生活事件及心理应激对绝经前后诸证心身症状影响的研究
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摘要
研究背景:
     绝经前后诸证,亦称”经断前后诸症”,是指妇女在绝经期前后,围绕月经紊乱或绝经而出现烘热汗出、烦躁易怒、潮热面红、乍寒乍热、眩晕耳鸣、心悸失眠、腰背酸楚、面浮肢肿、皮肤蚁行感、情志不宁等症状。相当于现代医学的绝经期综合征(menopausal syndrome, MPS)。
     传统的生物学观点把围绝经期出现的症状均归咎于卵巢功能减退、内分泌改变等。但随着生物医学模式向生物—社会—心理医学模式的转变,人们已经越来越意识到心理社会因素在疾病的发生、发展和转归中起着重要作用。而人们在日常生活中遇到的各种各样的社会生活的变动,即生活事件,如结婚,升学,亲人亡故等对人的思想、心理起到重要的影响作用,因而各种心理变化影响到疾病的发生
     研究目的:
     本课题对广州某医院的围绝经期妇女的心身症状进行调查研究。在中医“整体观”、“心身合一”、“情志致病”理论指导下,探讨社会因素、生活事件、及其产生的心理应激与绝经前后诸证疾病的相互关系,分析其可能的危险因素,为中医“情志致病”理论和防治方案提供科学证据。
     研究方法:
     本研究为横断面研究,从现代医学心理学、中医情志病因学角度,采用心理测量学、临床流行病学和循证医学等科研方法,以国内改良Kupperman Index (KI)量表、团体用心理社会应激调查表(PSSG)、绝经综合征评定量表、90项症状自评量表(SCL-90)等为研究载体,对广州某医院178例更年期妇女的心身症状进行问卷调查,探讨社会因素、生活事件、及其产生的心理应激与绝经前后诸证心身症状的发生变化规律,为进一步探讨中医“情志致病”理论内涵和临床防治方案提供科学依据。
     研究结果:
     .背景资料分析
     本研究共纳入了170例符合标准的更年期妇女,其中病例组86例,对照组84例。其中病例组根据KI量表总分显示,轻度有38例,占44.20%,中度有45例,占52.30%,重度有3例,占3.50%。KI量表总分及各条目比较,显示两组女性的各绝经前后诸证症状的严重程度均有明显差异。分析86例绝经前后诸证患者KI量表各条目症状特点,最常见的五大症状按出现频率排序依次为:失眠(91.86%);疲乏(88.37%);易激动(87.21%);潮热出汗(84.88%);骨关节肌肉痛(83.72%)
     二.绝经前后诸证患者与对照组的比较
     (一)两组生活事件及其心理应激的比较
     比较病例组和对照组的生活事件总数、负性生活事件总数、消极情绪、积极情绪、消极应对、应激总分有统计学差异(P<0.05)。
     其中对于病例组86例患者,发病前5年内的生活事件出现频率最高的依次为:个人健康变化(74.40%);过度劳累(60.50%);子女前途问题(40.70%);亲人亡故(34.90%);亲人重病(34.90%);职业变化(33.70%);家庭不和或婚姻问题(19.80%)。
     (二)两组绝经前后诸证身心症状的比较。
     两组的身心症状均提示有统计学差异(P<0.05)。
     病例组86例患者的SCL-90各因子得分较高的依次为:其他因子(睡眠饮食)、强迫症状因子、躯体化因子、抑郁因子、焦虑因子等。
     三.绝经前后诸证组按病情轻重分级,分组比较生活事件及其心理应激。
     比较轻度病例组及中、重度病例组,两组的消极应对、应激总分组间差异有统计学意义(P<0.05)。
     四.病例组按生活事件多寡分组比较
     高生活事件组与低生活事件组在躯体症状、心理症状、社会职能工作等方面得分都存在差距,两组差异具有统计学意义(P<0.05)。另外,躯体领域差异较心理领域差异少。
     五.病例组按应激总分高低分组比较
     比较高应激总分组及低应激总分组,绝经综合征评定量表各维度,两组的绝经综合征总分、心理领域、社会职能与工作能力组间差异均有统计学意义(P<0.05)。
     对于SCL-90量表各维度,两组的SCL-90总分、躯体症状、心理症状组间差异均有统计学意义(P<0.05)
     六.高生活事件组按应激总分高低分组比较
     高生活事件高应激总分组与高生活事件低应激总分组比较,两组的心理症状得分组间差异均有统计学意义(P<0.05)。
