| 摘要: | 冠狀動脈疾病（coronary artery disease, CAD）是女性重要死因，針對中年女性CAD相關研究卻很少。本研究分兩階段進行，第一階段旨在探討中年婦女CAD之預測因子，第二階段旨在探討生活型態管理計畫對改善CAD危險因素之成效。
第一階段採橫斷式研究設計。於2010年2月至2014年9月期間，在臺北地區兩家醫學中心心臟內科病房進行收案。選取247位因疑似CAD接受心導管檢查40-64歲中年婦女為對象，依自述停經狀態分為未停經（n=46）、已停經（n=156）及子宮切除（n=45）三組。依心導管結果分為CAD組（至少一條主要血管狹窄>50%）與non-CAD組。第二階段採隨機對照試驗，針對第一階段CAD組選取35位個案，隨機分配至實驗（n=17）或控制組（n=18），實驗組接受12週生活型態管理計畫，控制組則維持原來的生活型態。以填寫問卷、查閱病歷、血液檢驗及測量方式收集資料。
第一階結果顯示，整體平均年齡56.8±5.9歲，憂鬱與焦慮間具中度正相關（ψ=0.36, p<0.01），高hsCRP與不活動（ψ=0.23, p<0.01）具輕度正相關。中年婦女危險因素發生百分率最高為脂質異常，其次為肥胖；未停經者目前或曾經抽菸的比例顯著高於已停經和子宮切除者（30.4% vs. 11.5% vs.13.3%, p=0.01），未停經者不活動的比例顯著高於子宮切除者（56.5% vs. 28.9%, p=0.03）。中年婦女有糖尿病史者會增加2.74倍罹患CAD的風險（p<0.01），有CAD家族史發生CAD的機率是沒有家族史的1.97倍（p=0.03）。不同停經狀態，其發生CAD的預測因子不同。未停經者，曾經或目前抽菸者發生CAD的機率是從未抽菸者的7.5倍（p=0.03）。已停經者，有糖尿病史者發生CAD的機率是沒有糖尿病史的3.07倍（p<0.01），有暴露二手菸者發生CAD的機率是沒有暴露者的2.07倍（p=0.04）。子宮切除者，收縮壓每增加1mmHg，增加4%發生CAD的風險（p=0.04）。第二階段結果顯示，實驗組執行生活型態管理計畫後，可顯著增加高密度脂蛋白（B=7.83, p<0.01）、降低總膽固醇（B= -49.21, p=0.04）及腰圍（B= -6.42, p<0.01），減少64%發生肥胖的風險（OR=0.36, p=0.04）。
本研究結果將有助於接受心導管檢查中年婦女，更精確有效的進行CAD的初級與次級預防。
Coronary artery disease (CAD) is a leading cause of death in women. Scant studies on middle-aged women with CAD have been conducted. This study comprised two stages. Stage 1 explored predictors of CAD in middle-aged women; Stage 2 explored the effectiveness of a lifestyle management program on improving the risk factors of CAD.
A cross-sectional design was adopted for Stage 1. From February 2010 to September 2014, patients in the cardiology wards of two medical centers in Taipei were recruited to participate in this study. A total of 247 middle-aged women aged 40 to 64 years who had undergone cardiac catheterization because of suspected CAD were recruited for this study. These participants were divided into three groups: the premenopause (n = 46), postmenopause (n = 156), and hysterectomy (n = 45) groups. These participants were further divided into two groups: the CAD (with at least one coronary artery with > 50% stenosis) and non-CAD groups. A randomized controlled trial was adopted for Stage 2. A total of 35 patients were selected from the CAD group and were randomly assigned to the experimental (n = 17) or control (n = 18) groups. The experimental group received a 12-week lifestyle management program, and the control group maintained their original lifestyle. The data were collected by administering a questionnaire, reviewing medical records, and performing a blood test.
The results obtained from Stage 1 showed that the average age of the participants was 56.8 ± 5.9 years. The depression level of the participants was moderately positively correlated with the anxiety level of the participants (ψ= 0.36, p < 0.01); high-sensitivity c-reactivity protein was slightly positively correlated with physical inactivity (ψ= 0.23, p < 0.01). The highest risk factor for CAD in middle-aged women was dyslipidemia, followed by obesity. The proportion of women who ever or currently smoked in the premenopause group was higher than those in the postmenopause and hysterectomy groups (30.4% vs. 11.5% vs.13.3%, p = 0.01); the proportion of women who exhibited physical inactivity in the premenopause group was significantly higher than that in the hysterectomy group (56.5% vs. 28.9%, p = 0.03). The risk of CAD in middle-aged women with diabetes was 2.74 times higher than that in middle-aged women without diabetes (p < 0.01); the incidence of CAD in middle-aged women with a family history of CAD was 1.97 times higher than that in middle-aged women without a family history of CAD (p = 0.03). The predictors of CAD varied among the premenopause, postmenopause, and hysterectomy groups. For the premenopause group, the risk of CAD in those who ever or currently smoked was 7.5 times higher than that in those who never smoked (p= 0.03). For the postmenopause group, the risk of CAD in those who experienced diabetes was 3.07 times higher than that in those who had not experienced diabetes (p < 0.01); the risk of CAD in those who were exposed to second-hand smoke was 2.07 times higher than that in those who were not exposed to second-hand smoke (p = 0.04). For the hysterectomy group, an increase in systolic blood pressure of 1 mmHg increased the risk of CAD by 4% (p = 0.04). The results obtained from Stage 2 showed that after receiving the lifestyle management program, the experimental group’s high-density lipoprotein level significantly increased (B = 7.83, p < 0.01), whereas their total cholesterol level (B = -49.21, p = 0.04) and waist circumference (B = -6.42, p < 0.01) significantly decreased; in addition, their risk of obesity decreased by 64% (Odds ratio [OR] = 0.36, p = 0.04).
The results of this study can facilitate middle-aged women with catheterization effectively applying primary and secondary CAD preventions. |
