運動訓練對停經後婦女代謝症候群嚴重度及其預測因子成效之探討

本研究目的主要探討停經後婦女介白素-6（interleukin-6, IL-6）濃度、胰島素阻抗、脂締素、三酸甘油脂對於高密度脂蛋白膽固醇（triglyceride to high-density lipoprotein cholesterol, TG/HDL-C）比值與代謝症候群嚴重度及其組成因子的相關性，以及運動訓練對於停經後婦女在心肺適能、IL-6濃度、胰島素阻抗、脂締素、TG/HDL-C比值與代謝症候群嚴重度及其組成因子之成效。根據研究目的一，以橫斷式相關性研究設計收集停經後婦女人口學屬性、IL-6濃度、胰島素阻抗、脂締素、TG/HDL-C比值與代謝症候群嚴重度等資料，以探討停經後婦女IL-6濃度、胰島素阻抗、脂締素、TG/HDL-C 比值與代謝症候群嚴重度及其組成因子的相關性。根據研究目的二，以隨機臨床試驗研究設計探討運動訓練對於停經後婦女在心肺適能、IL-6濃度、胰島素阻抗、脂締素、TG/HDL-C 比值與代謝症候群嚴重度及其組成因子之成效，經由EXCEL亂數表將停經後婦女隨機分派為運動組與對照組，其中運動組婦女參與為期12週的跑步機運動訓練，對照組婦女則是維持平常的生活形態。研究資料經由獨立樣本t檢定、卡方檢定、皮爾森相關、階層性複迴歸、Sobel 檢定與廣義估計方程式等統計方法進行統計檢定分析。結果發現：1. 停經後婦女呈現有腹部肥胖（平均腰圍為90.09± 9.39 cm），空腹血糖值升高（平均104.87±13.56 mg/dL）、略低的HDL-C（平均48.79±11.87 mg/dL），IL-6濃度增高與脂締素降低的情形。2. 年齡、胰島素阻抗、脂締素、三酸甘油脂與TG/HDL-C比值可顯著預測代謝症候群嚴重度。3. TG/HDL-C比值對IL-6濃度與代謝症候群嚴重度呈現有中介效果。4.經12週運動訓練後，運動組婦女在腰圍、HDL-C、心肺適能、IL-6濃度、脂締素與代謝症候群嚴重度有顯著成效。5. 其中心肺適能、IL-6濃度與代謝症候群嚴重度的成效與HDL-C的增加成效有關，脂締素增加的成效則是與收縮壓的改變量有關。目前脂締素還未列入代謝症候群診斷項目，胰島素阻抗與TG/HDL-C比值對於我國停經後婦女還沒有一致的建議參考值，除了五項診斷代謝症候群組成因子外，還可參考胰島素阻抗、脂締素與TG/HDL-C 比值的變化以早期篩檢出代謝症候群的高危險群婦女，未來研究可針對停經後婦女胰島素阻抗以及TG/HDL-C比值的切點深入研究。除此，經由12週的運動訓練計畫，可顯著改善停經後婦女心肺適能、IL-6濃度、脂締素與代謝症候群嚴重度，但目前對於能提升脂締素與HDL-C的非藥物治療措施相當有限，因此對於低脂締素或低HDL-C的婦女可參酌本研究結果與運動訓練計畫，做為提升停經後婦女健康照護相關介入措施之參考，以期能減緩停經後婦女代謝症候群的盛行率及預防合併症發生，進而提昇我國停經後婦女的健康狀態。

關鍵字

代謝症候群；停經後婦女；運動訓練

並列摘要

The aims of this study were to: (1) explore the relationships among interleukin-6 (IL-6), insulin resistance, adiponectin, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, risk components of metabolic syndrome (MS) and MS scores in postmenopausal women, and (2) investigate the exercise effects on maximal oxygen uptake (VO2max), IL-6, insulin resistance, adiponectin, TG/HDL-C ratio, risk components of MS and MS scores. The cross-section study explored the relationships among IL-6, insulin resistance, adiponectin, TG/HDL-C ratio, risk components of MS and MS scores in postmenopausal women. The randomized clinical trial explored the exercise effects on VO2max, IL-6, insulin resistance, adiponectin, TG/HDL-C ratio, risk components of MS and MS scores among postmenopausal women. Women in an exercise group participated in a 12 week-exercise program, whereas women in a control group maintained their customary lifestyle. Data of demographics, physiological assessments, and blood sampling were collected and analyzed by independent t-test, Chi-squared test, Pearson's correlation, Hierarchical Multiple Regression, Sobel test and Generalized Estimating Equations analysis. The results showed that: (1) the major risk factors of MS for postmenopausal women include central obesity (mean waist circumference, 90.09± 9.39 cm), elevated levels of fasting glucose (mean, 104.87±13.56 mg/dL) and IL-6, and low values of HDL-C (mean, 48.79±11.87 mg/dL) and adiponectin; (2) age, insulin resistance, adiponectin, TG/HDL-C ratio were significantly predicted the risk components of MS and MS scores; (3) the mediating effect of TG/HDL-C ratio in the relationships between IL-6 levels and MS scores; (4) significant improvements in waist circumference, serum HDL-C, IL-6 levels, VO2max, adiponectin and MS scores were observed following exercise training ; (5) the beneficial effects of exercise on IL-6 (r = -0.33, p = 0.03), MS scores (r = -0.42, p < 0.01) and VO2max (r = 0.31, p = 0.04) were related to the improvements of the HDL-C levels. The beneficial effects on increased adiponectin were associated with the improvements of the systolic blood pressure. The results of this study suggest in addition to the components described by National Cholesterol Education Program Adult Treatment Panel III (2011), the adiponectin plays a key role in the development of MS. Few pharmacological treatments are available to treat patients who have low levels of HDL-C and adiponectin. Base on study results, health-care providers can include an exercise program in treatments to improve postmenopausal women’s health. In addition, further study needs to confirm the cut-points of insulin resistance and TG/HDL-C ratio which can be applied to screen the high risk group of postmenopausal women with MS.

並列關鍵字

Metabolic Syndrome ； Postmenopausal Women ； Exercise Training

參考文獻

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國民健康署（2007）•成人（20歲以上）代謝症候群之判定標準（2007 台灣）•HTTP:// WWW.HPA.GOV.TW/ BHPNET/WEB/ HEALTHTOPIC/TOPICARTICLE.ASPX?NO=200712250123&PARENTID=200712250023。