     七.病例组的生活事件、应激总分与绝经身心症状的Spearman相关性分析。
     生活事件总数和绝经综合征的身心症状均有正相关性,并且所有相关系数通过了显著性检验。
     同理,负性生活事件总数和绝经综合征的身心症状均有正相关性,并且所有相关系数通过了显著性检验。
     正性生活事件总数和绝经综合征的身心症状无明显相关性,未能通过显著性检验。
     而应激总分和绝经综合征的身心症状均有正相关性。其中与心理领域、SCL-90总分、心理症状呈强相关性,并且所有相关系数通过了显著性检验。
     八.绝经前后诸证不同中医证型之间的比较
     86例绝经前后诸证患者中,肾阴虚14例(16.28%);肾阳虚6例(6.98%);肾阴阳两虚16例(18.60%);肾虚肝郁42例(48.84%);心肾不交7例(8.14%);阴虚火旺1例(1.16%)。
     肾虚肝郁组与其他证型组比较,两组的生活事件总数、负性生活事件总数、消极情绪、消极应对、应激总分组间差异有统计学意义(P<0.05)
     对于绝经综合征评定量表各维度,两组的绝经综合征总分、心理领域、社会职能与工作能力组间差异均有统计学意义(P<0.05)。
     对于SCL-90量表各维度,两组的SCL-90总分、躯体症状、心理症状组间差异均有统计学意义(P<0.05)。
     研究结论:
     1.本研究发现绝经前后诸证症状出现频率之高十分显著,KI量表中13个条目症状,其中12个条目症状出现的频率均在50%以上,有5个条目症状出现频率在80%以上。而通过调查SCL-90量表发现,心理症状较为严重的因子依次为:强迫症状、抑郁、焦虑。
     2.86例绝经前后诸证患者发病前5年内的生活事件有6项出现频率超过30%,依次为:个人健康变化,过度劳累,子女前途问题,亲人亡故,亲人重病,职业变化。
     3.生活事件增多对绝经前后诸证心、身症状皆有影响。而当生活事件发生,不良的心理应激会大大加重绝经前后诸证的心理症状。
     4.绝经前后诸证多个中医证型里,显示肾虚肝郁证的负性生活事件数、消极情绪、消极应对方式明显高于其他证型。肾虚肝郁证的心理症状比其他证型严重得多,躯体症状差异不大。
Background
     Menopausal syndromes, refers to women in the before and after menopause, around the menstrual disorders or menopause appear Hongrehanchu, irritability, hot flashes red, chills and fever, dizziness, palpitation and insomnia, tinnitus, waist sour, floating face swollen limbs, skin creepss, emotional restless and so on.
     The traditional view of the biology of perimenopausal symptoms are attributed to ovarian dysfunction, endocrine changes. But with the biomedical model changing to biopsychosocial medical model, it has been more and more aware of psychological and social factors in the occurrence of diseases and development plays an important role in. But the people encountered in daily life to a variety of social life changes, i. e., life events, such as marriage, education, family death affect people's thought and psychological activity, so the various psychological changes affect disease occurrence.
