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研究生:陳昱伶
研究生(外文):Yu-Ling Chen
論文名稱:停經後婦女血中去氫上雄性固酮硫酸鹽和總睪固酮濃度之橫斷性流行病學研究:影響因素及健康效應
論文名稱(外文):A Cross-sectional Epidemiologic Study on Serum Levels of Dehydroepiandrosterone Sulfate and Total Testosterone among Post-menopausal Women:Correlates and Effects.
指導教授:孫建安孫建安引用關係
指導教授(外文):Chien-An Sun
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:101
中文關鍵詞:停經後婦女去氫上雄性固酮硫酸鹽總睪固酮影響因素健康效應
外文關鍵詞:post-menopasual womendehydroepiandrosterone sulfatetotal testosteronecorrelateshealth effects
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此一橫斷性研究之研究目的是分析停經後婦女血中總睪固酮和去氫上雄性固酮硫酸鹽濃度之影響因素及其健康效應。本研究以前往美兆台北診所381位進行健康檢查之停經後婦女為研究對象,以自填式問卷收集其社會人口學、生活習慣、飲食習慣等變項資料。另外,在健檢過程中所測量之身高、體重、腰圍、臀圍及體脂肪率亦作為體位變項納入分析。至於健康效應則包括健檢過程中所測量之血壓、飯前血糖、總膽固醇、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、三酸甘油脂及骨質密度。本研究族群的平均總睪固酮濃度為0.345 ±0.152 ng/ml,而去氫上雄性固酮硫酸鹽濃度為107.01 ±71.69 μg/dl。研究結果顯示,停經後婦女血中去氫上雄性固酮硫酸鹽濃度隨著年齡及停經年數的增加有顯著下降的趨勢,而總睪固酮濃度則與年齡和停經年數並無顯著的相關。在多變項迴歸模式分析中發現,體位因素為影響停經後婦女血中總睪固酮濃度和去氫上雄性固酮硫酸鹽濃度之重要因素。至於停經後婦女血中總睪固酮和去氫上雄性固酮硫酸鹽濃度之健康效應方面,在校正年齡及身體質量指數後,總睪固酮濃度與舒張壓和收縮壓呈現顯著的正相關;而血中去氫上雄性固酮硫酸鹽濃度則與總膽固醇、低密度脂蛋白膽固醇及骨質密度具有顯著的正相關。這些研究結果顯示停經後婦女血中雄性素濃度受其體位因素影響,而雄性素濃度又與其血壓及血脂和血脂蛋白有顯著的相關。這些研究結果,顯示出性賀爾蒙在停經後婦女健康問題的重要性。
This cross-sectional study examined the correlates and health effects of endogenous androgens including total testosterone and dehydroepiandrosterone sulfate (DHEA-SO4) in 379 postmenopausal women randomly selected from those attending the MJ Health Screening Center in Taipei between August and September 2001.Correlates of interest included demographic characteristics, lifestyle habits, and dietary factors obtained by self-administered questionnaire, as well as body composition measures including height, weight, waist and hip circumferences, and body fat percentage measured at examination. In addition, data on health effects including blood pressure, fasting blood sugar level, as well as blood lipids and lipoproteins determined at examination were also collected for the analysis. In this study, the mena±standard deviation for total testosterone and DHEA- SO4 in 379 postmenopausal women were 0.345 ±0.152 ng/ml and 107.01 ±71.69 μg/dl, respectively. Study results showed that serum level of DHEA-SO4 was significantly decreased with increasing age and years since menopause, whereas there were no significant associations between serum level of total testosterone and age and years since menopause. In the multivariate analyses, body mass index was positively and significantly associated with endogenous androgens of interest. With respect to health effects of endogenous androgens of interest, after adjustment of age and body mass index was made, serum level of total testosterone was positively correlated with systolic and diastolic blood pressure, while serum level of DHEA-SO4 was significantly and positively correlated with total cholesterol, low-density lipoprotein cholesterol and bone density. These study results suggest androgen-related atherogenic changes in cardiovascular risk factors among postmenopausal women.
