女性生存质量、衰老征象及衰老机制研究

【作者】 石作荣；

【导师】 郑洪新；

【作者基本信息】 辽宁中医药大学 ， 中医基础理论， 2010， 博士

【摘要】 目的:以《内经》“天癸”理论为指导,调查不同年龄阶段女性生存质量、衰老征象,为“肾藏精”藏象理论及肾虚与衰老的相关性研究提供一定的临床依据;制定女性衰老的中医测量量表,寻找衰老进程中促性腺激素-性激素-性激素受体表达的变化,以探求女性衰老的现代生物学表征机制;了解衰老对女性生活质量的影响,并针对女性特点探索防老抗衰的中医策略,以提高女性群体的生活品质,促进社会健康和谐发展。方法:以传统中医基本理论和实践经验为基础,选取山东省不同地区、不同年龄阶段女性群体为研究对象,运用临床流行病学方法,采用世界卫生组织生存质量测定简表(WHOQOL-BREF)和自制的女性衰老中医测量量表,调查与评估女子以七为基数递进的壮盛-渐衰-衰老进程及阶段特点;在此基础上,结合现代医学研究进展,采用酶联免疫、流式细胞仪免疫荧光法、彩色多普勒超声等方法,测定不同年龄阶段女性血清E2、FSH、INHB水平、外周血白细胞ER-β的表达以及卵巢体积、早卵泡期窦卵泡数目、卵巢间质血流等情况,探求女性衰老的现代生物学表征机制;并根据女性的心理、生理、病理特点,制定相应的防老抗衰中医策略。结果:1、生存质量调查结果显示,随着年龄增长,女性生理领域及心理领域得分下降,对健康状况的主观评价也逐渐降低;学历、职业、婚姻状况、生育子女数以及慢性疾病等因素对女性生存质量产生较大影响;心身疾患、各种慢性疾病、负性生活事件、恶劣生活环境以及社会关系,严重影响着女性寿命和生活质量。2、不同年龄阶段女性五脏系衰老研究结果显示,在女性衰老过程中,心、肝、脾、肺、肾五脏系同时发生增龄性衰老;肾系的得分均数在各个年龄阶段均处于最高水平,到衰退期达到顶峰;在五脏系当中,按均数大小排列,排在肾系之后的依次为脾系、肺系、心系、肝系。3、与壮盛期(21～35岁)及渐衰期(36～49岁)女性相比,衰退期(50～63岁,相当于《内经》七七以上)女性血清E2水平显著降低,FSH浓度明显升高;壮盛期血清INHB浓度最高,渐衰期出现下降趋势,衰退期则明显降低;女性外周血白细胞ER-β表达在壮盛期到渐衰期呈逐渐增高趋势,渐衰期后随着年龄的继续增长,ER-β的表达逐渐降低,至衰退期达到最低值。4、女性由壮盛期至渐衰期,卵巢体积、卵巢动脉血流速度明显下降,窦卵泡数目、卵巢动脉血流搏动指数、阻力指数变化不明显;进入衰退期后,卵巢体积、窦卵泡数目、卵巢动脉血流速度均明显下降,卵巢动脉血流搏动指数、阻力指数呈现显著升高。结论:1、女性生存质量受到年龄、学历、职业、婚姻状况、生育子女数以及慢性疾病等因素影响。良好的身体机能、心理状态、生活环境以及社会关系,必然会延长寿命、颐养天年;相反,心身疾患、各种慢性疾病、负性生活事件、恶劣生活环境以及社会关系,都将严重影响女性寿命和生活质量。2、肾气虚衰是女性衰老的主导因素,五脏并衰是女性衰老过程的共同特点,多因素共同影响是诱导或加速女性衰老的重要原因。3、女性衰老确有其独特表征,与《内经》“天癸”理论的时间阶段性变化特点基本相吻合,其生物学机制与促性腺激素-性激素-性激素受体表达的变化密切相关。4、女性衰老进程与体内激素水平、卵巢动脉血流、卵巢储备功能变化关系密切。5、未老先防、平衡阴阳、调和气血是延缓女性衰老的重要原则。6、调补五脏、生活有节、七情调和、防治结合是延缓女性衰老的主要方法。更多还原

