不同生殖衰老状态女性血脂和脂蛋白变化分析

冯钰婷; 盛少琴; 于晓

doi:10.16766/j.cnki.issn.1674-4152.002983

不同生殖衰老状态女性血脂和脂蛋白变化分析

doi: 10.16766/j.cnki.issn.1674-4152.002983

1.
浙江中医药大学附属第二医院临床营养科，浙江杭州 310005
2.
杭州市妇产科医院，浙江杭州 310008

基金项目:

浙江省中医药科学研究基金项目 2022ZB155

详细信息

通讯作者:
盛少琴, E-mail: shshaoqin@sina.com

中图分类号: R173.4 R446
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出版历程
- 收稿日期: 2022-03-10

Analysis of lipid and lipoprotein levels of women in different reproductive aging stages

1.
Nutriology Department, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310005, China

摘要

摘要: 目的调查生育期、围绝经期和绝经后期女性各年龄段的血脂、脂蛋白水平。方法选取2020年1—12月于浙江中医药大学附属第二医院住院的944例40~60岁女性，根据生殖衰老分期系统STRAW+10标准分为3组：生育期(352例)、围绝经期(127例)、绝经后期(465例)。比较各组患者的BMI和血清TC、TG、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)、载脂蛋白E(Apo E)、脂蛋白(a)[Lp(a)]等脂代谢相关指标。结果 (1) 生育期、围绝经期、绝经后期女性的TC水平分别为(4.65±0.98)mmol/L、(4.75±1.02)mmol/L、(4.99±1.03)mmol/L，差异有统计学意义(P＜0.05)；3组的TG、LDL-C、non-HDL-C水平差异有统计学意义(均P＜0.05)；(2)50~60岁3组的TC、LDL-C、non-HDL-C水平差异有统计学意义(均P＜0.05)；(3)3组的Apo B、Apo E水平差异有统计学意义(均P＜0.05)；(4)绝经后期TC异常和LDL-C异常的发生率高于生育期、围绝经期(均P＜0.017)。结论不同生殖衰老状态女性的部分血脂和脂蛋白发生改变，尤其50岁以上女性血脂水平改变明显。
- 绝经 /
- 血脂 /
- 脂蛋白
Abstract: Objective To analyse the lipid and lipoprotein levels of women in different reproductive aging stages and different age groups. Methods A total of 944 female patients aged from 40 to 60 years who were hospitalized in the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January to December 2020 were selected and divided into three groups according to STRAW+10: reproductive period (n=352), perimenopausal period (n=127) and postmenopausal period (n=465). BMI, serum total cholesterol (TC), serum triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), apolipoprotein E (Apo E), and lipoprotein [Lp(a)] were compared in each group. Results (1) The TC level significantly differed among reproductive, perimenopausal and postmenopausal periods [(4.65±0.98) mmol/L vs. (4.75±1.02) mmol/L vs. (4.99±1.03) mmol/L (P < 0.05)]. The levels of TG, LDL-C and non-HDL-C were also significantly different (all P < 0.05). (2) The TC, LDL-C and non-HDL-C levels were significantly different among the three groups with ages ranging from 50 to 60 years (all P < 0.05). (3) The levels of Apo B and Apo E were significantly different among the three groups (all P < 0.05). (4) The abnormal incidence rates of TC and LDL-C were significantly higher in the postmenopausal period than in the reproductive period or perimenopausal period (all P < 0.017). Conclusion Some blood lipids and lipoproteins of women in different reproductive aging states have changed, especially in women aged more than 50 years.
- Menopause /
- Lipid /
- Lipoprotein
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表 1 不同生殖衰老状态女性一般资料比较(x±s)

Table 1. Comparison of general data of women in different reproductive aging states(x±s)