目 錄
正文目錄 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ I
表目錄 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ III
圖目錄 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ VI
附錄目錄 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ VII
中文摘要 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ VIII
Abstract ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ IX
第一章 前言 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 1
第二章 文獻探討 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 2
第一節 血中性賀爾蒙之合成、運輸及代謝 ‧‧‧‧‧‧‧‧ 2
第二節 影響性賀爾蒙濃度的因素 ‧‧‧‧‧‧‧‧‧‧‧‧ 5
第三節 性賀爾蒙濃度與人體健康的關係 ‧‧‧‧‧‧‧‧‧ 8
第三章 研究目的 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 15
第四章 材料與方法‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 16
第一節 研究對象 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 16
第二節 血中性賀爾蒙濃度之測量 ‧‧‧‧‧‧‧‧‧‧‧‧ 17
第三節 資料收集 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 18
第四節統計分析 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 21
第五章 結果 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 23
第一節 基本資料分析 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 23
第二節 影響血中總睪固酮和去氫上雄性固酮硫酸鹽濃度之因素 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 24
第三節 血中總睪固酮濃度和去氫上雄性固酮硫酸鹽濃度之健康效應 ‧‧‧‧‧‧‧‧‧‧‧‧ 29
第六章 討論 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 31
第一節 影響停經後婦女血中總睪固酮和去氫上雄性固酮硫酸鹽濃度之相關因素探討 ‧‧‧‧‧ 31
第二節 停經後婦女血中總睪固酮和去氫上雄性固酮硫酸鹽濃度之健康效應探討 ‧‧‧‧‧‧‧ 35
第三節 研究限制 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 37
第七章 結論 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 38
第八章 參考文獻 ‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧‧ 39
Arisaka O, Hoshi M, Kanazawa S, Numata M, Kanno S, Negishi M, Nishikura K, Nitta A, Imataka M, Kuribayashi T, Kano K. Effect of adreanal adrogen and estrogen on bone maturation and bone mineral density. Metabolism:Clinical & Experimental 2001;50:377-379.
Abbasi A, Duthie EH, Sheldahl L, Wilson C, Sasse E, Rudman I, Mattson DE. Association of dehydroepiandrosterone sulfate, body composition, and physical fitness in independent community-dwelling older men and women. J Am Geriatr Soc 1998;46:391-392.
Berrino F, Muti P, Micheli A, Bolelli G, Krogh V, Sciajno R, Pisani P, Panico S, Secreto G. Serum sex hormone levels after menopause and subsequent breast cancer. J Natl Cancer Inst 1996;88:291-296.
Berrino F, Bellati C, Secreto G, Camerini E, Pala V, Panico S, Allegro G, Kaaks R. Reducing bioavailable sex hormones through a comprehensive change in diet:the diet and androgens (DIANA) randomized trial. Cancer Epidemiol Biomark & Prev 2001;10:25-33.
Barrett-Connor E, Goodman-Gruen D. Dehydroepiandrosterone sulfate does not predict cardiovascular death in postmenopausal women. The Rancho Bernardo Study. Circulation 1995;91:1757-1760.
Barrett-Connor E, Young R, Notelovitz M, Sullivan J, Wiita B, Yang JM, Nolan J. A two-year, double-blind comparison of estrogen-androgen and conjugated estrogens in surgically menopausal women: effects on bone mineral density, symptoms and lipid profiles. J Reprod Med 1999;44:1012-1020.
Barbieri RL, Gochberg J, Ryan KJ. Nicotine, cotinine, and anabasine inhibit aromatase in human trophoblast in vitro. J Clin Invest 1986;77:1727-1733.
Baron JA, Comi RJ, Cryns V, Brinck-Johnsen T, Mercer NG. The effect of cigarette smoking on adrenal cortical hormones. J Pharmacol & Exp Ther 1995;272:151-155.
Browner WS, Pressman AR, Nevitt MC, Cauley JA, Cummings SR. Association between low bone density and stroke in elderly women. The study of osteoporotic fractures. Stroke 1993;24:940-946.
Browner WS, Seeley DG, Vogt TM, Cummings SR. Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 1991;338:355-358.
Cauley JA, Gutai JP, Sandler RB, LaPorte RE, Kuller LH, Sashin D. The relationship of endogenous estrogen to bone density and bone area in normal menopausal women. Am J Epidemiol 1986;124:752-761.
Cauley JA, Gutai JP, Kuller LH, Donne DL, Powell JG. The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 1987;6:1120-1131.
Cauley JA, Lucas FL, Kuller LH, Vogt MT, Browner WS, Cummings SR. Bone mineral density and risk of breast cancer in older women: the study of osteoporotic fractures. Study of Osteoporotic Fractures Research Group. JAMA 1996;276:1404-1408.
