Shaffer Eldon A
Faculty of Medicine, GI Division, University of Calgary, Canada.
Curr Gastroenterol Rep. 2005 May;7(2):132-40. doi: 10.1007/s11894-005-0051-8.
Gallstone disease is common and costly, creating over 700,000 cholecystectomies annually. Its complications consume approximately $6.5 billion in the United States. Surveys using noninvasive ultrasonography have identified its true prevalence and the associated risk factors. In developed countries, at least 10% of white adults harbor cholesterol gallstones; women have twice the risk, and age further increases the prevalence in both sexes. Gallstones reach epidemic proportions in the North and South American Indian populations, accompanied by an increased risk for gallbladder cancer. In contrast, the rate in sub-Saharan Africa and Asia is quite low. Obesity, a major risk factor, likely relates to insulin resistance (the metabolic syndrome). Evolution and circumstance in American Indians may have ironically selected those with "thrifty" genes that conserve energy. Our abundant access to food places us at the increased risk of obesity and cholelithiasis. The general rise in obesity in many countries raises the specter of heightened disease, best identified by epidemiologic studies.
胆结石疾病很常见且代价高昂，每年导致超过70万例胆囊切除术。在美国，其并发症的花费约为65亿美元。使用非侵入性超声检查的调查已确定了其真实患病率及相关风险因素。在发达国家，至少10%的白人成年人患有胆固醇结石；女性患病风险是男性的两倍，且年龄会进一步增加男女两性的患病率。胆结石在北美和南美印第安人群中呈流行态势，同时胆囊癌风险也增加。相比之下，撒哈拉以南非洲和亚洲的发病率相当低。肥胖是一个主要风险因素，可能与胰岛素抵抗（代谢综合征）有关。具有讽刺意味的是，美洲印第安人的进化和环境可能选择了那些具有“节俭”基因、能保存能量的人。我们获取食物的机会很多，这使我们患肥胖症和胆结石的风险增加。许多国家肥胖率的普遍上升引发了疾病增加的担忧，最好通过流行病学研究来确定。