     Objective
     The subject is about perimenopausal women with somatic and psychological symptoms investigated in a hospital in Guangzhou. Under the guidance of traditional Chinese medicine, including "holistic view"," psychosomatic unity"," the emotional pathogenic theory", we explore the relationship among social factors, life events, psychosocial stress and menopausal syndromes. And analysis the possible risk factors. All of them is for providing scientific evidence of traditional Chinese medicine" the emotional pathogenic theory" and control scheme.
     Methods
     This study is a cross-sectional study. From modern medical psychology, traditional Chinese medicine emotional pathogenic etiological perspective, using psychometric, clinical epidemiology and evidence-based medical research method, with the domestic modified Kupperman Index, Psychosocial Stress Survey for Groups (PSSG), Chinese Menopause Rating Scale, Self-reporting Inventory (SCL-90), investigate178perimenopausal women with somatic and psychological symptoms in a hospital in Guangzhou. Explore somatic and psychological symptoms of menopausal syndromes occurring regularity by the effects of social factors, life events, and psychosocial stress. All of them is for providing scientific evidence of traditional Chinese medicine" the emotional pathogenic theory " and control scheme.
     Results
     1. Background Analysis.
     The study included170menopausal women, among them86cases of Menopausal Syndromes Group,84cases of Healthy Group. The Menopausal Syndromes Group according to KI Scale total score display, mild38cases, accounted for44.20%, moderate in45cases, accounting for52.30%, severe3cases, accounting for3.50%. of. KI Scale total score and each item comparison show the severity of menopause symptoms from two groups of women obviously different. Analysising KI each symptom of86menopausal syndrome patients, the most common five symptoms according to the frequency of occurrence are:Insomnia (91.86%); fatigue (88.37%); irritability (87.21%); hot flashes and sweating (84.88%); joint and muscle pain (83.72%).
     2. Menopausal Syndromes Group and Healthy Group Comparison
     2.1Group of Two Life Events and Psychosocial Stress Comparison
     Comparison of the Menopausal Syndromes Group and Healthy Group in life events, negative life events, negative emotion, positive emotions, negative coping, positive coping, total stress are statistical differences (P<0.05).
     To Menopausal Syndromes Group, life events in the highest frequency in previous five years before suffering menopausal syndromes are:personal health changes (74.40%); overwork (60.50%); children's future (40.70%); the death of their loved ones (34.90%); relatives of seriously i11(34.90%); occupation changes (33.70%); a family feud or marital problems (19.80%).
     2.2Group of Two Somatic and Psychological Symptoms Comparison
     Two groups'somatosensory and psychological field scrores are statistically significant differences (P<0.05).
     The Menopausal Syndromes Group with each factor of SCL-90, the highest5factor scores are as follows:other factors (sleeping and eating), obsessive symptoms, somatization, depression, anxiety
     3. The Menopausal Syndrome Group according to severity grading, comparison of life events and psychosocial stress.
     Comparison of mild Menopausal Syndrome Group and moderate severe Menopausal Syndrome Group, negative coping, total stress are statistically significant differences (P<0.05).
     4. The Menopausal Syndrome Group according to the amount of life events group
     comparison
     The high number life event group and the low number life events group, their somatic symptoms, psychological symptoms, social function are put in difference. The difference of the two groups is significant (P<0.05). In addition, somatosensory areas difference is less than psychological differences.
     5. The Menopausal Syndrome Group according to total stress score group comparison
     Comparison of high total stress and low total stress groups, Chinese Menopause Rating Scale of each dimension, menopausal syndrome scores, psychological field, social function and the ability in work are statistically significant differences (P<0.05).
     For the SCL-90of each dimension, SCL-90scores, somatic symptoms, psychological symptoms between group differences are statistically significant differences (P<0.05).
     6. The high number life event group according to the total stress level group comparison
     The high number life event high total stress group and high low stress life events total group comparison, psychological field differences between group are statistically significant (P<0.05).
     7. Menopause syndrome group life events, total stress, somatic and psychological symptoms of menopause Spearman correlation analysis.
