围绝经期妇女铁蛋白水平及与慢性疾病危险性分析

发布时间：2019-02-20 21:30

【摘要】：目的围绝经期是指妇女绝经前后的一段时期(从45岁左右开始至停经后12个月内的时期),是正常的生理变化时期。血清铁蛋白水平可反映机体铁的营养状况,不同生理状况可影响机体对铁的吸收和利用,铁含量的过高或过低都将影响机体的正常生理功能。以往研究发现女性绝经后铁蛋白水平升高,但研究对象多是西方人群,且围绝经期铁蛋白与慢病的研究在国内外较为少见。本研究的目的就是分析围绝经期妇女血清铁蛋白水平的年龄变化特征及与慢性疾病的关系,为深入探讨铁过载对人群健康的影响及疾病预防提供参考。方法采用流行病学横断面研究方法。选取2014年6月—2015年10月青岛市某医院体检的40~65岁女性2635例作为研究对象,平均年龄49岁,按年龄分组为40~44岁、45~49岁、50~54岁、55~59岁和60~65岁;收集研究对象体格检查、生化检测、铁蛋白水平等检测结果,并结合问卷调查其既往病史,充分了解研究对象的健康状况。按体质指数(BMI)分组为体重过低(18.5 kg/m2)、正常(18.5~23.9 kg/m2)、超重(24.0~27.9 kg/m2)和肥胖(≥28.0 kg/m2),按铁蛋白水平分组为铁缺乏(15μg/L)、铁正常(15~150μg/L)和铁过载(150μg/L),分析年龄和BMI与不同铁蛋白水平的关系及影响。分别计算高脂血症、高血压、糖尿病和高尿酸血症四种常见慢病在不同年龄组、BMI组和铁蛋白水平组的患病率,采用多因素logistic回归分析铁过载对慢性疾病患病风险的影响。结果研究对象平均铁蛋白水平为38.6(16.9,67.7)μg/L,随年龄增长,铁蛋白水平呈上升趋势,其中50至59岁迅速升高。随年龄增长铁缺乏检出率下降,而铁过载检出率升高,两者在55~56岁之间相交;随BMI增加,铁蛋白水平升高,肥胖者铁蛋白浓度46.2(21.7,87.3)μg/L高于体重正常者33.8(14.7,62.0)μg/L,P0.05。多因素logistic回归分析结果表明,50~54岁、45~49岁和40~44岁组铁过载患病风险分别是60~65岁组的7.529、4.057和9.197倍(95%CI分别为:2.203~7.472,4.132~13.717,5.043~16.772),而55~59岁和60~65岁组铁过载患病风险分别是40~44岁组的4.470和4.346倍(95%CI分别为:1.987~10.057,1.840~10.266)。铁过载组高脂血症、高血压、高尿酸血症和糖尿病患病率均明显高于铁缺乏和铁正常组(P均0.05)。多因素logistic回归分析结果表明,铁过载组高脂血症患病风险是铁正常组的1.782倍(95%CI:1.127~2.818,P0.05),高血压患病风险是铁正常组的1.700倍(95%CI:1.031~2.803,P0.05),糖尿病患病风险是铁正常组的2.832倍(95%CI:1.479~5.426,P0.05),高尿酸血症患病风险是铁正常组的2.374倍(95%CI:1.097~5.138,P0.05)。结论围绝经期妇女铁蛋白水平在50岁时铁蛋白水平迅速升高导致铁过载检出率增高,提示应避免过度补铁。绝经引起的铁蛋白水平升高可增加机体患慢病的风险,提示铁蛋白对于慢性疾病的诊断可能具有早期预警作用。因此,围绝经期妇女应定期进行健康体检,根据自身铁储量和生理状况适量补铁以维持铁蛋白在150μg/L以下;同时积极锻炼控制体重,避免铁过载危害并预防慢性疾病的发生。
[Abstract]:Perimenopausal period is a period of time before and after menopause (from about 45 to 12 months after the menopause), which is a normal period of physiological change. The serum ferritin level can reflect the nutritional status of iron in the body. Different physiological conditions can affect the absorption and utilization of iron, and the excessive or too low iron content will affect the normal physiological function of the body. In the past, the level of post-menopausal ferritin in women was increased, but the number of subjects in the study was the western population, and the study of perimenopausal and slow-disease was rare at home and abroad. The purpose of this study is to analyze the age-changing characteristics of serum ferritin in perimenopausal women and the relationship with the chronic diseases, and to provide a reference for the further study of the effect of iron overload on the health of the population and the prevention of the disease. Methods The epidemiological cross-sectional study was used. A total of 2635 women aged from 40 to 65 years of age, aged from 40 to 44 years, 45 to 49 years, 50 to 54 years, 55 to 59 years and 60 to 65 years of age, were selected from June, 2014 to October, 2015. The results of physical examination, biochemical test and ferritin level were collected. and the health status of the study object was fully understood in combination with the previous medical history of the questionnaire. According to the body mass index (BMI) group, the body weight was too low (18. 