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Article(id=1241022944860763018, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410521, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1730304000000, receivedDateStr=2024-10-31, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812527146, onlineDateStr=2026-03-18, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812527146, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812527146, creator=13701087609, updateTime=1773812527146, updator=13701087609, issue=Issue{id=1241022939957621542, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812525976, creator=13701087609, updateTime=1773815469296, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035285174219432, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035285174219433, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1069, endPage=1073, ext={EN=ArticleExt(id=1241022945636709288, articleId=1241022944860763018, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between cardiovascular health and depression in postmenopausal women: a cross-sectional study based on NHANES, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between cardiovascular health (CVH) and depression in postmenopausal women.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018, logistic regression analysis was conducted to examine the association between CVH and depression in postmenopausal women. Restricted cubic spline (RCS) models were employed to reveal potential nonlinear associations between the two.

Results

After adjusting the covariates, the risk of depression was significantly reduced in the moderate and high CVH groups (OR=0.50, 95% CI: 0.34-0.72; OR=0.25, 95% CI: 0.07-0.90). A significant nonlinear association was also observed between CVH and depression (P-overall<0.001, P-nonlinear<0.001). Subgroup analysis results showed a significant negative association between high levels of CVH and depression among 18 to 59 years of age (OR=0.12, 95% CI: 0.02-0.55), non-Hispanic blacks (OR=0, 95% CI: 0.00-0.00), other races (OR=0.14, 95% CI: 0.04-0.55), below high school (OR=0.06, 95% CI: 0.01-0.33), above high school (OR=0.12, 95% CI: 0.02-0.89), married/cohabiting (OR=0.06, 95% CI: 0.01-0.25), overweight/obese (OR=0.06, 95% CI: 0.02-0.21), and non-users of hormone replacement therapy (OR=0.12, 95% CI: 0.04-0.42).

Conclusion

A significant negative correlation exists between CVH levels and the risk of depression in postmenopausal women. This underscores the importance of CVH in the mental health of postmenopausal women. Healthcare providers should prioritize the potential psychological impact of CVH on postmenopausal women and incorporate it into comprehensive strategies for depression prevention and intervention.

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目的

探究绝经后女性心血管健康(cardiovascular health, CVH)与抑郁症之间的关联。

方法

基于2007—2018年美国国家健康与营养调查(National Health and Nutrition Examination Survey, NHANES)数据，采用logistic回归分析绝经后女性CVH与抑郁症之间的关系，采用限制性立方样条(RCS)模型揭示二者潜在的非线性关联。

结果

调整协变量后，中等和高等水平CVH组患抑郁症的风险显著降低(OR=0.50, 95% CI: 0.34~0.72; OR=0.25, 95% CI: 0.07~0.90)，并且二者之间存在显著的非线性关联(P-overall<0.001, P-nonlinear<0.001)。亚组分析结果显示，在18~59岁(OR=0.12, 95% CI: 0.02~0.55)、非西班牙裔黑人(OR=0, 95% CI: 0.00~0.00)、其他种族(OR=0.14, 95% CI: 0.04~0.55)、高中以下(OR=0.06, 95% CI: 0.01~0.33)、高中以上(OR=0.12, 95% CI: 0.02~0.89)、已婚/同居(OR=0.06, 95% CI: 0.01~0.25)、超重/肥胖(OR=0.06, 95% CI: 0.02~0.21)和未使用激素替代疗法(OR=0.12, 95% CI: 0.04~0.42)的组别中，高水平CVH与抑郁症之间存在显著负相关。

结论

绝经后女性的CVH水平与抑郁症的发病风险呈显著的负相关，强调了CVH在绝经后女性心理健康中的重要性。因此，医疗保健人员应重视CVH对绝经后女性潜在的心理影响，并将其纳入抑郁症预防和干预的综合策略中。

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朱艳华，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=12QBKhtke1wtfCQIe75A5A==, magXml=ocfDWq5qBpPdlz/cp1pr/Q==, pdfUrl=null, pdf=NtfHWRWWXdnQ22A1oizXCA==, pdfFileSize=876811, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=fGDkHoH2PbYa2QwqofYL/Q==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=x5FTTDxkc7e9RflbAVskyg==, mapNumber=null, authorCompany=null, fund=null, authors=

