indicators of obesity in metabolic syndrome(MS) risks among elderly women[J]. Arch Gerontol Geriatr, 2012,55(3):718-723.

[13] Zivkovic T B, Vuksanovic M, Jelic M A, et al. Obesity and metabolic syndrome during the menopause transition in Serbian women[J]. Climacteric, 2011,14(6):643-648.

[14] Lakka H M, Laaksonen D E, Lakka T A, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men[J]. JAMA, 2002,288(21):2709-2716.

[15] Ford E S, Giles W H, Mokdad A H. Increasing prevalence of the metabolic syndrome among U.S. adults[J]. Diabetes Care, 2004,27(10):2444-2449.

[16] Ford E S. Risks for all-cause mortality,cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence[J]. Diabetes Care, 2005,28(7):1769-1778.

[17] Mathieu P, Pibarot P, Larose E, et al. Visceral obesity and the heart[J]. Int J Biochem Cell Biol, 2008,40(5):821-836.

[18] Barton M, Meyer M R. Postmenopausal hypertension: mechanisms and therapy[J]. Hypertension, 2009,54:11-18.

[19] Barton M, Meyer M R. Postmenopausal hypertension: mechanisms and therapy[J]. Hypertension, 2009,54(1):11-18.

[20] USPSTF. Postmenopausal hormone replacement therapy for the primary prevention of chronic condition. Recommendations and rationale. U.S. Preventive Services Task Force[J]. Am Fam Physician,2003,67(2):358-364.

[21] Sitges M, Heras M, Roig E, et al. Acute and mid-term combined hormone replacement therapy improves endothelial function in post-menopausal women with angina and angiographically normal coronary arteries[J]. Eur Heart J, 2001,22(22):2116-2124.

[22] 杨红霞,吕美娜.中老年女性心脑血管疾病的危险因素和综合干预措施[J].解放军医药杂志,2012,24(4):64-68.

[23] 张润军,杨丽霞.冠心病危险因素与冠状动脉病变的相关性分析[J].解放军医药杂志,2011,23(1):7-11.