以體位測量指標預測中年婦女罹患冠狀動脈疾病之研究

Anthropometric Indicators as Predictors of Coronary Artery Disease among Middle-Age Women

蔡秋琳(Chiu-Ling Tsai)

指導教授 ： 鄭 綺

臺北醫學大學/護理學院/護理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00175

摘要

女性心臟疾病的死亡率逐年上升，以2008年死因統計來看，心臟疾病已躍升女性國人死因第二位 ，且女性死於心血管疾病比男性多。先前研究結果顯示，身體質量指數（Body mass index, BMI）、腰圍（waist circumference, WC）、腰臀比（waist to hip ratio, WHR）、腰高比（waist to height ratio, WHtR）、體脂肪率（Body fat percentage, BF％）能有效預測CAD的發生，但因年齡、族群不同，其預測因子亦有所不同。女性隨著年齡的增加，尤其停經後婦女體脂肪重量及分步明顯中央化。由於不同停經階段婦女體脂肪的分布不同，是否在罹患CAD的體位測量指標上也會不同，因此探討女性罹患CAD的相關議題是刻不容緩且非常重要的。本研究目的主要在比較不同經期階段之中年婦女，其罹患CAD之體位測量指標的差異。
本研究共收135位個案，分為CAD 組、Non CAD組、健檢組，平均年齡為54.3±6.9歲，體位測量指標數值平均值 BMI 25.6 ±4.6 kg/m2，WC為79.8±11.3公分，WHR為0.84±0.08，WHtR 為 0.51 ±0.08，BF%為32.5±5.8。單獨比較一項體位測量指標時，皆得出CAD顯著危險性，但在校正可能影響因子後，五項體位測量指標皆不具統計上顯著差異。但將五項體位測量指標與其他可能影響因子同時列為自變項比較後，卻發現有四種體位測量指標變得不顯著，僅有影響力較強的WHR具統計上顯著差異。另發現，CAD組相較於健檢組，有職業、已停經、有糖尿病者有較高的CAD風險。Non CAD組相較於健檢組，有職業、已停經、有高血壓者有較高的Non CAD風險。CAD組相較於Non CAD組，糖尿病是發展為CAD組主要危險因子。
總結，BMI、WC、WHR、WHtR及BF%都可以作為預測罹患CAD風險指標，但在校正其它變項後，只有WHR具有較佳的預測能力。因此，WHR為中年婦女預測罹患CAD之最佳體位測量指標，WHR測量方式經濟、簡單又方便，值得推廣並應用於臨床。

關鍵字

中年婦女 ； 體位測量指標 ； 冠狀動脈疾病

並列摘要

The incidence of female coronary artery disease (CAD) is rising every year, and it has already risen to the second leading cause of death among Taiwanese women in the statistics for cause of death in the year 2008. Furthermore, deaths resulting from CAD are more commonly seen in female patients rather than male patients. Previous studies showed that body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), and body fat percentage (BF%) can efficiently predict the incidence of CAD, but these predictive factors may vary due to differences in age and race. The fat distribution and weight is clearly more centralized as the female population ages, especially in postmenopausal women. Due to the difference in distribution of fat in the different stages of menopause, anthropometric indicators to predict the incidence of CAD may also differ. Thus, the aims of this study are to compare the differences in anthropometric indicators in middle aged women of different menstrual stages and the CAD predictability of anthropometric indicators.
In our study, a total of 135 subjects were divided into three groups: CAD, Non-CAD, and health exam group. The results showed in mean±standard deviation . The mean age was 54.3±6.9 years old, with anthropometric indicators as BMI (25.6±4.6kg/m2), WC (79.8±11.3cm), WHR (0.84±0.08), WHtR (0.51±0.08), and BF% (32.5±5.8). When comparing a single anthropometric indicator, each indicator showed that women with CAD had significantly higher risks. However, after correction and adjustment with the possible influencing factors, this study showed no statistical significance when comparing the five anthropometric indicators. But when comparing the five anthropometric indicators with other possible influencing factors in a univariate analysis, we found four anthropometric indicators with no statistical significance except for waist to hip ratio (WHR), which showed statistical significance. Furthermore, when comparing the CAD group to the health exam group, patients with occupation, post - menopausal, and diabetes mellitus had higher risk for CAD. On the contrary, the non CAD group had less risk for CAD when comparing the factors of occupation, post-menopause, and diabetes mellitus with the health exam group. Upon comparison of the CAD group and the non CAD group, diabetes mellitus is the main risk factor of progression to the CAD group.
In conclusion, BMI, WC, WHR, WHtR, and BF% can all be risk indices and predictors of coronary artery disease. However, after correction for other variables, only WHR retained a better predictive potential. Thus, WHR has become the best anthropometric indicator and predictor of coronary artery disease among middle-aged women, quantified in an economic, simple, and convenient method, worthy of promotion and application in the clinical setting.

並列關鍵字

middle aged women ； anthropometric indicators ； coronary artery disease

參考文獻

黃國晉、林瑞雄、陳慶餘、宋丕錕、周松男(2000)．停經後體脂肪組成與血清瘦素質之研究．台灣醫學．

Tsao, C. C., Lin, K. H., Lai, J. S., & Lan, C.(1995). Reliability of body fat measurement: Skindfold, bioelectrical impedance analysis and infrared. Journal of the Physical Therapy Association of the R.O.C., 20(2), 102-109.

劉丁松（2008）．腰高比為預測臺灣族群男性痛風之良

American Heart Association .( 2004 ).Women and cardiovascular

American Heart Association.(2009).Facts about Women and