朱艳芝（1985—），女，硕士在读，主管护师，研究方向：疾病预防与护理

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Journal of Clinical Medicine, 2024, 13(5): 1443., articleTitle=Hormone replacement therapy in Post-Menopause Hormone-Dependent gynecological cancer patients: a narrative review, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241022951777169645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, xref=1．, ext=[AuthorCompanyExt(id=1241022951789752560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, companyId=1241022951777169645, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Otolaryngology Ward Ⅱ, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China), AuthorCompanyExt(id=1241022951798141169, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, companyId=1241022951777169645, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1．山东第一医科大学附属省立医院耳鼻喉科二病区，山东　济南　250021)]), AuthorCompany(id=1241022951953330427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, xref=2．, ext=[AuthorCompanyExt(id=1241022951970107646, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, companyId=1241022951953330427, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2．山东第一医科大学附属省立医院妇科一病房)]), AuthorCompany(id=1241022952116908301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, xref=3．, ext=[AuthorCompanyExt(id=1241022952133685517, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, companyId=1241022952116908301, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3．山东第一医科大学附属省立医院东院重症医学科)])], figs=[ArticleFig(id=1241022955757564402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=EN, label=Fig.1, caption=Flow chart of participant screening, figureFileSmall=lMja5Bn7iCZ1K102ixbmyA==, figureFileBig=fGDkHoH2PbYa2QwqofYL/Q==, tableContent=null), ArticleFig(id=1241022955891782140, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=CN, label=图1, caption=参与者的筛选流程图, figureFileSmall=lMja5Bn7iCZ1K102ixbmyA==, figureFileBig=fGDkHoH2PbYa2QwqofYL/Q==, tableContent=null), ArticleFig(id=1241022956286046747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=EN, label=Fig.2, caption=Subgroup analysis of the CVH and depression in postmenopausal women, figureFileSmall=DXA8Qve4SWyGYWH17szVlg==, figureFileBig=MuydpcrVH1Y2Y9/qWihdXg==, tableContent=null), ArticleFig(id=1241022956399292966, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=CN, label=图2, caption=绝经后女性CVH与抑郁关系的亚组分析, figureFileSmall=DXA8Qve4SWyGYWH17szVlg==, figureFileBig=MuydpcrVH1Y2Y9/qWihdXg==, tableContent=null), ArticleFig(id=1241022956588036660, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=EN, label=Fig.3, caption=Dose-response relationship between CVH and risk of depression in postmenopausal women after adjusting for all covariates, figureFileSmall=2cT75mHDiiqC4TBRDkEPWw==, figureFileBig=IQpUn25v3a6q9/ojd/Y1PA==, tableContent=null), ArticleFig(id=1241022956768391750, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=CN, label=图3, caption=调整所有协变量后绝经后女性CVH与抑郁症患病风险的剂量-反应关系, figureFileSmall=2cT75mHDiiqC4TBRDkEPWw==, figureFileBig=IQpUn25v3a6q9/ojd/Y1PA==, tableContent=null), ArticleFig(id=1241022956885832274, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=EN, label=Table 1, caption=

Comparison of general characteristics between non-depressed and depressed participants

