新疆乌苏市育龄妇女生殖健康现况调查研究

目的:了解新疆乌苏市育龄妇女生殖健康现状,生殖保健知识水平和生殖保健意识,为提高育龄妇女的生殖健康水平提供理论依据。方法:采用单纯随机抽样的方法,选择乌苏市育龄妇女1000名,应用自填问卷并结合妇科各项相应检查进行调查分析。结果:(1)妇科健康情况:52.6%被调查者认为自身目前妇科健康状况一般;仅有14.0%的被调查者没有出现过白带异常、下身瘙痒等症状;而平时对生殖道进行日常护理的人仅占57.4%。(2)妇科常见病患病情况:妇科常见疾病按患病率高低排列分别为阴道炎(70.2%)、痛经(25.5%)、宫颈糜烂/乳腺增生(19.2%、19.1%)、子宫肌瘤(11.9%),各因素对痛经的影响均无统计学意义(P>0.05);各因素对阴道炎的影响均无统计学意义(P>0.05);但不同年龄段有宫颈疾病的患病情况差别有统计学意义(P<0.01),其中40～50岁年龄组患病率最大(65.3%),30岁以下年龄组患病率最低(37.6%);城市患病率(57.7%)高于农村(45.6%),差异有统计学意义(P<0.05);小学文化程度患病率(69.0%)高于其他各组差异有统计学意义(P<0.05)。(3)求医行为:37.5%的人选择去药店买药,41.5%的人选择就医;对就医单位的选择中,75.3%的人采取就近原则选择医疗单位,9.1%的人则是通过报纸媒体广告选择相关医疗单位;选择就医单位影响因素中42.3%的人认为专家资质较重要,26.3%的人则认为有先进设备较重要。结论:乌苏市育龄妇女生殖健康水平一般,妇女患常见妇科病比率较大的为阴道炎及痛经,其次为宫颈糜烂/乳腺增生,子宫肌瘤,40～50岁、文化程度较低妇女对宫颈其他疾病的患病情况影响较大,妇女生殖保健知识较全面、自我护理较好的妇女患病率较低。乌苏市育龄妇女需要加强生殖健康宣传教育,提高自我保健意识,掌握基本的生殖保健常识,对40～50岁围绝经期妇女要加强体检力度,以降低妇女病发病率,提高妇女健康水平,改善乌苏市各年龄段的妇女生活质量为关键。     

昌平区沙河镇高血压流行病学分析

目的:了解昌平区沙河镇群众高血压发病现状,掌握本地区群众的高血压知晓率、治疗率、控制率。方法:采取整群随机抽样调查方法,随机抽取昌平区沙河镇12个自然村年龄≥18岁的群众进行调查,内容涉及问卷咨询、体格检查、血糖、血脂检测。结果:1933名成人完成调查,共有1744名资料完整,其中男597例,女1147例,平均(53.1±10.8)岁。高血压患病率为48.0%,且在性别间和年龄组间差异均有统计学意义,高血压患者中知晓者占70.4%,治疗者占61.9%,血压得到控制者占24.7%,超重者高血压患病率显著增高,而且女性超重较男性更易患高血压。结论:昌平区沙河镇人群高血压患病率较前明显升高,同时人群高血压知晓率、治疗率较前提升,但是高血压控制率仍较低有待提高。     

女性患者十二导联远程动态心电图与门诊动态心电图对比分析

为探讨十二导联远程动态心电图对基层女性心血管疾病诊断的临床价值,本研究通过观察不同年龄段(青年组,围绝经期组,绝经组)的基层女性患者的远程动态心电图检测指标,与同期我院门诊女性患者相关指标进行比较。研究发现,围绝经期组、绝经组,远程女性患者和门诊女性患者的多项动态心电图指标检出率差异无统计学意义(p0.05),并且异常动态心电图检出率高,表明十二导联远程动态心电图有助于提高基层女性心血管疾病的检出率,进而提高了基层地区女性心血管健康的关注度。另外,三甲医院门诊的青年女性患者动态心电图异常检出率高,青年女性心血管疾病的发病率呈逐年增加的趋势。     

