磐安縣部分女性MPS癥狀評(píng)分及影響因素分析

厲美珍，單小蘭

(1.浙江省金華市磐安縣婦幼保健院婦產(chǎn)科，浙江 金華 322300；2.浙江省東陽(yáng)市中醫(yī)院婦產(chǎn)科，浙江 金華322100)

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磐安縣部分女性MPS癥狀評(píng)分及影響因素分析

厲美珍1，單小蘭2

(1.浙江省金華市磐安縣婦幼保健院婦產(chǎn)科，浙江 金華 322300；2.浙江省東陽(yáng)市中醫(yī)院婦產(chǎn)科，浙江 金華322100)

目的探討圍絕經(jīng)期綜合征(MPS)女性更年期癥狀評(píng)分及危險(xiǎn)因素。方法選擇2011年1月至2013年12期間在金華市磐安縣婦幼保健院婦產(chǎn)科就診的78例MPS患者為研究對(duì)象，選擇同期在我院健康體檢的72例健康女性為對(duì)照組使用女性版圍絕經(jīng)期Greene量表評(píng)估更年期癥狀。對(duì)更年期癥狀相關(guān)危險(xiǎn)因素進(jìn)行單因素及多因素Logistic回歸分析。結(jié)果兩組學(xué)歷、與子女關(guān)系、性格方面比較，差異有統(tǒng)計(jì)學(xué)意義(χ2值分別為5.838、6.086、5.788，均P<0.05)，觀察組Greene評(píng)分顯著高于對(duì)照組(t=9.962，P<0.05)。78例MPS患者中，輕度圍絕經(jīng)期癥狀27例(34.62%)，中度圍絕經(jīng)期癥狀48例(61.54%)，重度圍絕經(jīng)期癥狀3例(3.85%)。觀察組癥候群1～3評(píng)分顯著高于對(duì)照組(t值分別為3.168、4.913、2.963，均P<0.05)，觀察組癥候群4評(píng)分顯著低于對(duì)照組(t=2.082，P<0.05)。低文化程度癥候群1～3評(píng)分顯著高于高文化程度(t值分別為2.019、1.990、2.287，均P<0.05)；性格內(nèi)向的女性癥候群1～3評(píng)分顯著高于性格外向組(t值分別為3.000、1.022、1.077，均P<0.05)，子女關(guān)系較差的組別癥候群2～3評(píng)分顯著高于與子女關(guān)系好組(t值分別為3.190、3.265，均P<0.05)。結(jié)論MPS女性更年期癥狀和與子女關(guān)系、學(xué)歷、性格密切相關(guān)。文化程度、與子女關(guān)系、性格、癥候群1、癥候群2、癥候群3為MPS更年期癥狀的主要影響因素。

圍絕經(jīng)期綜合征；更年期癥狀評(píng)分；癥候群；影響因素

[Abstract]Objective To study climacteric symptom scores and risk factor of female perimenopausal syndrome (PMS). Methods During January 2011 to December 2013 78 cases of PMS patients visiting department of gynecology and obstetrics in Pan’an Maternal and Child Health Hospital of Jinhua in Zhejiang Province were selected as research objects in observation group. At the same period 72 cases of healthy women receiving physical examination in the hospital were selected as control group, and PMS were evaluated with female perimenopausal Greene scale. Menopausal symptom associated risk factors were analyzed by univariate and multivariate Logistic regression analysis. Results The differences between two groups in cultural degree, relationship with children, and personality were statistically significant (χ2value was 5.838, 6.086 and 5.788, respectively, allP<0.05). In the observation group Greene scores were significantly higher than in the control group (t=9.962,P<0.05). Among 78 cases of PMS, there were 27 cases (34.62%) with mild PMS, 48 cases (61.54%) with moderate menopausal symptoms, and 3 cases (3.85%) with severe menopausal symptoms, respectively. Compared with the control group, the observation group had remarkably higher scores of syndrome 1-3 (tvalue was 3.168, 4.913 and 2.963, respectively, allP<0.05) but lower score of syndrome 4 (t=2.082,P<0.05). The scores of low cultural degree syndrome 1-3 were obviously higher than those of high culture degree (tvalue was 2.019, 1.990 and 2.287, respectively, allP<0.05), and the scores of introverted female syndrome 1-3 were obviously higher than those of extroverted female syndromes (tvalue was 3.000, 1.022 and 1.077, respectively, allP<0.05). Scores of syndrome 2-3 of women with poor relationships with children were higher than those of women with good relationships with children (tvalue was 3.190 and 3.265, respectively, bothP<0.05). Conclusion MPS female menopausal symptoms are closely related to the relationships with children, educational level and personality. Cultural degree, relationships with children, personality, syndrome 1, 2 and 3 are risk factors of MPS menopausal symptoms.

