生殖衰老过程中抑郁症状的4年随访发生率及影响因素研究

A 4-year follow-up study of depressive symptoms incidence and influencing factors during the process of reproductive aging

目的前瞻性观察女性生殖衰老过程中抑郁症状的4年累积发生率,探讨其与生殖衰老阶段、血清激素水平变化及绝经相关症状的相关性。方法便利抽样北京市西城区228名30-54岁未绝经、且符合STRAW＋10分期纳入标准的健康、无抑郁症状女性,随访4年,内容包括一般人口学特征、血清FSH和E2水平、抑郁及绝经相关症状及月经情况。主要评估工具包括：医院焦虑抑郁量表（HADS）、绝经生活质量问卷（MENQOL）和月经日记记录表。结果抑郁症状4年累积发生率22.4%,绝经过渡期的持续期发生比例最高。条件logistic回归显示：血清FSH水平升高（OR=1.10,P=0.008）,血管舒缩症状（OR=3.54,P=0.033）和躯体症状得分（OR=5.89,P=0.032）增加与抑郁症状的发生密切相关;但未发现血清E2水平变化和性问题症状对抑郁症状有显著影响（P〉0.05）。结论绝经过渡持续阶段抑郁高发。躯体症状、血管舒缩症状和以FSH水平升高为标志的垂体-卵巢轴功能改变可能是影响生殖衰老阶段抑郁症状发生的重要原因。

Objective To prospectively observe the 4years＇ calculative incidence of depressive symptoms during the reproductive aging process in Chinese women,and to explore predictive effects of changes of menstrual cycles,serum hormones,and menopausal symptoms on depressive symptoms.Methods Two hundred and twenty-eight healthy women,aged 30 to 54years,with no depression,and meeting with requirements of Stages of Reproductive Aging Workshop＋10（STRAW＋10）criteria were recruited in Xicheng district of Beijing by using the way of convenience sampling and were followed up for 4years.The investigation of basic demographic characteristics,depression symptoms and other menopausal symptoms,the fasting blood draw for serum FSH and E2 level assay and the monthly menstruation recording were conducted at each follow up.Instruments included the Hospital Anxiety and Depression Scale（HADS）,the Menopause-specific Quality of Life Questionnaire（MENQOL）and the menstrual diary.Results A total of 51 women were observed depressive symptoms during the 4years＇ follow-up,with accumulative incidence of 22.4%.The higher incidence of depressive symptoms occurred in menopausal transition continue stage.Conditional logistic regression model analysis showed that within-woman increased levels of serum FSH（OR=1.10,P=0.008）and increased scores of vasomotor symptoms（OR=3.54,P=0.033）and somatic symptoms（OR=5.89,P=0.032）were significantly associated with new onset of depression.But no significantly statistical effects of the changed levels of serum E2 and increased scores of sexual symptoms on depressive symptoms were found（P〈0.05）.Conclusion Menopausal transition is also the vulnerable stage of depressive symptoms in Chinese women.Combined effects of menopausal symptoms and functional changes of pituitary ovarian axis which are demonstrated by increased levels of serum FSH and changes of menstrual cycles,might be main reasons which lead to depressive symptoms.