社区老年人慢性肾脏病患病率调查及其危险因素分析

目的:调查北京市通州区永顺社区老年人的慢性肾脏病(CKD)患病率,并分析其危险因素。方法:采用横断面调查方法,对该社区长期居住的65岁及以上的通州区户籍老年人进行问卷调查、肾脏损伤指标及其他实验室指标的检测,收集资料并分析CKD患病的危险因素。结果:本次调查共获得948例该社区常住老年人的完整资料,参与研究的老年人平均年龄为70.86±4.89岁;镜下血尿患病率为9.39%,白蛋白尿患病率为22.15%,5.70%的老年人出现肾功能下降,该人群中CKD患病率为36.81%(349/948)。单因素分析结果显示,两组吸烟史、饮酒史、血肌酐、体质量指数(BMI)、尿微量白蛋白肌酐比(ACR)、糖尿病、甘油三酯、总胆固醇及血尿酸水平对比无显著性差异(P0.05),而CKD组较非CKD组年龄更大、合并高血压的比例更高、女性占比更高(P0.05),多因素logistic回归分析显示年龄、女性与高血压是通州区永顺社区老年人CKD患病的危险因素(OR=1.432、1.163、1.335,P0.05)。结论:北京市通州区永顺社区老年人CKD患病率较高,其危险因素为年龄、女性与高血压。     

兰州市1907 例不同年龄正常人群骨密度测定综合分析

目的:了解兰州地区正常人群骨密度的变化特点,分析其变化规律,为预防和治疗骨质疏松症提供科学依据。方法:使用天津圣鸿公司SHY-Ⅰ数字式骨密度测定仪对兰州地区1907人进行检测,其中男1381例,女526例,分别做左前臂尺、桡骨测量。年龄20～85岁,每10岁为一年龄组进行统计分析。结果:男、女组骨密度峰值均在30～39岁,峰值后随年龄增加而骨密度下降,女性下降较男性显著。骨量减少及骨质疏松患病率在40岁后随年龄增长而增高,女性高于男性。老年人骨量减少及骨质疏松患病率高于中青年人,老年女性骨质疏松患病率与老年男性比较有明显差异(P<0.05)。结论:兰州地区健康人群骨密度随年龄变化,并与性别有关。骨密度的检测在骨质疏松症的早期预防和治疗中具有重要意义。     

补肝益肾活血化瘀法治疗子宫切除术后围绝经期的疗效观察

目的:探讨应用六味地黄汤和四物汤加减即补肝益肾法活血化瘀法治疗绝经前子宫切除术后围绝经期症状的临床疗效.方法:治疗组:55例自愿接受补肝益肾法活血化瘀中药治疗,并愿意配合我们完成各项相关表格的患者作为观察对象.4周为一疗程,对照组:60例单纯服用雌激素类药物,4周为一疗程,一疗程后分别统计疗效(按治疗前与治疗后症状的变化进行).观察期间不再使用其它相关的中药、西药及与本病治疗相关的其它治疗方法.结果:发现用药后治疗组症状改善率为87.2%,对照组症状改善率66%明显低于治疗组.结论:补肝益肾法活血化瘀法可以改善子宫切除术后围绝经期症状,提高子宫切除术后患者生活质量.     

110例绝经后子宫出血相关因素分析

目的:探讨绝经后子宫出血的年龄、绝经年限、子宫内膜厚度与疾病的关系,以及相关因素分析。方法:回顾分析2003～2005诊治的110例自然绝经1年以上子宫再次出血者的诊刮或子宫切除的临床病理资料。结果:绝经后病理结果分别为非器质性病变44例占40%、良性病变26例占23.6%和恶性肿瘤(子宫内膜癌)40例占36.4%,相关影响因素有IUD 13例占11.8%、高血压22例占20%和肥胖17例占15.5%。结论:绝经后子宫出血的首要原因是子宫内膜非器质性病变,年龄越大、绝经年限越长、内膜越厚、恶性肿瘤发生率愈高,其中IUD、高血压、肥胖为影响因素。     

与蛇伤恶化有关的发病情况的前瞻性研究

背景 :与蛇伤恶化相关的发病率文献报道不多。方法 :利用标准化的询问调查 ,对2 0 0 1年地区中毒中心报告的所有蛇咬伤病人出院后通过电话随访直到症状消失。结果 :报告了 1 2 8例蛇咬伤病例 ,其中 1 6例 (占 1 2 .5% )失访 ,31例 (占 2 4 .2 % )除刺伤外 ,无症状发展 ,而认为是“干咬”。对 81例 (占 63.3% )病人随访了其症状持续时间。年龄在 1～ 86岁 ,平均 32岁 ,男性病例 64例 (占 79% )。确诊为铜头蛇 (蝮蛇 )咬伤 57例 ,未确定有毒的为 1 7例 ,森林响尾蛇 6例和 1例毒水蛇咬伤。所有病人最初都在医院急诊科评估 ,其中 51例住院 ,9例…     