Cauley JA, Lucas FL, Kuller LH, Stone K. Browner W, Cummings SR. Elevated serum estradiol and testosterone concentrations are associated with a high risk for breast cancer. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1999;130(4 Pt 1):270-277.
Cauley JA, Gutai JP, Kuller LH, Powell JG. Reliability and interrelations among serum sex hormones in postmenopausal women. Am J Epidemiol 1991;133:50-57.
Cauley JA, Gutai JP, Kuller LH, Scott J, Nevitt MC. Black-white differences in serum sex hormones and bone mineral density. Am J Epidemiol 1994;139:1035-1046.
Cauley JA, Gutai JP, Kuller LH, Powell JG. The relation of endogenous sex steroid hormone concentrations to serum lipid and lipoprotein levels in postmenopausal women. Am J Epidemiol 1990;132:884-894.
Colvin PL, Auerbach BJ, Case LD, Hazzard WR, Applebaum-bowden D. A dose response relationship between sex hormone-induced change in hepatic triglyceride lipase and high-density lipoprotein cholesterol in postmenopausal women. Metabolism 1991;140:1052-1056.
Dorgan JF, Longcope C, Stephenson HE, Jr., Falk RT, Miller R, Franz C, Kahle L, Campbell WS, Tangrea JA, Schazkin A. Relation of prediagnostic serum estrogen and androgen levels to breast cancer. Cancer Epidemiol Biomark & Prev 1996;5:533-539.
Dorgan JF, Baer DJ, Albert PS, Judd JT, Brown ED, Corle DK, Campbell WS, Hartman TJ, Tejpar AA, Clevidence BA, Giffen CA, Chandler DW, Stanczyk FZ, Taylor PR. Serum hormones and the alcohol-breast cancer association in postmenopausal women. J Natl Cancer Inst 2001;93:710-715.
Davis SR, McCloud P, Strauus BJG, Burger HG. Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality. Maturitas 1995;21:227-236.
Enrior CL, Reforzo-Membrives J. Peripheral aromatization as a risk factor for breast and endometrial cnacer in postmenopausal women :a review. Gynecol Oncol 1984;17:1-21.
Eriksen EF, Colvard DS, Berg NJ, Graham ML, Mann KG, Spelsberg TC, Riggs BL. Evidence of estrogen receptors in normal human osteoblast-like cells. Science 1988;241:84-86.
Friedlander WT, Levy R, Fredrickson DS. Estimation of the concentration of low-density lipoprotein-cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
Gavaler JS, Thiel DV. The association between moderate alcoholic beverage consumption and serum estradiol and testosterone levels in normal postmenopausal women : relationship to the literature. Alcohol Clin Exp Res 1992;16:87-92.
Guthrie JR, Ebeling PR, HopperJL. Bone mineral density and hormone levels in menopausal Australian women. Gynecol Endocrinol 1996;10:199-205.
Howe GR, Frideenreich CM, Jain M, Miller AB. A cohort study of fat intake and risk of breast cancer. J Natl Cancer Inst 1991;83:336-340.
Holmes MD, Hunter DJ, Colditz GA, Stampfer MJ, Hankinson SE, Speizer FE, Rosner B, Willett WC. Association of dietary intake of fat and fatty acids with risk of breast cancer. JAMA 1999;281:914-920.
Haffner SM, Newcomb PA, Marcus PM, Klein BEK, Klein R. Relation of sex hormones and dehydroepiandrosterone sulfate (DHEA-SO4) to cardiovascular risk factors in postmenopausal women. Am J Epidemiol 1995;142:925-934.
Jacquotte AZ, Bruning PF, Bonfrer JMG, Koenig DL, Shore RE, Kim MY, Pasternack BS, Toniolo P. Relation of serum levels of testosterone and dehydroepiandrosterone sulfate to risk of breast cancer in postmenopausal women. Am J Epidemiol 1997;145:1030-1038.
Johannes CB, Stellato RK, Feldman HA, Longcope C, McKinlay JB. Relation of dehydroepiandrosterone and dehydroepiandrosterone sulfate with cardiovascular disease risk factors in women:longitudinal results from the Massachusetts Women’s Health Study. J Clin Epidemiol 1999;52:95-103.
Katsouyanni K, Boyle P, Trichopoulos D. Diet and urine estrogen among postmenopausal women. Oncology 1991;48:490-494.