组别	例数	BMI(x±s)	年龄(x±s，岁)	年龄[例(%)]
组别	例数	BMI(x±s)	年龄(x±s，岁)	40~44岁	45~49岁	50~54岁	55~60岁
生育期	352	23.85±4.41	46.59±4.19	111(31.5)	157(44.6)	68(19.3)	16(4.5)
围绝经期	127	23.98±3.57	52.36±3.94	5(3.9)	18(14.2)	62(48.8)	42(33.1)
绝经后期	465	23.81±3.84	56.00±3.16	0	17(3.7)	128(27.5)	320(68.8)
统计量		0.054^a	654.419^a	516.528^b
P值		0.947	< 0.001	< 0.001
注：^a为F值，^b为χ²值。

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表 2 不同生殖衰老状态女性的血脂和脂蛋白水平比较

Table 2. Comparison of serum lipid and lipoprotein levels in women with different reproductive aging states

组别	例数	TC (x±s，mmol/L)	TG (x±s，mmol/L)	HDL-C (x±s，mmol/L)	LDL-C (x±s，mmol/L)	non-HDL-C (x±s，mmol/L)	Apo A1 ( x±s，g/L)	Apo B (x±s，g/L)	Apo E (x±s，mg/L)	Lp(a)[M (P₂₅, P₇₅)，mg/L]
生育期	352	4.65±0.98	1.17±0.67	1.24±0.31	2.61±0.72	3.41±0.86	1.26±0.23	0.85±0.18	36.03±8.99	151.25(76.58, 287.63)
40~49岁	268	4.52±0.96	1.11±0.65	1.24±0.31	2.50±0.71	3.28±0.84	1.25±0.23	0.83±0.18	34.62±8.02	152.90(74.80, 347.70)
50~60岁	84	5.09±0.90	1.34±0.74	1.26±0.29	2.96±0.65	3.83±0.80	1.27±0.23	0.92±0.12	41.19±10.69	149.60(79.90, 232.70)
围绝经期	127	4.75±1.02	1.19±0.66	1.23±0.30	2.69±0.78	3.51±0.92	1.33±0.23	0.92±0.25	35.82±6.94	115.60(58.40, 153.85)
40~49岁	23	5.00±0.89^b	1.15±0.58	1.21±0.25	2.97±0.60^b	3.79±0.72^b	1.39±0.37	0.92±0.10	41.75±11.10	171.90(74.30, 369.50)
50~60岁	104	4.68±1.05^b	1.20±0.68	1.23±0.31	2.63±0.81^b	3.44±0.95^b	1.33±0.22	0.92±0.27	35.28±6.58	115.60(56.00, 152.35)
绝经后期	465	4.99±1.03^bc	1.32±0.77^b	1.27±0.32	2.85±0.82^bc	3.73±0.97^bc	1.29±0.28	0.94±0.22^b	40.20±14.06^b	159.00(83.98, 299.78)
40~49岁	17	4.92±1.25	1.08±0.61	1.39±0.39	2.64±0.81	3.52±0.98	1.44±0.26	0.88±0.20	53.48±21.77^b	117.65(76.70, 262.55)
50~60岁	448	5.00±1.02^c	1.33±0.78	1.26±0.31	2.86±0.82^c	3.73±0.97^c	1.29±0.28	0.94±0.22	39.74±13.63	160.70(84.37, 311.53)
F值^a		12.077	5.188	1.227	9.709	11.970	0.821	4.074	3.278	4.127
P值^a		< 0.001	0.006	0.294	< 0.001	< 0.001	0.441	0.018	0.040	0.127
注：^a为3组总体数据比较的统计量及P值；与同年龄段生育期比较，^bP＜0.05；与同年龄段围绝经期比较，^cP＜0.05。

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表 3 不同生殖衰老状态女性的血脂异常发生率比较[例(%)]

Table 3. Comparison of the incidence of dyslipidemia in women with different reproductive aging states[cases (%)]

组别	例数	TC异常	TG异常	HDL-C异常	LDL-C异常
生育期	352	93(26.4)	60(17.0)	71(20.2)	50(14.2)
围绝经期	127	33(26.0)	21(16.5)	26(20.5)	17(13.4)
绝经后期	465	175(37.6)^ab	103(22.2)	86(18.5)	106(22.8)^ab
合计	944	301(31.9)	184(19.5)	183(19.4)	173(18.3)
χ²值		13.953	4.144	0.471	12.272
P值		0.001	0.126	0.790	0.002
注：3组间两两比较校正检验水准α=0.017。与生育期比较，^aP＜0.017；与围绝经期比较，^bP＜0.017。