黑龙江省南部农村白内障术后视力的调查

目的:调查白内障的手术情况并评估其手术疗效。方法:采用整群随机抽样方法将黑龙江省南部农村人口按一定的标准划分成抽样单位,两组人员通过预实验统一标准后对年龄(?)50岁共5058人(受检率91%)进行视力和眼部检查,先后在其中的两个抽样单位进行一致性检验。结果:高年龄组、女性和低教育程度者的白内障患病率较高。在所有调查的68只白内障手术眼,最佳矫正视力(?)20/60的占51.5%(35/68)。结论:白内障是50及50岁以上农村人口的主要致盲眼病,迫切需要提高手术质量是关键,特别是高龄和女性患者。     

男性与女性痛风对比研究

目的探讨不同性别痛风的临床特点。方法对比分析74例男性痛风患者和8例女性痛风患者的临床表现,计数资料的对比均采用χ2检验。结果两组发病年龄高峰不同与男性相比,女性的年龄较男性大,男性集中在40～70岁,女性集中在60～70岁;绝经后女性患病多因服用利尿剂诱发痛风;男女均出现痛风石;首发第一跖趾关节;合并高血压、高血脂、糖尿病的机率二者无差异(P>0.05),但女性患者合并冠心病占62.5%,男性占9.5%,女性冠心病发病率明显高于男性(P<0.05)。女性服用利尿剂后发病者7例占87.5%,而男性服利尿剂后发病者有2例,占2.7%,因服利尿剂致痛风发作在女性明显高于男性(P<0.05)。结论女性痛风患者年龄较男性大,多与服利尿剂有关,二者临床表现相近,均易合并冠心病、高血压、高血脂、糖尿病,均易出现痛风石,女性因发病年龄大,更易合并冠心病,二者一般治疗相同,低嘌呤饮食,控制饮食,碱化尿液,抑制尿酸形成,促进尿酸排泄,治疗并发症,去除诱因,停用利尿剂。     

Serum Lipoprotein(a) Dynamics before/after Menopause and Long-term Effects of Hormone Replacement Therapy on Lipoprotein(a) Levels in Middle-aged and Older Japanese Women.

AIM: To assess lipoprotein(a) Lp(a) dynamics before and after menopause and to examine long-term changes during hormone replacement therapy (HRT) in middle-aged and older Japanese women. METHODS: (1) Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and Lp(a) concentrations of 526 patients were compared. The patients were divided into 3 groups on the basis of menopausal status (premenopause, perimenopause, postmenopause). (2) Serum markers of lipid metabolism were measured at baseline and at 6-month intervals in 161 postmenopausal women who continuously received HRT with conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) for 4 years. (3) Changes in serum concentrations of markers were compared among 120 women with hypercholesterolemia who were randomly assigned to receive HRT (CEE plus MPA, or transdermal estradiol plus MPA) or pravastatin. RESULTS: (1) Lp(a) concentrations were significantly higher in the postmenopausal women than in the premenopausal or perimenopausal women. (2) The mean Lp(a) concentration after 6 months of HRT decreased by about 19%, and similar levels were maintained for 4 years (3). The mean Lp(a) concentration after 6 months of HRT decreased by 19.9% in the CEE plus MPA group, but did not change significantly in the transdermal estradiol plus MPA group or the pravastatin group. CONCLUSION: Our results suggest that HRT with CEE plus MPA is useful for the management of elevated serum Lp(a) concentrations in middle-aged and older women. However, follow-up studies are needed to determine whether this finding is related to the future prevention of coronary heart disease events.     

Accelerated vertebral bone loss in relation to the menopause: a cross-sectional study on lumbar bone density in 286 women of 46 to 55 years of age

Bone mineral density (BMD) of the lumbar spine was measured in 286 women (46–55 years of age) using dual photon absorptiometry. The women were classified in three categories: premenopausal, perimenopausal and postmenopausal. The postmenopausal group was subdivided according to the number of years since the last uterine bleeding. with multiple linear regression analysis of lumbar BMD on age and menopausal status, an acceleration of bone loss was observed during the perimenopausal period and the following first two postmenopausal years. No significant bone loss was detected in relation to age or during the later postmenopausal years. Applying both an additive and a multiplicative model of bone loss, the mean perimenopausal bone loss was 0.061 gramequivalents hydroxyapatite (geqHA)/cm² and 6.4%, respectively. In the first 2 postmenopausal years the mean bone loss was 0.044 geqHA/cm² and 5.1% per year. These results suggest a substantial menopause related acceleration of lumbar bone loss in a relatively short time span with its onset in the perimenopausal period.     

Study of symptoms in middle life with special reference to the menopause.