Khaw KT, Chir MBB, Tazuke S, Barrett-Connor Elizabeth. Cigarette smoking and levels of adrenal androgens in postmenopausal women. N Engl J Med 1988;318:1705-1708.
Khaw KT, Barrett-Connor E. Fasting plasma glucose levels and endogenous androgens in non-diabetic postmenopausal women. Clin Sci 1991;80:199-203.
Khosla S, Atkinson EJ, Melton LJ, Riggs BL. Effects of age and estrogen status on serum parathyroid hormone levels and biochemical markers of bone turnover in women: a population-based study. Clin Endocrinol Metab 1997;82:1522-1527.
Lucas FL, Cauley JA, Stone RA, Cummings SR, Vogt MT, Weissfeld JL, Kuller LH. Bone mineral density and risk of breast cancer: differences by family history of breast cancer. Study of Osteoporotic Fractures Research Group. Am J Epidemiol 1998;148:22-29.
Madigan MP, Troisi R, Potischman N, Dorgan JF, Brinton LA, Hoover RN. Serum hormone levels in relation to reproductive and lifestyle factors in postmenopausal women(United States). Cancer Causes Control 1998;9:199-207.
Messina M, Barnes S. The role of soy products in reducing risk of cancer. J Natl Cancer Inst 1991;83:541-546.
MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R,,Godwin J, Dyer A, Stamler J. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990;335:765-774.
Newcomb PA, Klein R, Klein BEK, Haffner S, Perlman JM, Cruickshanks KJ, Marcus PM. Association of dietary and life-style factors with sex hormones in postmenopausal women. Epidemiology 1995;6:318-321.
Nguyen TV, Jones G, Sambrook PN. Effects of estrogen exposure and reproductive factors on bone mineral density and osteoporotic fractures. J Clin Endocrinol Metab 1995;80:2709-2714.
Nagata C, Kabuto M, Takatsuka N, Shimizu H. Association of alcohol, height, and reproductive factors with serum hormone concentrations in postmenopausal Japanese women. Steroid hormones in Japanese postmenopausal women. Breast Cancer Res Treat 1997;44:235-241.
Osei-Hyiaman D, Satoshi T, Ueji M, Hideto T, Kano K. Timing of menopause, reproductive years, and bone mineral density. Am J Epidemiol 1998;148;11:1055-1061.
Olsson H, Hagglund G. Reduced cancer morbidity and mortality in a prospective cohort of women with distal forearm fractures. Am J Epidemiol 1992;136:422-427.
Peters HW, Westendorp ICD, Hak AE, Grobbee DE, Stehouwer CDA, Hofman A, Witteman JCM. Menopausal status and risk factors for cardiovascular disease. J Intern Med 1999;246:521-528.
Pasquali R, Casimirri F, Pascal G, Tortelli T, Labate AMM, Bertazzo D, Vicennati V, Gaddi A. Influence of menopause on blood cholesterol levels in women: the role of body composition, fat distribution and hormonal milieu. J Intern Med 1997;241:195-203.
Persson I, Adami HO, McLaughlin JK, Naessen T, Fraumeni JF. Reduced risk of breast and endometrial cancer among women with hip fractures (Sweden). Cancer Causes Control 1994;5:523-528.
Riggs BL, Melton LJ. Involutional osteoporosis. N Engl J Med 1986;314:1676-1686.
Riggs BL, Melton LJ, O’Fallon WM. Drug therapy for vertebral fractures in osteoporosis: evidence that decreases in bone turnover and increases in bone mass both determine antifracture efficacy. Bone 1996;18:S197-201.
Raisz LG, Wiita B, Artis , Bowen A, Schwartz S, Trahiotis M, Shoudri K, Smith J. Comparsion of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resumption in postmenopausal women. J Clin Endocrinol Metab 1996;81:37-44.
Slemenda C, Longcope C, Peacock M, Jui S, Johnston CC. Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri-, and postmenopausal women. J Clin Invest 1996;97:14-21.
Secreto G, Toniolo P, Berrino F, Recchione C, Cavalleri A, Pisani P, Totis A, Fariselli G, Pietro SD. Serum and urinary androgens and risk of breast cancer in postmenopausal women. Cancer Res 1991;51:2572-2576.
Shu XO, Jin F, Dai Q, Wen W, Potter JD, Kushi LH, Ruan Z, Gao YT, Zheng W. Soyfood intake during adolescence and subsequent risk of breast cancer among Chinese women. Cancer Epidemiol Biomark & Prev 2001;10:483-488.