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计(n=3 702)非抑郁(n=3 270)抑郁(n=432)t/χ2值P值
年龄(岁，)62.81±0.2363.21±0.2459.45±0.62-5.733<0.001
种族[n(%)]7.3270.001
非西班牙裔白人1 811(76)1 603(77)208(67)
非西班牙裔黑人756(8.9)674(8.8)82(10)
其他1 135(15)993(14)142(23)
教育程度[n(%)]15.012<0.001
高中以下775(13)636(12)139(24)
高中2 132(59)1 885(59)247(62)
高中以上795(27)749(29)46(14)
婚姻状况[n(%)]10.6260.002
已婚/同居1 900(60)1 717(61)183(49)
其他1 802(40)1 553(39)249(51)
贫困收入比()3.15±0.063.28±0.072.05±0.14-8.471<0.001
吸烟[n(%)]22.987<0.001
是1 492(41)1 247(39)245(59)
否2 210(59)2 023(61)187(41)
饮酒量(g/天，)5.88±0.505.93±0.505.46±1.76-1.7700.094
BMI[n(%)]4.0760.046
正常体重/体重不足819(25)754(26)65(17)
超重/肥胖2 883(75)2 516(74)367(83)
总体力活动(METs-h/d，)8.45±0.408.61±0.397.15±0.92-0.2600.796
流产次数(次，)0.64±0.030.60±0.031.00±0.103.669<0.001
激素替代疗法[n(%)]0.1650.700
是1 422(44)1 259(44)163(45)
否2 280(56)2 011(56)269(55)
绝经年龄(岁，)45.39±0.2145.82±0.2041.80±0.83-4.693<0.001
LE8得分()64.50±0.4465.77±0.4753.83±1.06<0.001
CVH[n(%)]18.594<0.001
高CVH408(15)396(16)12(4.3)
中CVH2 605(70)2 356(71)249(59)
低CVH689(15)518(13)171(36)
), ArticleFig(id=1241022957061993053, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=CN, label=表1, caption=

非抑郁与抑郁人群的一般特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计(n=3 702)非抑郁(n=3 270)抑郁(n=432)t/χ2值P值
年龄(岁，)62.81±0.2363.21±0.2459.45±0.62-5.733<0.001
种族[n(%)]7.3270.001
非西班牙裔白人1 811(76)1 603(77)208(67)
非西班牙裔黑人756(8.9)674(8.8)82(10)
其他1 135(15)993(14)142(23)
教育程度[n(%)]15.012<0.001
高中以下775(13)636(12)139(24)
高中2 132(59)1 885(59)247(62)
高中以上795(27)749(29)46(14)
婚姻状况[n(%)]10.6260.002
已婚/同居1 900(60)1 717(61)183(49)
其他1 802(40)1 553(39)249(51)
贫困收入比()3.15±0.063.28±0.072.05±0.14-8.471<0.001
吸烟[n(%)]22.987<0.001
是1 492(41)1 247(39)245(59)
否2 210(59)2 023(61)187(41)
饮酒量(g/天，)5.88±0.505.93±0.505.46±1.76-1.7700.094
BMI[n(%)]4.0760.046
正常体重/体重不足819(25)754(26)65(17)
超重/肥胖2 883(75)2 516(74)367(83)
总体力活动(METs-h/d，)8.45±0.408.61±0.397.15±0.92-0.2600.796
流产次数(次，)0.64±0.030.60±0.031.00±0.103.669<0.001
激素替代疗法[n(%)]0.1650.700
是1 422(44)1 259(44)163(45)
否2 280(56)2 011(56)269(55)
绝经年龄(岁，)45.39±0.2145.82±0.2041.80±0.83-4.693<0.001
LE8得分()64.50±0.4465.77±0.4753.83±1.06<0.001
CVH[n(%)]18.594<0.001
高CVH408(15)396(16)12(4.3)
中CVH2 605(70)2 356(71)249(59)
低CVH689(15)518(13)171(36)
), ArticleFig(id=1241022957179433572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=EN, label=Table 2, caption=

Association between CVH and depression in postmenopausal women

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1a模型2b模型3c
OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值
CVH (连续变量)0.94(0.93~0.95)<0.0010.95(0.93~0.96)<0.0010.96(0.94~0.97)<0.001
CVH (分类变量)
低1.001.001.00
中0.30(0.21~0.42)<0.0010.35(0.25~0.49)<0.0010.50 (0.34~0.72)<0.001
高0.09(0.03~0.34)<0.0010.13(0.03~0.51)0.0040.25(0.07~0.90)0.034
), ArticleFig(id=1241022957280096879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022944860763018, language=CN, label=表2, caption=