In an attempt to clarify the nature of the "menopausal syndrome" a survey of symptoms was carried out by means of postal questionnaires in a population sample of 1120 women and 510 men. Special care was taken to avoid letting the participants know that the survey was mainly concerned with the menopause. Response rates were 72% for women and 68% for men. Analysis of patterns of symptoms by age and sex showed that peaks of prevalence of flushing and sweating were closely associated with the mean age of menopause, coinciding with it or occurring a little after it. Less impressive peaks of prevalence of a group of minor mental symptoms were associated with an age just preceding the mean age of menopause. Complaints about aching breasts, irritability, and low backache diminished after the menopause. No association with the menopause was found for various other symptoms. The results of this study support the view that the menopausal syndrome exists but do not, of course, provide any evidence concerning the effectiveness (or safety) of hormone treatment.     

Menopausal Status and Physical Performance in Middle Aged Women: A Cross-Sectional Community-Based Study in Northeast Brazil

Objective

To examine associations between menopausal status and physical performance in middle-aged women from the Northeast region of Brazil.

Methods

Cross-sectional study of women between 40 to 65 years old living in Parnamirim. Women were recruited by advertisements in primary care neighborhood centers across the city. Physical performance was assessed by grip strength, gait speed and chair stands. Menopausal status was determined using the Stages of Reproductive Aging Workshop classification and women were classified in: premenopausal, perimenopausal or postmenopausal. Multiple linear regression analyses were performed to model the effect of menopausal status on each physical performance measure, adjusting for covariates (age, family income, education, body mass index, parity and age at first birth).

Results

The premenopausal women were significantly stronger and performed better in chair stands than perimenopausal and postmenopausal women. Gait speed did not vary significantly by menopausal status. In multivariate analyses, menopausal status remained statistically significant only for grip strength. In fully adjusted analyses, premenopausal women had grip strength mean of 2.226 Kgf (95% CI: 0.361 – 4.091) higher than the postmenopausal group.

Conclusions

This study provides further evidence for the associations between menopause and physical performance in middle-aged women, since grip strength is weaker in peri and postmenopausal women compared to premenopausal, even adjusted for age and other covariates.     

Estrogenic regulation of skeletal muscle proteome: a study of premenopausal women and postmenopausal MZ cotwins discordant for hormonal therapy

Female middle age is characterized by a decline in skeletal muscle mass and performance, predisposing women to sarcopenia, functional limitations, and metabolic dysfunction as they age. Menopausal loss of ovarian function leading to low circulating level of 17β‐estradiol has been suggested as a contributing factor to aging‐related muscle deterioration. However, the underlying molecular mechanisms remain largely unknown and thus far androgens have been considered as a major anabolic hormone for skeletal muscle. We utilized muscle samples from 24 pre‐ and postmenopausal women to establish proteome‐wide profiles, associated with the difference in age (30–34 years old vs. 54–62 years old), menopausal status (premenopausal vs. postmenopausal), and use of hormone replacement therapy (HRT; user vs. nonuser). None of the premenopausal women used hormonal medication while the postmenopausal women were monozygotic (MZ) cotwin pairs of whom the other sister was current HRT user or the other had never used HRT. Label‐free proteomic analyses resulted in the quantification of 797 muscle proteins of which 145 proteins were for the first time associated with female aging using proteomics. Furthermore, we identified 17β‐estradiol as a potential upstream regulator of the observed differences in muscle energy pathways. These findings pinpoint the underlying molecular mechanisms of the metabolic dysfunction accruing upon menopause, thus having implications for understanding the complex functional interactions between female reproductive hormones and health.     

Trace mineral status in post menopausal women: impact of hormonal replacement therapy.

The risks of disturbances in trace mineral nutrition and metabolism are high following menopause. The aim of the study was to investigate the trace mineral status in postmenopausal women and the influence of hormonal replacement therapy on this status. Forty-four healthy postmenopausal women, aged 50-60 years old participated in the study. Eighteen were treated by combined hormonal replacement therapy (HRT) per os for at least two years, and 26 were untreated. Plasma trace mineral levels (Zn, Se, Cr, Mn, Cu), red blood cell antioxidant enzymes (Cu-Zn SOD, Se-GPX, Cu), urinary Zn, Cr, Mg, and Ca excretion were measured. Zinc, selenium and manganese plasma levels, activities of Cu-Zn-SOD and GSH-Px in erythrocytes were not statistically different between the two groups. The percentage of zinc plasma levels below the cut off of 10.7 micromol/L was higher in HRT treated group than in untreated one, whereas zinc excretion was reduced. Plasma copper concentrations were higher in women treated by HRT, whereas erythrocyte copper levels were not modified. Plasma chromium concentrations were significantly higher in women receiving HRT and urinary Cr excretion was decreased. The HRT group also exhibited lower losses of urinary zinc and magnesium than untreated women. These data suggest that hormonal replacement therapy provides beneficial effects on trace mineral status related to menopause.     

