發(fā)布時間：2018-02-12 16:47

  本文關鍵詞： 抑郁 焦慮 社會-心理因素 抑郁 雌激素受體 基因多態(tài)性 更年期癥狀　出處：《中國協(xié)和醫(yī)科大學》2008年博士論文　論文類型：學位論文

【摘要】： 絕經是每個婦女生命進程中必然發(fā)生的生理過程,是卵巢功能不斷衰退、雌孕激素不斷下降的過程。女性進入圍絕經期,除了潮熱、出汗等血管運動癥狀,往往也會伴隨一些情緒問題,如抑郁、焦慮等。隨著我國逐步進入老齡化社會以及社會經濟的發(fā)展,老年婦女精神健康也越來越受到重視。但目前國內相關研究仍較少,結果也不一致。本文通過以下兩部分了解北京市城區(qū)圍絕經期婦女抑郁癥狀的現(xiàn)狀及與E_2、FSH和雌激素β受體基因多態(tài)性相關性。 第一部分北京市城區(qū)圍絕經期婦女抑郁癥狀的流行病學調查 目的:了解北京市城區(qū)圍絕經期婦女抑郁、焦慮癥狀的現(xiàn)狀和影響因素。 方法:采用分層隨機抽樣的方法,從北京市8個城區(qū)隨機抽取45～59歲婦女,進行問卷調查。問卷內容包括:1)一般情況和家庭經濟情況;2)SF-36健康調查量表(36-item Short Form Health Survey,SF-36);3)社會支持評定量表;4)Kupperman評分(Kupperman Menopause Index,KMI);5)抑郁自評量表(Self-RatingDepression Scale,SDS);6)焦慮自評量表(Self-Rating Anxiety Scale,SAS)。建立數(shù)據(jù)庫,應用SPSS 11.5軟件進行t檢驗、x~2檢驗、非參數(shù)檢驗和BinaryLogistic回歸分析。 結果:共有1280例婦女完成調查問卷。1)1280例婦女平均年齡51.8歲,其中絕經過渡期487例(38.0%),絕經早期394例(30.8%),絕經晚期348例(27.2%)。2)1280例中有抑郁癥狀者為306例(23.9%),焦慮癥狀131例(10.2%)。絕經過渡期、絕經早期和絕經晚期抑郁、焦慮癥狀發(fā)生無明顯差異(P＞0.05)。3)抑郁癥狀者和焦慮癥狀者組SF-36評分均明顯低于無癥狀者(P＜0.01)。4)抑郁癥狀組與無癥狀組比較,社會支持量表評分均顯著降低(P＜0.01),而焦慮癥狀組與無癥狀組的社會支持量表評分無差異(P＞0.05)。5)與抑郁癥狀發(fā)生有關的因素包括:家庭生活滿意度、社會支持量表總分與抑郁癥狀負相關,經濟困難、潮熱出汗、性交痛和陰道干癥狀、子女升學就業(yè)失敗與抑郁癥狀正相關。與焦慮癥狀發(fā)生有關的因素包括:家庭生活滿意度、社會支持程度、既往經前期緊張綜合癥史、潮熱出汗、性交痛陰道干癥狀、1年內存在以下負性事件:經濟困難、本人重病、工作壓力大、夫妻不和。 結論:抑郁、焦慮癥狀是圍絕經期婦女的常見癥狀,它們的發(fā)生與更年期癥狀以及多種社會心理緊張因素有關。抑郁癥狀者、焦慮癥狀者SF-36評分明顯降低,抑郁癥狀者社會支持明顯下降。 第二部分圍絕經期婦女抑郁癥狀與雌激素受體β基因多態(tài)性的關系 目的:了解圍絕經期婦女抑郁癥狀與雌激素受體β基因多態(tài)性的關系。 方法:于2007年11月～2008年3月在我院婦產科門診和社區(qū)選擇圍絕經期婦女,分別采用抑郁自評量表和Kupperman評分評價抑郁癥狀和更年期癥狀。取空腹靜脈血查E_2和FSH,應用PCR-RFLP技術分析ERβAluI和RsaI基因多態(tài)性,采用PCR和基因掃描技術分析ERβ(CA)n重復序列多態(tài)性。應用SPSS 11.5軟件進行t檢驗、x~2檢驗、非參數(shù)檢驗和Binary Logistic回歸分析。 結果:1)共有165例婦女入選,平均年齡51.21±3.67歲。2)無抑郁癥狀(SDS指數(shù)＜0.5)119例,輕度抑郁癥狀(SDS為0.5～0.59)22例,中度抑郁癥狀(SDS為0.6～0.69)15例,重度抑郁癥狀(SDS為0.7～)為9例。無抑郁癥狀和抑郁癥狀組的E_2、FSH無明顯差異(P＞0.05)。ERβRsaI和ERβAluI基因多態(tài)性與抑郁癥狀無關。重度抑郁癥狀組(CA)n片段長度明顯低于無抑郁組和輕度抑郁組,具有顯著的統(tǒng)計學意義(P=0.008和P=0.009)。3)按照改良Kupperman評分將樣本分為三組:輕度(≤15)77例,中度(16～30)63例,重度(≥31)25例。在絕經過渡期,輕度、中度和重度更年期綜合癥組的E_2逐漸降低,FSH水平逐漸升高,具有統(tǒng)計學意義(P＜0.05)。更年期綜合癥與ERβAhI、RsaI基因多態(tài)性以及(CA)n重復序列無關,各基因型之間Kupperman改良評分也無統(tǒng)計學差異,但心悸與RsaI基因型和(CA)n片段長度有關。頭暈與(CA)n重復序列分類有關。 結論:圍絕經期婦女抑郁癥狀與ERβ基因(CA)n重復序列長度相關,與血清E_2、FSH以及ERβ基因RsaI基因多態(tài)性無關。ERβAluI可能與抑郁程度有關。在絕經過渡期,更年期綜合癥嚴重程度與E_2和FSH水平有關。某些更年期癥狀可能與ERβ基因多態(tài)性相關。
