绝经前后妇女颈动脉斑块情况及相关因素分析

Analysis for carotid artery plaque of premenopausal and postmenopausal women and related factors

目的分析不同绝经时期妇女的颈动脉斑块情况,探讨影响颈动脉斑块形成的相关因素。方法2014年11月至2015年6月,在山西医科大学第一医院门诊及体检中心就诊的患者中,纳入40~55岁、有子宫及至少一侧卵巢、从未接受过绝经激素治疗的妇女,共224例,按照STRAW+10分期法,分为生育晚期组(53例)、围绝经期组(70例)、绝经后期组(101例)。彩色超声测量颈动脉内膜中层厚度(intimamedia thickness,IMT)及斑块,分为正常组(164例)、IMT增厚组(27例)、斑块形成组(33例)。比较各组的体重指数、血压、血脂、空腹血糖等基本情况;比较不同生殖衰老阶段组的颈动脉异常情况;分析颈动脉IMT增厚及斑块形成的危险因素。采用方差分析、秩和检验、χ2检验或Fisher确切概率法进行统计分析。结果生育晚期、围绝经期、绝经后期3组的BMI、腰围、腰臀比、收缩压、舒张压、总胆固醇(total cholesterol,TC)、低密度脂蛋白(low density lipoprotein,LDL)、空腹血糖比较,差异均无统计学意义(P值均﹥0.05)。绝经后期组的甘油三酯(triglyceride,TG)高于前两组[1.41(1.14~1.95)与1.04(0.77~1.50)、1.21(0.87~1.55)mmol/L,P﹤0.05],高密度脂蛋白(high density lipoprotein,HDL)低于前两组[1.40(1.26~1.69)与1.55(1.36~1.88)、1.47(1.31~1.86),P﹤0.05]。虽然绝经后期组的IMT增厚及颈动脉斑块的比例[16.8%(17/101)和15.8%(16/101)]高于生育晚期组[7.6%(4/53)和13.2%(7/53)]和围绝经期组[8.6%(6/70)和14.3%(10/70)],但差异无统计学意义(P﹥0.05),但围绝经期组中不稳定斑块的比例[70.0%(7/10)]高于生育晚期组[14.3%(1/7)]和绝经后期组[25.0%(4/16)](P﹤0.05)。Logistic回归分析结果显示,IMT增厚的危险因素有舒张压、年龄和LDL升高,OR值分别为14.397、4.948和3.209;颈动脉斑块的危险因素有TG、年龄和LDL升高,OR值分别为4.375、3.979和3.575(P值均﹤0.05)。结论随着绝经进展,妇女的TG和HDL等血脂指标水平发生改变;舒张压、年龄和LDL是IMT增厚的危险因素,TG、年龄和LDL是颈动脉斑块的危险因素。

Objective To analyze the carotid artery plaque in different stages of menopause and to explore the related factors that influence the formation of carotid plaque. Methods From November 2014 to June 2015, 224 patients who were admitted to the clinic and physical examination center of the First Hospital of Shanxi Medical University, aged 40 to 55 years old, with uterus and at least one ovary, and never received menopause hormone treatment were included. According to the stages of reproductive aging workshop＋ 10, they were divided into the late reproductive group （53 cases）, the perimenopausal group （70 cases）, and the postmenopausal group （101 cases）. According to the thickness of carotid intima-media thickness （IMT） and plaques by ultrasonography, they were divided into normal group （164 cases）, IMT thickening group （27 cases） and plaque formation group （33 cases）. The weight index, blood pressure, blood lipid and fasting blood glucose were compared; carotid artery anomalies in different stages of reproductive aging were compared; and the risk factors of carotid artery IMT thickening and plaque formation were analyzed. Statistical analysis was performed by variance analysis, rank sum test, χ^2 test, or Fisher＇s exact test. Results Compared BMI, waist circumference, waist-hip ratio, systolic pressure, diastolic blood pressure, total cholesterol（TC）, low density lipoprotein（LDL） and fasting blood sugar of the late reproductive, perimenopausal and postmenopausal group, there were no statistically significant difference （P 〉 0.05）. Triglyceride （TG） of postmenopausal group was higher than the other two groups [ 1.41 （1.14-1.95） vs 1.14 （0.77-1.50） and 1.21 （0.87-1.55） , P 〈 0.05 ] , and high density lipoprotein （HDL） was lower than the former two groups [1.40 （1.26-1.69） vs 1.55 （1.36-1.88） and 1.47 （1.31-1.86）, P 〈 0.05 ] . Although IMT thickening and the proportion of carotid plaques of postmenopausal group [ 16.8% （17/101） and 15.8% （16/101） ] were higher than that of late reproductive group [7.6% （4/53） and 13.2% （7/53） ] and perimenopausal group [ 8.6% （6/70） and 14.3% （10/70） ] , but there was no statistically significant difference （P 〉 0.05）. However, the proportion of unstable plaques in the perimenopausal group E 70.0% （7/10） ] was higher than that of the late reproductive group [ 14.3% （1/7） ] and postmenopausal group E 25.0% （4/16） ] （P 〈 0.05）. Logistic regression analysis showed that the risk factors for IMT thickening were increase of diastolic blood pressure, age and LDL （ OR=14.397, 4.948 and 3.209 respectively）; the risk factors for carotid plaque were increase of TG, age and LDL （OR=4.375, 3.979 and 3.575 respectively ） （all P 〈 0.05）. Conclusions Along the progress of menopause, the blood lipid index level of women＇s TG and HDL changed. Diastolic blood pressure, age and LDL are risk factors for IMT thickening, and TG, age and LDL are risk factors for carotid plaque.