     Life events and both somatic and psychological symptoms of menopause have positive correlation, and all pass the test of correlation coefficient.
     Negative life events and both somatic and psychological symptoms of menopause have positive correlation, and all pass the test of correlation coefficient.
     Positive life events and both somatic and psychological symptoms of menopause have no correlation, and all fail the test of correlation coefficient.
     Total stress score and both somatic and psychological symptoms of menopause have positive correlation. Expecially with the psychological field, SCL-90total score and psychological symptoms were highly correlated, and all pass the test of correlation coefficient.8. A comparison among different syndromes of traditional Chinese Medicine of menopausal syndromes
     86cases of menopausal syndrome, with kidney yin deficiency in14cases(16.28%), kidney yang deficiency in6cases(6.98%), kidney yin and yang deficiency in16cases (18.60%), kidney deficiency and liver stagnation in42cases (48.84%), disharmony of the heart and kidney in7cases (8.14%) yin deficiency and fire excess in1cases (1.16%)
     Kidney deficiency and liver stagnation group and other syndromes of comparison, life events, negative life events, negative emotion, negative coping, total stress were statistically significant differences (P<0.05).
     Chinese Menopause Rating Scale of each dimension, menopausal syndrome, psychological field, social function and the ability in work show statistically significant difference between group(P<0.05).
     For the SCL-90of each dimension, SCL-90total scores, somatic symptoms, psychological symptoms show statistically significant difference between groups (P<0.05).
     Conclusion
     1. This study found that menopausal syndrome symptoms occur in high frequency. There are12entries of KI scale, and their frequency of symtoms is more than50%,5entries occur at a frequency of80%or more. Through the investigation of SCL-90was found, the most serisous psychological symptoms are as follows: obsessive symptoms, depression, anxiety.
     2. To Menopausal Syndromes Group, there are6life events' frequency in previous five years before suffering menopausal syndromes higher than30%:health changes, overwork, children's future, the death of their loved ones, relatives of seriously ill, occupation change.
     3. There are effect on menopausal syndrome both somatic and psychological symptoms with life events increasing. When life events occur of, the bad psychosocial stress will greatly increase the psychological symptoms of menopause syndrome.
     4. Menopausal syndrome with multiple syndromes of traditional Chinese medicine, kidney deficiency and liver stagnation showed that negative life events, negative emotion and negative coping were significantly higher than that of the other TCM syndromes. Psychological symptoms of kidney deficiency and liver stagnation are more serious than other syndromes, while somatic symptoms have no much difference.
引文
[1]王清.围绝经期综合征的中医认识述评.中医杂志,2006,47(2):151
    [2]侯爱贞.从阴阳失调论绝经前后诸证.河南中医,2010,30(8):736
    [3]罗元恺.妇女更年期综合征的中医治疗[J].新中医,1992,24(1):16
    [4]祁秀兰.资肾宁心汤治疗更年期综合征70例.山西中医,2002,23(5):407
    [5]陆启滨.更年期综合征病因病机探源.中医药学刊,2001,4(4):139—140
    [6]肖新春,刘霞.谨守肾阴阳两虚病机论治绝经综合征.长春中医药大学学报,2008,24(4):435.
    [7]杨亚琴.肝失疏泄辨析[J].浙江中医杂志,2004,(4):142—143
    [8]叶燕萍.女性更年期综合征病机及辨证分型的研究[J].江苏中医,2000,21(8):19
    [9]钱丽旗.姜坤从肝论治更年期综合征经验[J].江苏中医,1999,20(8):5
    [10]李汉明.辨证分型治疗更年期综合征75例[J].湖南中医学院学报,1995,15(2):311.