绝经后女性CVH与抑郁症之间的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1a模型2b模型3c
OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值
CVH (连续变量)0.94(0.93~0.95)<0.0010.95(0.93~0.96)<0.0010.96(0.94~0.97)<0.001
CVH (分类变量)
低1.001.001.00
中0.30(0.21~0.42)<0.0010.35(0.25~0.49)<0.0010.50 (0.34~0.72)<0.001
高0.09(0.03~0.34)<0.0010.13(0.03~0.51)0.0040.25(0.07~0.90)0.034
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绝经后女性心血管健康与抑郁症的关系：基于NHANES的横断面研究
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朱艳芝 1 , 柳颖颖 2 , 朱艳华 3
现代预防医学 | 儿少卫生与妇幼保健 2025,52(6): 1069-1073
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(6): 1069-1073
绝经后女性心血管健康与抑郁症的关系：基于NHANES的横断面研究
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朱艳芝1, 柳颖颖2, 朱艳华3
作者信息
  • 1．山东第一医科大学附属省立医院耳鼻喉科二病区，山东　济南　250021
  • 2．山东第一医科大学附属省立医院妇科一病房
  • 3．山东第一医科大学附属省立医院东院重症医学科

    • 朱艳芝（1985—），女，硕士在读，主管护师，研究方向：疾病预防与护理

通讯作者:

朱艳华，E-mail：
Association between cardiovascular health and depression in postmenopausal women: a cross-sectional study based on NHANES
Yan-zhi ZHU1, Ying-ying LIU2, Yan-hua ZHU3
Affiliations
  • Department of Otolaryngology Ward Ⅱ, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
出版时间: 2025-03-25 doi: 10.20043/j.cnki.MPM.202410521
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摘要
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目的

探究绝经后女性心血管健康(cardiovascular health, CVH)与抑郁症之间的关联。

方法

基于2007—2018年美国国家健康与营养调查(National Health and Nutrition Examination Survey, NHANES)数据，采用logistic回归分析绝经后女性CVH与抑郁症之间的关系，采用限制性立方样条(RCS)模型揭示二者潜在的非线性关联。

结果

调整协变量后，中等和高等水平CVH组患抑郁症的风险显著降低(OR=0.50, 95% CI: 0.34~0.72; OR=0.25, 95% CI: 0.07~0.90)，并且二者之间存在显著的非线性关联(P-overall<0.001, P-nonlinear<0.001)。亚组分析结果显示，在18~59岁(OR=0.12, 95% CI: 0.02~0.55)、非西班牙裔黑人(OR=0, 95% CI: 0.00~0.00)、其他种族(OR=0.14, 95% CI: 0.04~0.55)、高中以下(OR=0.06, 95% CI: 0.01~0.33)、高中以上(OR=0.12, 95% CI: 0.02~0.89)、已婚/同居(OR=0.06, 95% CI: 0.01~0.25)、超重/肥胖(OR=0.06, 95% CI: 0.02~0.21)和未使用激素替代疗法(OR=0.12, 95% CI: 0.04~0.42)的组别中，高水平CVH与抑郁症之间存在显著负相关。

结论

绝经后女性的CVH水平与抑郁症的发病风险呈显著的负相关，强调了CVH在绝经后女性心理健康中的重要性。因此，医疗保健人员应重视CVH对绝经后女性潜在的心理影响，并将其纳入抑郁症预防和干预的综合策略中。

心血管健康  /  生命八要素  /  抑郁症  /  绝经后女性
Objective

To explore the relationship between cardiovascular health (CVH) and depression in postmenopausal women.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018, logistic regression analysis was conducted to examine the association between CVH and depression in postmenopausal women. Restricted cubic spline (RCS) models were employed to reveal potential nonlinear associations between the two.

Results

After adjusting the covariates, the risk of depression was significantly reduced in the moderate and high CVH groups (OR=0.50, 95% CI: 0.34-0.72; OR=0.25, 95% CI: 0.07-0.90). A significant nonlinear association was also observed between CVH and depression (P-overall<0.001, P-nonlinear<0.001). Subgroup analysis results showed a significant negative association between high levels of CVH and depression among 18 to 59 years of age (OR=0.12, 95% CI: 0.02-0.55), non-Hispanic blacks (OR=0, 95% CI: 0.00-0.00), other races (OR=0.14, 95% CI: 0.04-0.55), below high school (OR=0.06, 95% CI: 0.01-0.33), above high school (OR=0.12, 95% CI: 0.02-0.89), married/cohabiting (OR=0.06, 95% CI: 0.01-0.25), overweight/obese (OR=0.06, 95% CI: 0.02-0.21), and non-users of hormone replacement therapy (OR=0.12, 95% CI: 0.04-0.42).