5 kg/ m2), normal (18. 5-23. 9 kg/ m2), overweight (24. 0-27. 9 kg/ m2) and obesity (24.0kg/ m2), and the iron deficiency (15. mu.g/ L), the normal iron (15-150. mu.g/ L) and the iron overload (150. mu.g/ L) were grouped according to the ferritin level. The relationship and effect of age and BMI with different levels of ferritin were analyzed. The prevalence of four common slow diseases of hyperlipidemia, hypertension, diabetes and hyperuricemia in different age group, BMI group and ferritin level group were calculated, and the effect of iron overload on the risk of chronic disease was analyzed by multi-factor logistic regression. Results The mean ferritin level in the study was 38. 6 (16. 9, 67. 7). m u.g/ L, and the level of ferritin increased with age, of which 50 to 59 years of age increased rapidly. The rate of iron deficiency decreased with age, and the rate of iron overload increased, both of which were in the range of 55 to 56 years; with the increase of BMI, the level of ferritin increased, and the concentration of ferritin in the obesity group was 46. 2 (21.7, 87.3). m The multiple-factor logistic regression analysis showed that the risk of iron overload in the 50-54-year-old, 45-49-year-old group and 40-44-year-old group was 7.529, 4.057 and 9.197-fold (95% CI: 2.203-7.472, 4.132-13.717, 5.043-16.772), while the risk of iron overload in the 55-59-and 60-65-year-old group was 4.470 and 4.346-fold (95% CI: 1.987-10.057, 1.840-10.266, respectively). The prevalence of hyperlipidemia, hypertension, hyperuricemia and diabetes in the iron overload group was significantly higher than that of the iron deficiency group and the iron normal group (P 0.05). Multivariate logistic regression analysis showed that the risk of hyperlipidemia in the iron overload group was 1.782 (95% CI: 1.127-2.818, P0.05). The risk of hypertension was 1.700-fold (95% CI: 1. 031-2.803, P0.05), and the risk of diabetes was 2.832-fold (95% CI: 1.479-5.426, P0.05). The risk of hyperuricemia was 2.374-fold (95% CI: 1.097-5.138, P0.05). Conclusion The level of ferritin in perimenopausal women was increased rapidly at the age of 50, and the rate of iron overload was increased, and it was suggested that excessive iron supplementation should be avoided. The increase of the level of ferritin in the menopause can increase the risk of slow disease in the body, and it is suggested that the diagnosis of the chronic diseases may have an early warning effect. Therefore, the women in the perimenopausal period should carry out the health examination on a regular basis and make a proper amount of iron supplementation according to their iron reserves and physiological conditions to maintain the ferritin below 150 & mu; g/ L; and meanwhile, actively exercise the control of body weight, avoid the harm of iron overload and prevent the occurrence of chronic diseases.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R173

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