【Abstract】 Purpose:To investigate the quality of life and aging signs of women at different age stages under the guidance of the Tiangui theory in Huangdi’s Inner Cannon and offer certain clinical basis for the research about viscera-state doctrine of essence stored in the kidney and the study on the relation between kidney deficiency and aging; to develop TCM measurement scale for female aging and find the changes of gonadotropic hormone-sex hormones-sex hormone receptors in the aging process in order to explore the modern biological mechanism of the female aging; and to understand the effects of aging on the life quality of women, and explore the TCM strategies for preventing and delaying female aging to improve the life quality of women and promote the harmonious development of the society.Methods:To select different groups of women of different age stages from different parts of Shandong province for study, and to investigate and assess the female strong- gradually aging-aging process with 7 as the base and features of different stages with the methods of clinical epidemiology and with the World Health Organization Quality of Life Brief Form (WHOQOL-BREF) and self-made medicine TCM measurement scale for female aging on the basis of TCM basic theories and practice; based on this and with the combination of the progress of modern medical research, to measure the level of E2, FSH and INHB of the women at different age stages and ER-βexpression in peripheral blood leukocytes, and ovarian volume, follicular amounts at early follicular phase and the blood flow of ovarian artery using ELISA, flow cytometer immunofluorescence technique and Color Doppler Flow Imaging methods, to explore the modern biological mechanism of the female aging and determine the appropriate strategies for preventing and delaying aging in accordance with psychological, physiological and pathological features of women.Results:1. The survey about the life quality shows that the score in the women’s physical and psychological domain decreases with age and their assessment of health status also gradually decreases; education, occupation, marital status, number of children, chronic diseases and other factors greatly influence the life quality of women; and psychosomatic disorders, various chronic diseases, negative life events, poor living conditions and social relations have a serious impact on female life expectancy and quality of life.2. The study of the aging of the five organ systems of the women at different age stages showed that in the female aging process, the five organ systems of heart, liver, spleen, lung, kidney simultaneously deteriorate with age; the average score of kidney system is at the highest level at various reproductive stages and goes to the peak at the recession period; in the five organ systems, after the kidney system were the spleen system, lung system, heart system and liver system according to their average scores.3. Compared with the women at their most vigorous period (21 to 35 years) and the gradually declining period (36 to 49 years), the women at their recession period(50 to 63 years) have significantly decreased serum E2 levels and significantly increased FSH levels; the women at their most vigorous period have the highest INHB density, those at their gradually declining period have a gradually declining trend and those at their recession period have a significant decrease; women’s ER-βexpression in peripheral blood leukocytes shows the trend of gradual increase from their most vigorous period to their gradually declining period, it gradually decreases after their gradually declining period and goes to the lowest at their recession period.4. From the most vigorous period to the gradually declining period, ovarian volume and the velocity of ovarian blood flow are significantly descending. There are no changes in the follicular amounts, pulsatility index and resistent index of ovarian blood flow. At the recession period, the women have significantly decreased at ovarian volume, follicular amounts and the velocity of ovarian blood flow, increased at the pulsatility index and resistent index of ovarian blood flow.Conclusion:1. The life quality of women is influenced by age, education, occupation, marital status, number of children and chronic diseases and other factors. Good physical condition, psychological state, living environment and social relations will inevitably extend the life ; on the contrary, psychosomatic disorders, various chronic diseases, negative life events, poor living conditions and social relations, will seriously affect the female life expectancy and quality of life.2. Deficiency of kidney qi is the dominant factor of female aging, the deterioration of all the five internal organs is a common feature of women’s aging process, and the influence of many factors is one of the important reasons to induce or accelerate the women’s aging.3. Female aging does have its unique representation, basically matches the changing features of different stages in the Tiangui theory, and its biological mechanism is closely related to the gonadotropic hormone-sex hormones-sex hormone receptors expression.4. Female aging process is closely related to the levels of hormones, the blood flow of ovarian artery and the storage function of ovary.5. Preventing aging before becoming old, keeping balance of yin and yang and regulating qi and blood are the important principles of delaying female aging.6. Regulating and tonifying the five internal organs, regularizing life activities, harmonizing seven emotions and combining prevention and treatment are the main methods of delaying female aging.更多还原