Conclusion

A significant negative correlation exists between CVH levels and the risk of depression in postmenopausal women. This underscores the importance of CVH in the mental health of postmenopausal women. Healthcare providers should prioritize the potential psychological impact of CVH on postmenopausal women and incorporate it into comprehensive strategies for depression prevention and intervention.

Cardiovascular health  /  Life's Essential 8  /  Depression  /  Postmenopausal women
朱艳芝, 柳颖颖, 朱艳华. 绝经后女性心血管健康与抑郁症的关系：基于NHANES的横断面研究. 现代预防医学, 2025 , 52 (6) : 1069 -1073 . DOI: 10.20043/j.cnki.MPM.202410521
Yan-zhi ZHU, Ying-ying LIU, Yan-hua ZHU. Association between cardiovascular health and depression in postmenopausal women: a cross-sectional study based on NHANES[J]. Modern Preventive Medicine, 2025 , 52 (6) : 1069 -1073 . DOI: 10.20043/j.cnki.MPM.202410521
正文
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抑郁症作为全球范围内一个重大的公共卫生问题，以其情绪低落、兴趣缺失及精力与注意力减退等核心症状，深刻影响着患者的身心健康[1]。女性抑郁症的发病风险显著高于男性，约有20%的美国女性患有抑郁症，而在绝经后阶段，这一风险进一步攀升[2-3]，可能归因于绝经后特有的关系困扰、社会支持网络薄弱、肥胖以及性激素水平的剧烈波动等多重因素的作用[2,4]。抑郁症不仅严重干扰了绝经后女性的日常生活功能，还极大地削弱了其社会心理适应能力，降低了整体生活质量，甚至导致自杀行为的发生[5]，因此，针对绝经后女性抑郁症的有效预防策略显得尤为重要。
心血管疾病（cardiovascular disease，CVD）与抑郁症之间的密切联系，在临床实践中日益受到重视。研究表明，CVD患者并发抑郁症的比例显著增高[6]。在CVD高风险个体中，抑郁症与全因死亡率之间存在正相关关系[7]，进一步凸显了维护良好的心血管健康（cardiovascular health，CVH）对抑郁症预防与治疗的重要性。美国心脏协会最新引入了生命八要素（Life’s Essential 8，LE8）作为评估CVH的新工具，相较于2010年的生命七要素（Life’s Essential 7，LE7），LE8新增了睡眠健康这一维度，更能全面地反映个体的CVH状态[8]。然而，目前尚未有研究聚焦于绝经后女性群体来探讨LE8评估的CVH与抑郁症之间的潜在关联。因此，本研究旨在分析绝经后女性CVH与抑郁症之间的关系，以期为绝经后女性抑郁症的预防提供科学依据与实践指导。
1　对象与方法
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1.1　研究人群
采用美国国家健康与营养调查(National Health and Nutrition Examination Survey, NHANES)数据，选取2007—2018年的女性作为研究对象，排除标准：①绝经前或缺少绝经相关信息；②年龄<18岁；③缺少CVH、抑郁以及协变量信息。筛选过程见图1。
1.2　绝经的评价标准
