绝经前后女性血脂特征的比较

Lipid profile comparison between pre-and post-menopausal women

目的 比较绝经前后女性的血脂特征,并探讨绝经与血脂异常的关系.方法 选取2012年1月至2014年12月在北京同仁医院体检中心进行健康体检的40 ～ 59岁女性4 131名.将研究对象分为2组,即未绝经组（3 094名）和绝经后组（1 037名）.采用统一方法检测体重指数、腰围、臀围、腰臀比、血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）、TC/HDL-C、静脉空腹血糖、血清尿酸、血压以及脂肪肝.应用多因素logistic回归分析绝经与血脂异常的关系.结果 女性的血脂异常患病率为35.7％（1 475/4 131）,绝经后女性的血脂异常患病率高于未绝经女性[69.7％ （723/1 037）比24.3％（752/3 094）,P＜0.01].绝经后女性的TC[（5.74±0.91） mmol/L比（4.65±0.61） mmol/L,P＜0.01]、TG[（1.79±0.95） mmol/L比（0.89±0.32）mmoL/L,P ＜0.01]、LDL-C[（3.76±0.86） mmol/L比（2.87±0.57） mmol/L,P ＜0.01]、non-HDL-C[（4.27±0.80） mmol/L比（3.10±0.60） mmol/L,P＜0.01]、TC/HDL-C（4.15±1.04比3.13±0.72,P＜0.01）均高于未绝经女性,HDL-C水平低于未绝经女性[（1.47±0.43） mmol/L比（1.54±0.33）mmol/L,P＜0.01].多因素logistic回归分析显示,校正年龄、体重指数、腰围、腰臀比、血压、静脉空腹血糖、血清尿酸和脂肪肝后,绝经是血脂异常的独立影响因素（OR =6.65,95％ CI 5.22～8.48,P＜0.01）;体重指数等级（正常体重：OR =2.19,95％ CI 1.31～3.67,P＜0.01;超重：OR=3.41,95％ CI 2.00 ～ 5.83,P＜0.01;肥胖：OR=3.84,95％ CI 2.05～7.18,P＜0.01）、腰臀比异常（OR=1.68,95％CI 1.44～ 1.97,P＜0.01）和脂肪肝程度（轻度：OR=1.84,95％ CI 1.54 ～2.20,P＜0.01;中度：OR=1.67,95％ CI 1.25 ～2.23,P＜0.01;重度：OR=5.23,95％ CI 1.78～15.35,P＜0.01）也是血脂异常的影响因素.结论 绝经后女性的血脂异常患病率高于未绝经女性,TC、TG、LDL-C、non-HDL-C、TC/HDL-C也高于未绝经女性;绝经与血脂异常相关.

Objective To compare serum lipid values in premenopausal and postmenopausal women and to evaluate the relationship between menopause and lipid profiles.Methods From January 2012 to December 2014,a total of 4 131 women aged between 40 and 59 years old were recruited as subjects in the Checkup Department of Beijing Tongren Hospital,and were grouped as pre-menopausal group （3 094subjects） and post-menopausal group （1 037 subjects）.Data including body mass index （BMI）,waist circnmference,hip circumference,waist-hip circumference ratio,serum total cholesterol （TC）,triglyceride （TG）,low density lipoprotein cholesterol （LDL-C）,high density lipoprotein cholesterol （HDL-C）,non-high-density lipoprotein cholesterol（non-HDL-C）,TC/HDL-C ratio,fast plasma glucose,serum uric acid,blood pressure and degree of fatty liver were compared between the two groups.Multivariate logistic regression analysis was applied to analyze the relationship between menopause and dyslipidemia.Results The overall prevalence rate of dyslipidemia was 35.7％ （1 475/4 131） in this cohort,and the prevalence rate of dyslipidemia in post-menopausal women group was significantly higher than in pre-menopausal women group （69.7％ （723/1 037） vs.24.3％ （752/3 094）,P ＜ 0.01）.TC （（5.74 ± 0.91） mmol/L vs.（4.65 ±0.61）mmol/L,P＜0.01）,TG（（1.79±0.95）mmol/L vs.（0.89 ± 0.32） mmol/L,P＜0.01）,LDL-C （（3.76 ± 0.86） mmol/L vs.（2.87 ± 0.57） mmol/L,P ＜ 0.01）,non-HDL-C （（4.27 ± 0.80） mmol/L vs.（3.10 ±0.60）mmol/L,P ＜0.01）,and TC/HDL-C ratio（4.15 ± 1.04 vs.3.13 ±0.72,P ＜0.01）were all significantly higher in post-menopausal subjects than in pre-menopausal subjects.HDL-C level was significantly lower in post-menopausal subjects than in pre-menopausal subjects （（1.47 ± 0.43） mmol/L vs.（1.54 ± 0.33） mmol/L,P ＜ 0.01）.Logistic regression analysis showed that after adjusting age,BMI,waist circumference,waist-hip circumference ratio,blood pressure,fast plasma glucose,serum uric acid and fatty liver,menopause was independently associated with dyslipidemia （OR =6.65,95％ CI 5.22-8.48,P ＜ 0.01）.Factors such as BMI grade （normal body weight：OR =2.19,95％ CI 1.31-3.67,P ＜ 0.01;overweight：OR =3.41,95％ CI 2.00-5.83,P ＜ 0.01;obesity：OR =3.84,95％ CI 2.05-7.18,P ＜0.01）,waist-hip circumference ratio abnormality （OR =1.68,95％ CI 1.44-1.97,P ＜ 0.01） and the degree of fatty liver （mild：OR =1.84,95％ CI 1.54-2.20,P ＜ 0.O1;moderate：OR =1.67,95％CI1.25-2.23,P＜0.01;severe：OR=5.23,95％CI 1.78-15.35,P＜0.01） were also associated with dyslipidemia in this cohort.Conclusions The prevalence of dyslipidemia is higher in postmenopausal women than in pre-menopausal women,and the values of TC,TG,LDL-C,non-HDL-C,TC/HDL-C ratio of postmenopausal women are significantly higher than those of premenopausal women.Menopause is associated with dyslipidemia in this cohort.