Objective: To investigate the association between reproductive lifespan duration (RLD) and urinary albumin-creatinine ratio (UACR) in a Chinese postmenopausal population. Methods: This cross-sectional study included 11 055 naturally postmenopausal women from seven regions of China from May to December 2011. RLD was divided into four groups. Propensity score matching was performed to reduce bias, and logistic regressions and stratifications were conducted to investigate the association between RLD and increased UACR (≥30 mg/g). Mediation effect analysis was performed to quantify the effect of RLD on cardiovascular disease (CVD) induced by elevated UACR. Results: There were 2 373 participants with a RLD of 18-31 years, 2 888 participants with a RLD of 32-34 years, 2 472 participants with a RLD of 35-36 years, and 3 322 participants with a RLD of 37-50 years. The shortest RLD (18-31 years) group was characterized with older age (P<0.001), a higher incidence of CVD (P=0.025), and the highest level of UACR (P<0.001). After adjusting for confounders, women with a longer RLD (37-50 years group) exhibited a lower risk of UACR elevation compared with those with the shortest RLD (18-31 years group) (OR=0.72, 95%CI 0.64-0.82, P<0.001). Every 1-year extension in RLD was linked to a 2% reduction in the risk of UACR elevation (OR=0.98, 95%CI 0.97-0.99, P<0.001). Stratified analysis revealed a more significant association between RLD and UACR in women who were a normal weight (P=0.003) or overweight (P=0.001), in those without CVD history (P=0.001), and in those with impaired estimated glomerular filtration rate (P=0.004). The mediation casual analysis showed that 3.0% of proteinuria inducing CVD events was mediated by RLD (P=0.048). Conclusion: A longer RLD (37-50 years) is associated with a lower UACR in Chinese postmenopausal women.
目的： 探讨中国人群绝经后女性生育周期（RLD）与尿白蛋白/肌酐比值（UACR）的相关性。 方法： 横断面研究。纳入2011年5至12月在中国7个地区招募的共11 055名自然绝经后女性，按RLD分为4组，并使用倾向评分匹配减少偏倚，通过logistic回归模型及分层分析观察各RLD组出现UACR≥30 mg/g的比值比（OR），中介效应分析量化RLD在UACR对心血管疾病（CVD）发生中的影响。 结果： RLD 18~31年、32~34年、35~36年、37~50年组，分别有2 373、2 888、2 472、3 322人。RLD最短（18~31年）组的年龄偏大（P<0.001）、CVD发生率（P=0.025）和UACR水平最高（P<0.001）。充分校正混杂因素后，与最短RLD（18~31年）相比，RLD最长（37~50年）的女性发生UACR≥30 mg/g的风险降低28%（OR=0.72，95%CI 0.64~0.82，P<0.001）。RLD每延长1年，出现UACR≥30 mg/g的风险降低2%（OR=0.98，95%CI 0.97~0.99，P<0.001）。分层分析显示，在体重正常（P=0.003）或超重（P=0.001）、无CVD病史（P=0.001）以及估算的肾小球滤过率降低（P=0.004）的女性中，RLD与UACR的相关性更加显著。中介效应分析发现3.0%的尿白蛋白对发生CVD的影响是通过RLD介导的（P=0.048）。 结论： 在中国人群自然绝经后的女性中，长RLD（37~50年）与较低的UACR相关。.