    [11]杜新平.绝经前后诸证从脾胃论治探微[J].中国医药学报,2004,19(6):363—364
    [12]余庆.脾胃阴火与更年期综合征.福建中医学院学报,1999,9(3):34--36
    [13]谈勇,许小凤,卢苏.绝经前后诸证心肾病机探析[J].南京中医药大学报,2001,17(6):340
    [14]赵建明.调和肝脾法治疗女性更年期综合征62例[J].陕西中医.2002,23(5):406—407
    [15]李郑生.李振华教授治疗脏躁病经验.中医药学刊,2006,24(10):1804
    [16]张晓艳.更年期综合征的中医病因病机探析.长治医学院学报,2008,22(2):139—140
    [17]罗玉君.肾虚肝郁型绝经综合征抑郁焦虑与躯体症状的相关分析.2010.4
    [18]来齐.更年期综合征辨治体会.浙江中医杂志,2009,44(5):350
    [19]刘晓伟,邓虹珠.更年期综合征中医辨治研究进展[J].现代中西医结合杂志,2001,10(8):792.
    [20]闰润虎,刘志诚.女性更年期综合征的中西医认识[J].现代中西医结合杂志,2003,12(13):1442.
    [21]杜惠兰,段彦苍.女性更年期综合征中医研究进展.中华实用中西医杂志,2004,4(17):153—155
    [22]米一鄂.首批国家级名老中医效验秘方精选(续集).北京:今日中医出版社,1999,第1版:333—334
    [23]任婕,王天芳,李力,等.更年期综合征常见中医证候及其症状分布特点的文献分析[J].江苏中医药,2008,40(4):67—70.
    [24]辛意,王天芳,杜彩凤,等.基于经验辨证的更年期综合征围绝经期和绝经后期常见证候及证候要素分布[J].中西医结合学报,2009,7(6):522—526
    [25]郭艳,邹小娟.270例更年期综合征中医证型分析.湖北中医杂志,2009,31(6):28—29.
    [26]申春,张华强,朱雄华,等.400例更年期综合征临床证候辩证标准现场调查分析[J].中国中 西医结合杂志,2004,24(6):517—520.
    [27]关仔锦,李信,张利,等.上海地区绝经期综合征妇女流行病学调查[J].中西医结合学报,2009,7(9):827—830.
    [28]吴金,陈炳海,庄锦珊.不同中医证型围绝经综合征妇女身心症状、抑郁情绪和血清性激素水平差异.中国临床康复,2006,10(19):22—24.
    [29]刘雁峰,李峰.绝经期妇女中医症状、证型特征的调查及分析.北京中医药大学学报,2006,29(1):56—59.
    [30]The North Ameriean Menopause Society. Menopause Core Curriculum Study Guide 1st ed.2002
    [31]Li Y, Yu Q, Ma L, et al. Prevalence of depression and anxiety symptoms and their influence factors during menopausal transition and postmenopause in Beijing city [J]. Maturitas,2008,20;61(3):238-242.
    [32]田丰莲,詹新林,赵请国等.广东地区围绝经期综合征患病状况及其影响因素.中国妇幼保健,2004,19:67—70
    [33]Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints:a randomized trial [J]. Obstet Gynecol,2006,107(2 Pt 1):247-255.
    [34]PedroAO, Pinto-NetoAM, Costa-PaivaLH, etal. Climacteric syndrome:a population-based study in Campinas, SP, Brazil. Rev Saude Publica,2003,37(6):735-42
    [35]Bunpei Ishizuka, Yoshiko Kudo, Toshiro Tango. Cross-sectional community survey of menopause symptoms among Japanese women[J]. Maturitas,2008,61 (3):260-267.
    [36]Grady D. Management of Menopausal Symptoms[J]. N Engl J Med,2006,355:2338-2347.
    [37]Col NF, Fairfield KM, Ewan-Whyte C, et al. In the clinic. Menopause[J].Ann Intern Med,2009,150(7):ITC4-1-ITC4-16.
    [38]Hunter MS, Mann E. A cognitive model of menopausal hot flushes and night sweats[J]. Journal Of Psychosomatic Research,2010,69 (5):491-501.