[Key words]perimenopausal syndrome (PMS); menopausal symptoms score; syndrome; influencing factors

圍絕經(jīng)期綜合征(perimenopausal syndrome，MPS)發(fā)生于女性40歲以后，發(fā)病率達(dá)85%以上，臨床表現(xiàn)為絕經(jīng)前后出現(xiàn)內(nèi)分泌紊亂、免疫功能低下等癥狀[1-3]。MPS發(fā)病主要由下丘腦-垂體-性腺軸出現(xiàn)紊亂、雌激素水平下降引起，可嚴(yán)重影響女性生活質(zhì)量[4-5]。本研究對(duì)金華市磐安縣婦幼保健院婦產(chǎn)科78例MPS患者更年期癥狀進(jìn)行評(píng)估，并對(duì)相關(guān)影響因素進(jìn)行探討。

1對(duì)象與方法

1.1研究對(duì)象

選擇2011年1月至2013年12月期間在金華市磐安縣婦幼保健院婦產(chǎn)科就診的78例MPS患者為研究對(duì)象，均符合MPS診斷標(biāo)準(zhǔn)[6]?；颊吣挲g45～55歲，平均為51.92±4.29歲。選擇同期在本院健康體檢的72例健康女性為對(duì)照組。

1.2納入排除標(biāo)準(zhǔn)

納入標(biāo)準(zhǔn)：①年齡45～55歲；②無(wú)卵巢切除史；③無(wú)全身系統(tǒng)疾??；④知情同意。排除標(biāo)準(zhǔn)：①有精神疾病史；②存在嚴(yán)重抑郁癥狀者；③有酒精藥物濫用史；④有嚴(yán)重肝病史；⑤未完成隨訪者。

1.3觀察指標(biāo)

統(tǒng)計(jì)所有研究對(duì)象的一般資料，內(nèi)容包括年齡、婚姻狀況、文化程度、經(jīng)濟(jì)狀況等方面。對(duì)更年期癥狀相關(guān)危險(xiǎn)因素進(jìn)行多因素Logistic回歸分析。

1.4 Greene量表評(píng)分

使用女性版圍絕經(jīng)期Greene量表評(píng)估更年期癥狀，該表共包括21項(xiàng)癥狀表現(xiàn)，依據(jù)近1周的狀況進(jìn)行評(píng)分：0分：完全沒(méi)有，1分：輕度，2分：中度，3分：重度。21項(xiàng)癥狀分為5個(gè)癥候群。癥候群1為焦慮癥狀，包括1～6：①心跳加速；②緊張不安感加強(qiáng)；③睡眠障礙；④焦躁，不安；⑤恐慌或不安；⑥無(wú)法集中注意力。癥候群2為抑郁癥狀，包括7～11：⑦疲乏感增強(qiáng)；⑧對(duì)一般事物興趣感減弱；⑨憂郁、不開(kāi)心；⑩易哭泣；易怒。癥候群3為軀體癥狀，包括12～18。癥候群4為血管舒縮癥狀，包括19～20：熱潮紅；夜間流汗。癥候群5為性功能：對(duì)性失去興趣。

1.5統(tǒng)計(jì)學(xué)方法

使用SPSS 19.0軟件，計(jì)數(shù)資料和計(jì)量資料分別執(zhí)行χ2和t檢驗(yàn)；對(duì)相關(guān)危險(xiǎn)因素進(jìn)行多因素Logistic回歸分析，以P<0.05表示差異有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

2.1兩組一般資料比較

兩組年齡、體重指數(shù)等資料比較無(wú)統(tǒng)計(jì)學(xué)差異(均P>0.05)。但兩組在學(xué)歷、與子女關(guān)系、性格方面比較，差異有統(tǒng)計(jì)學(xué)意義(均P<0.05)，且觀察組Greene評(píng)分顯著高于對(duì)照組(P<0.05)，見(jiàn)表1。

