Psychosocial Stress and the Risk of Uterine Fibroids

描述（由申请人提供）：由于子宫平滑肌瘤（“肌瘤”）导致的严重发病率影响到每四到五名育龄妇女中的一名。许多妇女经历严重的不适，最终导致子宫切除术，一种侵入性手术。非洲裔美国妇女往往是在2至9倍的风险被诊断出在较年轻的年龄和/或更大的更先进的肌瘤比白色妇女。本申请的目的是研究随机选择的年龄在35岁至49岁之间的绝经前妇女中压力测量与肌瘤风险之间的关联。关于子宫肌瘤的已知危险因素和病因学的文献正在缓慢增加，研究表明子宫肌瘤是子宫依赖性的。心理社会压力已被证明与心理和其他身体健康结果有关，如妇女的肥胖和高血压。在动物和人类研究中，都有关于压力导致生殖激素水平波动的证据。核心假设是，肌瘤是由于压力水平增加导致激素水平增加所致。使用来自国家环境健康科学研究所的子宫肌瘤研究（UFS）的数据，提出了二次数据分析以解决四个具体目标：1）描述压力的测量（即心理社会，皮质醇和感知的种族主义）; 2）检查定性措施之间的关联（即感知压力和生活事件压力）心理社会压力和纤维瘤; 3）检查尿皮质醇（压力的生物标志物）和纤维瘤之间的关联;和4）使用来自种族主义感知研究（UFS的辅助研究）的数据，检查非裔美国妇女中种族主义感知与纤维瘤风险之间的关联。将使用多项Logistic和多分类回归分析来确定与压力相关的肌瘤风险，同时控制诸如未经产、初潮年龄和年龄增长等因素。这项研究意义重大，因为它有望推进和扩大我们对压力如何在体内表现和影响肌瘤发展的理解。拟议的研究是一个未充分调查的妇女健康领域，有可能为生殖流行病学提供信息，并提高我们对子宫肌瘤发病机制的理解。

DESCRIPTION (provided by applicant): Significant morbidity due to uterine leiomyomata ("fibroids") affects one of every four to five women in reproductive life. Many women experience severe discomfort that ultimately results in a hysterectomy, an invasive procedure. African American women tend to be at a 2 to 9-fold higher risk of being diagnosed at a younger age and/or with larger more advanced fibroids than white women. The objective of this application is to examine the association between measures of stress and the risk of fibroids among a randomly selected group of premenopausal women between the ages of 35 and 49 years. The literature on known risk factors and the etiology of fibroids is slowing increasing with research suggesting that fibroids are hormonally dependent. Psychosocial stress has been shown to be associated with mental and other physical health outcomes such as obesity and hypertension among women. Evidence of stress causing fluctuations in reproductive hormone levels has been reported in both animal and human studies. The central hypothesis is that fibroids result from an increase in hormone levels as a result of increased levels of stress. Using data from the National Institute of Environmental Health Sciences, Uterine Fibroid Study (UFS), a secondary data analyses is proposed to address four specific aims: 1) Describe the measures of stress (i.e. psychosocial, cortisol, and perceived racism); 2) Examine the association between qualitative measures (i.e. perceived stress and life events stress) psychosocial stress and fibroids; 3) Examine the association between urinary cortisol, a biomarker of stress, and fibroids; and 4) Examine the association between perceived racism and the risk of fibroids among African American women using data from the Perceived Racism Study, an ancillary study to the UFS. Multiple Logistic and Polytomous regression analyses will be used to determine the risk of fibroids associated with stress while controlling for factors such as nulliparity, age at menarche, and increasing age. This research is significant because it is expected to advance and expand our understanding of how stress may manifest in the body and influence fibroid development. The proposed research is an under-investigated area of women's health that has the potential to inform reproductive epidemiology as well as improve our understanding of the pathogenesis of uterine fibroids.