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参考文献(21)

[1]	KO S H, KIM H S. Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women[J]. Nutrients, 2020, 12(1): 202. doi: 10.3390/nu12010202
[2]	中华医学会妇产科学分会绝经学组. 绝经管理与绝经激素治疗中国指南(2018)[J]. 中华妇产科杂志, 2018, 53(11): 729-739. doi: 10.3760/cma.j.issn.0529-567x.2018.11.001 Menopause Group, Chinese Society of Obstetrics and Gynecology. Chinese Guidelines for Menopause Management and Hormone Therapy (2018)[J]. Chinese Journal of Obstetrics and Gynecology, 2018, 53(11): 729-739. doi: 10.3760/cma.j.issn.0529-567x.2018.11.001
[3]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 血脂异常基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2019, 18(5): 406-416. Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Pradice, et al. Guidelines for Primary Diagnosis and Treatment of Dyslipidemia (2019)[J]. Chinese JOurnal of General Practitioners, 2019, 18(5): 406-416.
[4]	刘璐, 姜雨佑, 李书书. 性激素及其受体在肝脏脂类代谢中的作用机制研究进展[J]. 中华内分泌代谢杂志, 2020, 36(3): 267-272. LIU L, JIANG Y Y, LI S S. Research progress on the mechanism of sex hormones and their receptors in liver lipid metabolism[J]. Chinese Journal of Endocrinology and Metabolism, 2020, 36(3): 267-272.
[5]	PINKAS J, BOJAR I, GUJSKI M, et al. Serum lipid, vitamin D levels, and obesity in perimenopausal and postmenopausal women in non-manual employment[J]. Med Sci Monit, 2017, 23: 5018-5026. doi: 10.12659/MSM.906895
[6]	王宁, 郑延坤, 秦明照. 绝经后女性促卵泡激素水平与血脂指标的关系[J]. 吉林大学学报(医学版), 2020, 46(1): 144-148. https://www.cnki.com.cn/Article/CJFDTOTAL-BQEB202001027.htm WANG N, ZHENG Y K, QIN M Z. Relationships between follicle-stimulating hormone level and lipid profiles in post-menopausal women[J]. Journal of Jilin University (Medical Edition), 2020, 46(1): 144-148. https://www.cnki.com.cn/Article/CJFDTOTAL-BQEB202001027.htm
[7]	SERVIENTE C, TUOMAINEN T P, VIRTANEN J, et al. Follicle-stimulating hormone is associated with lipids in postmenopausal women[J]. Menopause, 2019, 26(5): 540-545. doi: 10.1097/GME.0000000000001273
[8]	马依彤. 动脉粥样硬化患者甘油三酯升高的管理中国专家共识要点与解读[J]. 中国循环杂志, 2019, 34(z1): 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH2019S1015.htm MA Y T. Chinese expert consensus and interpretation on the management of elevated triglycerides in patients with atherosclerosis[J]. Chinese Circulation Journal, 2019, 34(z1): 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH2019S1015.htm
[9]	戴贤勇, 陈玮, 王燕, 等. 血清同型半胱氨酸和血脂水平与进展性缺血性脑卒中患者神经功能相关性分析[J]. 中国基层医药, 2021, 28(10): 1521-1524. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC201906009.htm DAI X Y, CHEN W, WANG Y, et al. Correlation of homocysteine and blood lipid levels with neurological function in patients with progressive ischemic stroke[J]. Chinese Journal of Primary Medicine and Pharmacy, 2021, 28(10): 1521-1524. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC201906009.htm
[10]	苑小星. 脂质代谢异常与恶性肿瘤相关性研究进展[J]. 中国基层医药, 2020, 27(18): 2300-2304. YUAN X X. Research progress on the relationship between dyslipidemia and malignant tumor[J]. Chinese Journal of Primary Medicine and Pharmacy, 2020, 27(18): 2300-2304.