2.2圍絕經(jīng)期綜合征女性臨床表現(xiàn)

78例MPS患者中，輕度圍絕經(jīng)期癥狀27例(34.62%)，中度圍絕經(jīng)期癥狀48例(61.54%)，重度圍絕經(jīng)期癥狀3例(3.85%)，患者臨床表現(xiàn)主要包括失眠、疲勞、焦慮等，見(jiàn)表2。

2.3Greene量表癥候群評(píng)分分析

觀察組癥候群1～3評(píng)分顯著高于對(duì)照組(均P<0.05)，觀察組癥候群4評(píng)分顯著低于對(duì)照組(P<0.05)。低文化程度癥候群1～3評(píng)分顯著高于高文化程度(均P<0.05)；性格內(nèi)向的女性癥候群1～3評(píng)分顯著高于性格外向組(均P<0.05)，子女關(guān)系較差的組別癥候群2～3評(píng)分顯著高于與子女關(guān)系好組(均P<0.05)，見(jiàn)表3。

2.4圍絕經(jīng)期綜合征患者出現(xiàn)更年期癥狀相關(guān)因素分析

對(duì)78例MPS分析結(jié)果顯示，癥候群1(95%CI：2.051～16.108)、癥候群2(95%CI：2.217～19.281)、癥候群3(95%CI：2.679～12.219)、學(xué)歷(95%CI：6.502～19.012)、與子女關(guān)系(95%CI：2.758～17.108)、性格(95%CI：4.302～18.819)等因素和更年期癥狀關(guān)系密切，為其主要危險(xiǎn)因素，見(jiàn)表4。

指標(biāo)觀察組(n=78)對(duì)照組(n=72)t/χ2P年齡(歲)51.89±5.1852.05±5.910.0130.922文化程度5.8380.016 大專及以上28(35.90)40(55.56) 大專以下50(64.10)32(45.71)體質(zhì)量指數(shù)(kg/m2)21.16±2.8920.83±2.450.0620.830Greene量表評(píng)分(分)24.05±5.1912.51±4.219.9620.000與子女關(guān)系6.0860.014 好54(69.23)62(86.11) 一般或較差24(82.05)10(13.89)性格特征5.7880.016 內(nèi)向56(71.79)38(52.78) 外向22(28.21)34(47.22)

表278例MPS女性臨床癥狀

Table 2Clinical symptoms of 78 cases of PMS

癥狀例數(shù)(n)百分比(%)失眠4861.54疲勞4658.97抑郁3139.74潮熱出汗3241.03頭痛3544.87心悸2937.18焦慮4152.56

表3　不同項(xiàng)目Greene量表5個(gè)癥候群評(píng)分對(duì)比

(轉(zhuǎn)下表)

(續(xù)上表)

項(xiàng)目例數(shù)(n)癥候群1癥候群2癥候群3癥候群4癥候群5文化程度 大專及以上280.81±0.48c0.67±0.52c0.71±0.51c1.15±0.670.91±0.62 大專以下501.06±0.560.99±0.621.07±0.631.04±0.530.82±0.52t2.0191.9902.2870.2130.299P0.0200.0390.0100.8920.900性格 外向220.79±0.45d0.66±0.48d0.70±0.52d1.09±0.630.87±0.63 內(nèi)向561.07±0.561.03±0.631.06±0.631.05±0.510.79±0.52t3.0001.0221.0770.3020.313P0.0200.0400.0260.9030.897

注：與對(duì)照組比較，aP<0.05；與子女關(guān)系較差組比較，bP<0.05；與大專以下組比較，cP<0.05；與內(nèi)向組比較，dP<0.05。

表4　MPS患者發(fā)生更年期癥狀危險(xiǎn)因素的Logistic回歸分析

3討論

3.1圍絕經(jīng)期綜合征女性臨床癥狀

MPS患者由于卵巢功能減退，內(nèi)分泌紊亂，激素分泌能力減弱，可出現(xiàn)激素水平紊亂、免疫力下降等臨床癥狀。Bintvihok等[1]發(fā)現(xiàn)MPS女性臨床主要癥狀為失眠、焦慮、抑郁、疲勞乏力等，可通過(guò)對(duì)下丘腦-垂體-卵巢軸進(jìn)行調(diào)節(jié)，改善MPS患者激素分泌失調(diào)癥狀，進(jìn)而改善圍絕經(jīng)期癥狀。本研究中78例MPS患者中輕度圍絕經(jīng)期癥狀27例(34.62%)，中度癥狀48例(61.54%)，重度癥狀3例(3.85%)，患者臨床表現(xiàn)主要包括失眠、疲勞、焦慮等癥狀，這和文獻(xiàn)報(bào)道相符[7-8]。