    [39]OhayonMM. Severe hot flashes are associated with chronic insomnia. Arch Intem Med, 2006:166(12):1262-8
    [40]Bromberger JT, MeyerPM, Kravitz HM, et al. Psychologic distress and natural menopause: a multiethnic community study. Am J Public Health,2001:91:1435-42
    [41]NIH State-of-the-Science Panel. National Institutes of Health State-of-the-Science Conference Statement:Management of Menopause-Related Symptoms. Ann Intern Med. 2005,142:1003—1013.
    [42]Depression. Obstetries & Gynecology,2004,104(4)Supplement:49S"55S
    [43]Deecher D, Andree T H, Sloan D, Schechter L E. From menarche to menopause:Exploring the underlying biology of depression in women experiencing hormonal changes[J]. Psychoneuroendocrinology,2008, (33):3-17.
    [44]Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition:the Harvard study of moods and cycles[J]. Arch Gen Psychiatry,2006,63:385-390.
    [45]Polisseni AF, de Aranjo DA, Polisseni F, et al. Depression andanxiety in menopausal women:assoeiated faetors [J]. Rev Bras Ginecol Obstet.2009,31(3):117-123.
    [46]Silva Filho EA, Costa AM. Evaluation of quality of life of climacteric women assisted at a school hospital of Recife, Pernambuco, Brazil [J]. Rev Bras Ginecol Obstet. 2008,30(3):113-120.
    [47]Syed Abdul Rahman SA, Zainudin SR, Lee Kar Mun V. Assessment of menopausal symptoms using modified Menopause Rating Seale (MRS) among middle age women in Kuehing, Sarawak Malaysia [J]. Asia Pac Fam Med,2010,22:9(z):5.
    [48]罗志莲,朱卫红,李家灵.广州市天河社区更年期妇女健康现状及需求的调查.中华医护杂志,2007,4(6):490—492.
    [49]马丽爽,陈长香,李淑杏,等.女性更年期综合征及抑郁影响因素的研究.中国老年学杂志,2009,29(3):354—355.
    [50]张清学,杨冬梓,干文军,等.妇女更年期症状调查结果分析.中国妇幼保健,2004,11(19):95—98
    [51]Chim H, TanBH, AngCC, et al.The Prevalence of menopausal symptoms in a community in Singapore Maturitas,2002,41(4):275-82
    [52]蔡娱飞.女性更年期症状现况调查与发中元素的测定.中国妇幼保健,2008,23(4):484--485.
    [53]王小莉,徐飚,栾荣生,等.综合医院更年期妇女抑郁焦虑患病情况调查.中国妇幼保健,2007,22(12):1596-1598.
    [54]李旭,白文佩,廖秦平,等.妇科门诊就诊者的抑郁症或(和)焦虑症患病率及妇科医生识别状况调查[J].中国全科医学,2009,12(23):2144—2147.
    [55]曲洪芳,李国海,陈霁等.女性更年期综合征患者人格特征、生殖激素、生活事件及生活质量的对比分析.中国行为医学科学,2006,15(10):893、894
    [56]曹辉珍.妇女更年期症状及与妊娠次数的相关性探讨.中国社会医学杂志,2010,27(3):167
    [57]厉建萍.围绝经期心理障碍的社会心理因素研究山东医学高等专科学校学,2009,31:472
    [58]周志强.季兴.甘怡群等.围绝经期抑郁状态的发生与影响因素临床观察.人民军医,2007,11(50):684、685
    [59]何燕娟,唐款秋,刘玉兰等.负性生活应激事件对农村围绝经期患者心理状况影响的调查分析及护理对策.2010,17(19):194、195
    [60]罗有年,李国荣,张晋碚等.生活事件、人格特征及应付方式在女性围绝经期情绪障碍中的作用.中国行为医学科学,2005,14(5)
    [61]侯敏,唐茂芹.更年期女性心理健康研究进展.国际精神病学杂志,2010,37(1):28-30
    [62]Nosek M, Kennedy HP, Gudmundsdottir M. Silence, stigma, and shame:a postmodern analysis of distress during menopause. ANS Adv Nurs Sci.2010.33(3):E24-36.