使用NHANES生殖健康调查问卷中的两项问题进行界定：①“您在过去12个月内是否至少有一次月经”；②“您在过去12个月内没有来月经的原因是什么”。若第一个问题回答“否”，第二个问题回答“更年期/子宫切除术”，则判定该受试者为绝经状态[9]。
1.3　心血管健康的测量
采用LE8评分体系量化CVH，综合考量了八大健康维度，包括四个健康行为指标（饮食、体力活动、尼古丁暴露及睡眠）与四个健康因素指标（体重指数、血压、血糖及非高密度脂蛋白胆固醇）[8]。饮食评估使用健康饮食指数-2015（HEI-2015）作为评价标准，基于美国农业部提供的食物模式等效数据，并结合个体的饮食摄入量数据综合计算得出[10]。采用标准化的问卷收集体力活动、尼古丁暴露情况及睡眠时间信息。血压、血糖在移动体检中心采集，体重指数（Body Mass Index, BMI）的计算方法为体重（千克）除以身高（米）的平方。非高密度脂蛋白胆固醇通过总胆固醇减去高密度脂蛋白胆固醇计算得出。每个健康维度的得分范围为0~100，通过对八个维度得分进行未加权平均计算得出最终LE8总分。根据美国心脏协会的标准，将LE8评分分为三个等级：LE8总分≥80分代表高水平CVH，50~79分表示中等水平CVH，而<50分为低水平CVH[8]。
1.4　抑郁的测量
使用病人健康问卷抑郁量表（Patient Health Questionnaire-9 Item, PHQ-9）进行抑郁症诊断，包括9个条目，旨在评估过去两周内个体经历的抑郁症状[11]。总分超过10分的个体被确定患有抑郁症[1]。PHQ-9用于抑郁患者的Cronbach’α系数为0.765~0.938，具有良好的信效度和准确性[12]。
1.5　协变量
根据既往文献确定了潜在的协变量[1]，包括年龄、种族、教育程度、婚姻状况、贫困收入比、吸烟、饮酒量、BMI、总体力活动、流产次数、激素替代疗法和绝经年龄。
1.6　统计分析
连续变量使用平均值和标准误描述，分类变量使用频数和百分比描述，通过卡方检验评估组间差异。在主要分析中，采用logistic回归分析评估绝经后女性CVH与抑郁症的关系。模型1未进行调整，模型2对年龄、种族、教育程度进行调整，模型3对所有协变量进行调整。通过亚组分析进一步探讨不同协变量组中绝经后女性CVH与抑郁症之间的关系。此外，限制性立方样条（RCS）被用来评估二者之间的非线性关联。基于赤池信息准则（AIC）最优性原则选择三个节点进行曲线拟合。最后通过2007—2016年的数据进行敏感性分析，以验证结果的稳健性。所有统计分析均使用R软件（4.3.1版本）进行，双侧检验水准α=0.05。
2　结果
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2.1　抑郁检出情况
共纳入3 702名绝经后女性参与者，平均年龄为62.81岁，其中有抑郁症患者432名，检出率11.67%。非抑郁组与抑郁组的CVH水平分布差异有统计学意义。见表1。
2.2　CVH与抑郁症患病风险的logistic分析
未调整的模型1显示，以低水平CVH组为参照组，中等和高等水平CVH组患抑郁症的风险均降低(OR=0.30, 95% CI: 0.21~0.42; OR=0.09, 95% CI: 0.03~0.34)，在调整所有协变量后，关系仍然成立，详见表2。
2.3　亚组分析
18~59岁、非西班牙裔黑人、其他种族、高中以下、高中以上、已婚、超重/肥胖和未使用激素替代疗法的人群高CVH与绝经后女性抑郁症呈显著负相关。详见图2。
2.4　绝经后女性CVH与抑郁症的非线性关联
在调整所有协变量后，绝经后女性CVH与抑郁症之间存在显著的非线性关联(P-overall<0.001, P-non-linearity <0.001)。平滑曲线拟合结果见图3。
2.5　敏感性分析
采用2007—2016年数据进行敏感性分析，结果表明，以低水平CVH组为参照组，中等和高等水平CVH组患抑郁症的风险均降低(OR=0.49, 95% CI: 0.33~0.73; OR=0.26, 95% CI: 0.07~0.96)，与之前保持一致，将CVH作为连续变量分析结果也相同，验证了结论的稳健性。
3　讨论
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受卵巢功能衰退的影响，绝经后女性所面临的下丘脑-垂体-卵巢轴性激素反馈系统的功能紊乱，导致雌激素水平下降，进而出现多种神经心理症状。抑郁症作为这一时期的常见心理并发症，其早期识别与预防成为预防医学领域的重要内容。