Circadian rhythms in hot flashes in natural and surgically-induced menopause

The aim of this study was to investigate circadian and ultradian variations in menopausal hot flash. The number of hot flashes per 2-hr period was collected from 25 diurnally-active, perimenopausal women for 1 week in January or February of each year for 3 consecutive years. Fourteen women were experiencing natural menopause (NM) (mean age 51.9 years) and 11 were experiencing surgically-induced menopause (SIM) (mean age 52.0 years). The difference in the number of hot flashes between the two types of menopause at each clock time was not statistically significant; neither was the mean number of hot flashes per 24 hr different between the two groups (Student's t-test). Data when normalized for each woman and placed end-to-end revealed by cosinor analysis circadian rhythmicity in the SIM group (P = 0.02) but not in the NM group. A 12-hr periodicity was detected in both groups (P less than 0.001 for both). An 8-hr rhythm was detected only for the NM group (P = 0.04). Both groups combined exhibited statistically significant rhythmicities with periods of 24 hr (P = 0.003), 12 hr (P less than 0.001) and 8 hr (P = 0.005). Regardless of the type of menopause, the women could be separated into two groups based on the temporal pattern of hot flashes during the day. One group was defined by the occurrence of peak frequency of flashes during the morning (0400-0959), while the second group was defined by the occurrence of the peak in the evening (1600-2159).(ABSTRACT TRUNCATED AT 250 WORDS)     

Significance of cytologically normal endometrial cells in cervical smears from postmenopausal women

OBJECTIVE: To determine the significance of cytologically normal endometrial cells in cervicovaginal (CV) smears from postmenopausal women over age 55 years. STUDY DESIGN: From January 1995 to January 1998, 220 women had CV smears demonstrating cytologically normal endometrial cells. The menopausal status, hormone replacement therapy (HRT) and information related to subsequent CV smears and endometrial sampling within 12 months of the initial diagnosis was recorded. RESULTS: Eighty-one of the 220 cases (36.8%) had histologic sampling of the endometrium. Thirty-four of 81 (42%) showed no endometrial pathology. Endometrial pathology was identified in 28 of 81 (34%), of which 19 were endometrial polyps (23.4%), 4 were endometrial hyperplasia (4.9%), 4 were endometrial carcinoma (4.9%) and 1 was a leiomyoma (1.2%). Nineteen (23.4%) were insufficient for diagnosis. Ninety-one of 220 women were on HRT, and 129 were not. In the group without HRT, endometrial disease was identified in 22/51 (43%) cases as compared to 6/30 (20%) in the group with HRT (P < .001). Endometrial carcinoma was identified in three (5.8%) cases and one (3.3%) case without and with HRT, respectively. CONCLUSION: Although the finding of normal endometrial cells in Pap smears from postmenopausal women was without any clinical significance in the majority of women in this study, in a small number it was associated with endometrial hyperplasia and carcinoma. Women who were not on HRT had a higher incidence of endometrial pathology.     

Circadian Rhythms in Hot Flashes in Natural and Surgically-Induced Menopause

The aim of this study was to investigate arcadian and ultradian variations in menopausal hot flash. The number of hot flashes per 2-hr period was collected from 25 diurnally-active, perimenopausal women for 1 week in January or February of each year for 3 consecutive years. Fourteen women were experiencing natural menopause (NM) (mean age 51.9 years) and 11 were experiencing surgically-induced menopause (SIM) (mean age 52.0 years). The difference in the number of hot flashes between the two types of menopause at each clock time was not statistically significant; neither was the mean number of hot flashes per 24 hr different between the two groups (Student's f-test). Data when normalized for each woman and placed end-to-end revealed by cosinor analysis circadian rhythmicity in the SIM group (P =0.02) but not in the NM group. A 12-hr periodicity was detected in both groups (P< 0.001 for both). An 8-hr rhythm was detected only for the NM group (P = 0.04). Both groups combined exhibited statistically significant rhythmicities with periods of 24 hr (p= 0.003), 12 hr (P<0.001) and 8 hr (P= 0.005). Regardless of the type of menopause, the women could be separated into two groups based on the temporal pattern of hot flashes during the day. One group was defined by the occurrence of peak frequency of flashes during the morning (0400–0959), while the second group was defined by the occurrence of the peak in the evening (1600–2159). The difference between the two groups in the number of hot flashes during the morning wasstatistically significant (Student's r-test, P = 0.009) as was the number of hot flashes in the evening (Student's r-test, P= 0.03).