[Abstract]:The menopause is the inevitable physiological process in every woman ' s life course . It is the process of decreasing the ovarian function and decreasing the estrogen and progesterone . In addition to hot flashes , sweating and other vascular motor symptoms , the mental health of the elderly women is getting more and more attention . However , the present situation of female depression in the peri - menopausal women in Beijing is closely related to the polymorphism of E _ 2 , FSH and estrogen - 尾 receptor . Epidemiological investigation of depressive symptoms in peri - menopausal women in the first part of Beijing Objective : To study the status and influencing factors of depression and anxiety in peri - menopausal women in Beijing . Methods : A questionnaire survey was conducted in eight urban districts of Beijing by stratified random sampling . The questionnaires included : 1 ) General and family economic situation ; 2 ) SF - 36 Health Survey Scale ( SF - 36 ) ; 3 ) Social Support Rating Scale ; 4 ) Kupperman Menopause Index ( KMI ) ; 5 ) Self - Rating Anxiety Scale ( SDS ) ; 6 ) Self - Rating Anxiety Scale ( SAS ) . The database was established and the t - test , x ~ 2 test , non - parametric test and binaryLogistic regression analysis were performed with SPSS 11.5 software . Results : A total of 1280 women completed the questionnaire . 1 ) The average age of 1280 women was 51.8 years . Among them , there were 487 cases ( 38.0 % ) in the menopausal transition period . There were no significant differences in the scores of anxiety symptoms ( P > 0.05 ) . Conclusion : Depression and anxiety symptoms are common symptoms of perimenopausal women , and their occurrence is related to climacteric symptoms and various psychosocial factors . The scores of SF - 36 in patients with depressive symptoms and anxiety symptoms are obviously lower , and the social support of depressive symptoms is obviously decreased . Relationship between depressive symptoms and estrogen receptor 尾 gene polymorphism in perimenopausal women in the second part Objective : To investigate the relationship between depressive symptoms and estrogen receptor 尾 gene polymorphism in perimenopausal women . Methods : From November 2007 to March 2008 , women in peri - menopausal period were selected by using depression self - rating scale and Kupperman score . The polymorphism of ER尾AluI and RsaI was analyzed by PCR - RFLP . The polymorphism of ER尾 ( CA ) n repeats was analyzed by PCR and gene scanning technique . Using SPSS 11.5 software , t - test , x ~ 2 test , non - parametric test and binary logistic regression analysis were performed . Results : 1 ) There were 165 women ( mean age 51.21 鹵 3.67 years ) . There were no depression symptoms ( SDS - index < 0.5 ) 119 cases , mild depression ( 0 . 5 - 0.59 ) , moderate ( 16 - 30 ) 63 cases , severe ( 鈮，

本文編號：1506097