本研究发现，绝经后女性较高水平CVH与抑郁症患病风险呈负相关，与先前研究结论一致，其他研究[13-15]同样发现了CVH与抑郁症之间的负向关联，其潜在机制可能包括：身体成分作为CVH的核心要素之一，其改变可能与绝经后女性的抑郁发生密切相关，绝经后女性的体脂分布变化及腹部肥胖增加，导致炎症生物标志物水平上升[16]，而促炎细胞因子通过影响神经递质代谢，进而对情绪及心理健康产生不利影响[17-18]。此外，氧化应激作为CVD与抑郁症的共同风险因素，其特征是活性氧（ROS）与抗氧化防御系统失衡，不仅促进CVD中的内皮损伤及动脉粥样硬化，还与抑郁症相关的神经生物学变化紧密相关[19]。健康饮食对大脑功能的改善及心理健康的支持作用显著[20]；体育活动不仅促进社会关系，增加社会支持，还有助于缓解心理压力，改善抑郁症状[21]，相反，身体活动不足与炎症标志物CRP水平升高相关联，可能通过慢性炎症反应途径诱发抑郁症[22]；睡眠质量不佳导致大脑去甲肾上腺素及5-羟色胺水平下降，进而增加抑郁风险[23]；长期尼古丁暴露则通过干扰下丘脑-垂体-肾上腺轴功能，导致皮质醇过度分泌，影响单胺类神经递质系统活性[24]。
亚组分析结果揭示了绝经后女性CVH与抑郁症之间关系的人群异质性。在18~59岁的绝经后女性中，高CVH组抑郁症风险较低，提示在相对低龄的绝经后女性中，心血管健康与抑郁的关联更为突出，强调了在整个成年期中维护心血管健康可能对缓解或预防抑郁情绪具有积极作用，尤其是在女性经历生理和社会角色转变的关键时期，与既往结论一致[25]。已婚绝经后女性处于高水平CVH时表现出更低的抑郁风险，这可能与社会支持网络的增强有关。婚姻作为一种社会支持形式，通过提供情感支持和共同应对生活压力，增强了CVH对精神健康的正面效应，支持了既往研究结果[26]。尽管肥胖通常与多种健康问题相关，但在这些女性中，高水平CVH也与较低的抑郁风险相关，这可能因为她们伴有胰岛素抵抗等代谢异常，会积极采取措施改善CVH，避免了因代谢异常导致大脑神经递质平衡失调而影响的情绪调节[27]。因此，强调了在不利条件下，通过改善CVH仍有可能获得精神健康上的益处。激素替代疗法是一种通过补充外源性激素来缓解绝经后女性不适症状的治疗方法[28]，本研究发现在未使用激素替代疗法的绝经后女性中，高水平CVH与抑郁症的负相关关系更为显著，因此，对于某些绝经后女性而言，自然维持或改善心血管健康可能比依赖药物干预更能有效预防抑郁症状。此外，本研究聚焦于绝经后女性心血管健康与抑郁症之间的关联，剂量-反应分析（采用限制性立方样条）揭示，LE8评分与抑郁症之间存在非线性负相关关系，表明LE8评分的提升有助于降低抑郁症的发病风险，分析结果显示存在阈值效应，即当LE8评分保持在60分以上时，可显著降低抑郁症的风险，这进一步强调了绝经后女性维持良好心血管健康水平对于改善抑郁症症状的重要性。
本研究存在一定的局限性。受横断面研究设计的限制，无法确立因果关系；使用自我报告的 PHQ-9 来评估抑郁症，缺乏临床验证；结果可能受未控制的潜在混杂因素的影响。未来研究需深入探索因果关系，控制潜在混杂因素，以全面阐明绝经后女性CVH与抑郁症之间的复杂联系。
本研究显示了绝经后女性高水平CVH与抑郁症之间存在显著的负相关，强调了采用健康生活方式、维持高水平CVH对于绝经后女性心理健康的促进作用，特别是在不同人群特征中表现出的普遍性和差异性，有必要通过个性化的健康促进计划来预防绝经后女性抑郁症的发生。
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doi: 10.20043/j.cnki.MPM.202410521
  • 接收时间：2024-10-31
  • 首发时间：2026-03-18
  • 出版时间：2025-03-25
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    1．山东第一医科大学附属省立医院耳鼻喉科二病区，山东　济南　250021
    2．山东第一医科大学附属省立医院妇科一病房
    3．山东第一医科大学附属省立医院东院重症医学科

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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