    [63]董胜莲,李丹,陈长香等22省(市)女性更年期抑郁现状调查.中国卫生事业管理,2()10(5):347-348
    [64]Freeman EW. Associations of depression with the transition to menopause. Menopause, 2010,17(4):823-7.
    [65]张巧利,李芬,于英等.更年期妇女潮热的相关因素分析.西安交通大学学报(医学版),2010,31(1):106-109
    [66]李庆.工作与否对更年期症状的影响.医学理论与实践,2010,23(5):610
    [67]黄卉,陈长香,李淑杏等.工作对女性更年期综合征的影响程度.中国妇幼保健,2010,25:985
    [68]曹书密.围绝经期妇女抑郁症相关因素分析.中国中医药现代远程教育,2009,7.(11):250
    [69]吴庆文,陈长香,李建民等.女性更年期综合征影响因素分析.中国公共卫生,2010,26(5):517
    [70]程颖莲,莫端豪,练坚贞.社区妇女围绝经期综合征流行病学调查.中国妇幼保健,2007,22:2110
    [71]王庆华.方秀新.郝玉玲等.围绝经期妇女生活质量与心理状况的相关研究.解放军护理杂志,2008,25(9B):208
    [72]李颖,郁琦,马良坤等.围绝经期妇女社会支持状况及与抑郁、焦虑症状的关系.中国妇产科科临床杂志,2009,10(2):116-118
    [73]谢萍.围绝经期妇女焦虑状态及其影响因素的研究.护理实践与研究,2009,6(23):1-3
    [74]王莉,下雅楠.围绝经期和绝经后期妇女的生存质量及其与Kupperman评分的相关性.中国老年学杂志,2011,15(31):2942
    [75]李艳华,危秀青,郑巧玲等.妇女围绝经期综合征发生率及相关因素的调查.海峡预防医学杂志,2006,12(4):68
    [76]陈志伟,赵春梅,王小云.影响更年期妇女健康状态的相关因素.中国妇幼保健,2011,7(26):1098
    [77]Feld J, Halbreich U, Karkun S. The association of perimenopausal mood disorders with other reproductive-related disorders. CNS Spectr,2005,10(6):461-70.
    [78]成芳平,杨洪艳,王小云.绝经综合征流行病学研究及治疗进展.广东医学,2005,26(1):122-123
    [79]下海英.顺义区医院妇女围绝经期综合征与影响因素的流行病学调查研究.中国民族民间医药.
    [80]刘格.绝经综合征评定量表与KI、更年期生存质量量表的比较研究.2008,4.
    [81]黎霄羽.更年期综合征五脏心身症状特征及其相关性分析.2010.5.
    [82]吴玉欢.佛山市顺德区女性医务工作者更年期健康状态调查分析[J].中国医疗前言,2008, 3(23):111—112.
    [83]张清学,杨冬梓,王文军,等.妇女更年期症状调查结果分析[J].中国妇幼保健,2004,13(11):95—98
    [84]邓小虹,张淞文.北京地区围绝经期妇女健康状况的流行病学调查[J].北京医学,2000,24(4):235—238.
    [85]李艳华,危秀青,郑巧玲,等.妇女围绝经期综合征发生率及相关因素的调查[J].海峡预防医学杂志,2006,12(4):68—69.
    [86]刘莹,陆秀英.佛山市社区妇女围绝经期健康现状及需求的调查[J].中国妇幼保健,2007,22(35):5022—5024
    [87]梁雪琼.更年期妇女心理健康状况现状调查.当代医学,2011,17(2):42
    [88]李文静.更年期综合征女性情志障碍的调查研究.2008.4.

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