Sowers MF, Beebe JL, McConnell D, Randolph J, Jannausch M. Testosterone concentrations in women aged 25-50 years:Associations with lifestyle, body composition, and ovarian status. Am J Epidemiol 2001;153:256-264.
Stevenson JC, Crook D, Godsland IF. Influence of age and menopausal on serum lipids and lipoprotein in healthy women. Atherosclerosis 1993;98:83-90.
Soler JT, Folsom AR, Kaye SA, Prineas RJ. Associations of abdominal adiposity, fasting insulin, sex hormone binding globulin, and estrone with lipids and lipoproteins in postmenopausal women. Atherosclerosis 1989;79:21-27.
Svendsen OL, Hassager C, Christiansen C. Relationships and independence of body composition, sex hormones, fat distribution and other cardiovascular risk factors in overweight postmenopausal women. Int J Obesity 1993;17:459-463.
Thomas HV, Key TJ, Allen DS, Moore JW, Dowsett M, Fentiman IS, Wang DY. A prospective study of endogenous serum hormone concentrations and breast cancer risk in postmenopausal women on the island of Guernsey. Br J Cancer 1997;76:401-405.
Thomas HV, Davey GK, Key TJ. Oestradiol and sex hormon-binding globulin in premenopausal and post-menopausal meat-eaters, vegetarians and vegans. Br J Cancer 1999;80:1470-1475.
Turcato E, Zamboni M, De Pergola G, Armellini F, Zivelonghi A, Bergamo-Andreis IA, Giorgino R, Bosello O. Interrelationships between weight loss, body fat distribution and sex hormones in pre- and postmenopausal obese women. J Intern Med 1997;241:363-372.
Verkasalo PK, Thomas HV, Appleby PN, Davey GK, Key TJ. Circulating levels of sex hormones and their relation to risk factors for breast cancer: a cross-sectional study in 1092 pre- and postmenopausal women (United Kingdom). Cancer Causes Control 2001;12:47-59.
Vermeulen A. Dehydroepiandrosterone sulfate and aging. Ann N Y Acad Sci 1995;774:121-127.
Vermeulen A. The hormonal activity of the postmenopausal ovary. J Clin Endocrinol Metab 1976;42:247-253.
Weiss SR, Ellman H, Dolker M. A randomized controlled trial of four doses of gransdermal estradiol for preventing postmenopausal bone loss. Obstet Gynecol 1999;94:330-336.
Wu AH, Pike WM, Stram DO. Meta-analysis : dietary fat intake, serum estrogen levels and the risk of breast cancer. J Natl Cancer Inst 1999;91:529-534.
Wu AH, Ziegler RG, Horn-Ross PL, Namura AM, West DW, Kolonel LN, Rosenthal JF, Joover RN, Pike MC. Tofu and risk of breast cancer in Asian-American. Cancer Epidemiol Biomark & Prev 1996;5:901-906.
Wu ZY, Wu XK, Zhang YW. Relationship of menopausal status and sex hormones to serum lipids and blood pressure. Int J Epidemiol 1990;19:297-302.
Xu X, Duncan AM, Wangen KE, Durzer MS. Soy comsumption alters endogenous estrogen metabolism in postmenopausal women. Cancer Epidemol Biomark & Prev 2000;9:781-786.
Yoo KY, Kim H, Shin HR, Kang D, Ha M, Park SK, Lee BK, Cho SH. Female sex hormones and body mass in adolescent and postmenopausal Korean women. J Korean Medic Sci 1998;13:241-246.
Young TK, Gelskey Delis noncentral obesity metabolically benign? JAMA 1995;274:1939-1941.
Zhang Y, Kiel DP, Kreger BE, Cupples LA, Ellison RC, Dorgan JF, Schatzkin A, Levy D, Felson DT. Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 1997;336:611-617.
行政院衛生署。民國86年癌症登記報告。行政院衛生署,2000。
行政院衛生署。民國89年衛生統計。行政院衛生署,2000。
李旺作。新編Gutton生理學。3版,1989。
丘思穎、白源禮編譯。甘龍醫用生理學。2版,1995。
盧立卿、賴宜君。高密度脂蛋白之影響因素-飲食、體能及荷爾蒙。中華營養學會雜誌1999;24:308-320.
美兆診所。89年健康檢查年度報告,2000。
楊燕雲,飲食因子與血脂生化值之相關性探討。國防醫學院公共衛生研究所碩士論文,2000。
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