3.2不同項(xiàng)目Greene量表5個(gè)癥候群評(píng)分

Polotsky等[2]的一項(xiàng)大規(guī)模臨床調(diào)查顯示，MPS女性在絕經(jīng)前后可有內(nèi)分泌紊亂、免疫功能低下表現(xiàn)，與骨質(zhì)疏松癥、自主神經(jīng)功能紊亂等多種疾病有關(guān)，而患者更年期癥狀嚴(yán)重程度與患者自身學(xué)歷、與子女關(guān)系及性格等均有關(guān)系。本研究結(jié)果顯示，觀察組癥候群1～3評(píng)分顯著高于對(duì)照組，觀察組癥候群4評(píng)分顯著低于對(duì)照組。低文化程度癥候群1～3評(píng)分顯著高于高文化程度；性格內(nèi)向的女性癥候群1～3評(píng)分顯著高于性格外向組，子女關(guān)系較差的組別癥候群2～3評(píng)分顯著高于與子女關(guān)系好組，學(xué)歷較低的女性由于對(duì)圍絕經(jīng)期相關(guān)知識(shí)了解較少，可加重畏懼心理，患者心理與生理壓力可加大；與子女關(guān)系較差的患者由于平時(shí)生活中缺少子女的關(guān)心與交流，無(wú)法像與子女關(guān)系好的女性那樣感受到子女的呵護(hù)與關(guān)愛(ài)，因此容易滋生抑郁、煩躁、失落等不良情緒，可嚴(yán)重影響正常人際交往；性格內(nèi)向的患者由于性格內(nèi)向，面臨不愉快的事情不易排解，壓力較大，可進(jìn)一步加重生理與心理壓力，導(dǎo)致更年期癥狀加重。提示社會(huì)和家庭平時(shí)要多關(guān)注相關(guān)女性人群，加強(qiáng)交流，給予關(guān)愛(ài)。

3.3圍絕經(jīng)期綜合征患者發(fā)生更年期癥狀的危險(xiǎn)因素

Midei等[5]發(fā)現(xiàn)，與子女關(guān)系不融洽、學(xué)歷低、性格內(nèi)向等多種因素是MPS女性更年期癥狀加重的主要影響因素。本研究結(jié)果發(fā)現(xiàn)，低學(xué)歷、與子女關(guān)系、性格內(nèi)向、癥候群1、癥候群2、癥候群3等因素和嚴(yán)重更年期癥狀密切相關(guān)，提示對(duì)此類人群尤其應(yīng)該加強(qiáng)關(guān)注，以減輕相關(guān)更年期癥狀，提高此類女性的生活質(zhì)量，以幫助此類人群更好地度過(guò)圍絕經(jīng)期。

綜上所述，MPS女性更年期癥狀和與子女關(guān)系、學(xué)歷、性格密切相關(guān)。文化程度、與子女關(guān)系、性格、癥候群1、癥候群2、癥候群3，為MPS更年期癥狀的主要影響因素。

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[專業(yè)責(zé)任編輯：楊文方]

Climacteric symptom scores and influencing factors of perimenopausal syndrome of some women in Pan’an of Zhejiang Province

LI Mei-zhen1, SHAN Xiao-lan2

(1.Department of Gynecology and Obstetrics, Pan’an Maternal and Child Health Hospital of Jinhua in Zhejiang Province,Zhejiang Jinhua 322300, China;2.Department of Gynecology and Obstetrics, Zhejiang Province Dongyang City Hospital of Traditional Chinese Medicine,Zhejiang Jinhua 322100, China)

2014-10-18

厲美珍(1968-)，女，副主任醫(yī)師，主要從事所轄山區(qū)宮頸疾病規(guī)范管理工作。

10.3969/j.issn.1673-5293.2016.02.015

R711.5

A

1673-5293(2016)02-0191-04