[11]	ZHANG L, LIU Q, ZENG X, et al. Association of dyslipidaemia with osteoporosis in postmenopausal women[J]. J Int Med Res, 2021, 49(3): 300060521999555. DOI: 10.1177/0300060521999555.
[12]	罗文平, 李小玉, 骆嵩, 等. 血清脂蛋白(a)水平与青年缺血性卒中CISS分型及严重程度的关系[J]. 中华全科医学, 2021, 19(7): 1091-1094, 1102. doi: 10.16766/j.cnki.issn.1674-4152.001992 LUO W P, LI X Y, LUO S, et al. Relationship between serum lipoprotein(a)level and CISS classification and severity of ischemic stroke in youth[J]. Chinese Journal of General Practice, 2021, 19(7): 1091-1094, 1102. doi: 10.16766/j.cnki.issn.1674-4152.001992
[13]	陈瑶琳, 王尹曼, 方达伟, 等. 脂蛋白(a)与冠状动脉病变严重程度的关系及对不良心血管事件的影响[J]. 中国临床医学, 2021, 28(1): 70-74. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202101013.htm CHEN Y L, WANG Y M, FANG D W, et al. Relationship between lipoprotein(a)and the severity of coronary artery disease and its influence on major adverse cardiovascular events[J]. Chinese Journal Of Clinical Medicine, 2021, 28(1): 70-74. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202101013.htm
[14]	侯云, 张秀兰. 血清脂蛋白a与急性心肌梗死的相关性分析[J]. 中国医药, 2021, 16(11): 1606-1609. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202111002.htm HOU Y, ZHANG X L. Correlation analysis between serum lipoprotein a and acute myocardial infarction[J]. Chinese medicine, 2021, 16(11): 1606-1609. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202111002.htm
[15]	MACH F, BAIGENT C, CATAPANO A L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk[J]. Eur Heart J, 2020, 41(1): 111-188.
[16]	LI C, CHEN J, WEI S, et al. Particles and corrected particles of LDL and non-HDL are stronger predicters of coronary lesion in postmenopausal women[J]. BMC Cardiovasc Disord, 2021, 21(1): 369.
[17]	IVERT T, HAMMAR N, TALBǍCK M, et al. Elevated apolipoprotein B/A-1 ratio is associated with an increased risk of aortic stenosis: experience from the AMORIS cohort[J]. Heart Lung Circ, 2021, 30(7): 1050-1057.
[18]	MARAIS A D. Apolipoprotein E in lipoprotein metabolism, health and cardiovascular disease[J]. Pathology, 2019, 51(2): 165-176.
[19]	李晓轩, 边云飞, 邱龄, 等. 载脂蛋白E基因多态性与女性冠心病相关性的Meta分析[J]. 中国动脉硬化杂志, 2019, 27(10): 893-898. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ201910012.htm LI X X, BIAN Y F, QIU L, et al. Meta analysis of the correlation between apolipoprotein E gene polymorphism and coronary heart disease in women[J]. Chinese Journal of Arteriosclerosis, 2019, 27(10): 893-898. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ201910012.htm
[20]	黄柳, 戴昕妤, 田雪, 等. ApoE基因型与颈动脉粥样硬化及脑梗死的相关性研究[J]. 中华全科医学, 2021, 19(8): 1287-1291. doi: 10.16766/j.cnki.issn.1674-4152.002042 HUANG L, DAI X S, TIAN X, et al. Correlation between ApoE genotype and carotid atherosclerosis and cerebral infarction[J]. Chinese Journal of General Practice, 2021, 19(8): 1287-1291. doi: 10.16766/j.cnki.issn.1674-4152.002042
[21]	SERRANO-POZO A, DAS S, HYMAN B T. APOE and Alzheimer's disease: advances in genetics, pathophysiology, and therapeutic approaches[J]. Lancet Neurol, 2021, 20(1): 68-80.