代谢综合征与胆石病。
Metabolic syndrome and gallstone disease.
机构信息
Department of Family Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
出版信息
World J Gastroenterol. 2012 Aug 21;18(31):4215-20. doi: 10.3748/wjg.v18.i31.4215.
AIM
To investigate the association between metabolic syndrome (MetS) and the development of gallstone disease (GSD).
METHODS
A cross-sectional study was conducted in 7570 subjects (4978 men aged 45.0 ± 8.8 years, and 2592 women aged 45.3 ± 9.5 years) enrolled from the physical check-up center of the hospital. The subjects included 918 patients with gallstones (653 men and 265 women) and 6652 healthy controls (4325 men and 2327 women) without gallstones. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG) and serum lipids and lipoproteins levels were measured. Colorimetric method was used to measure cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Dextrose oxidizing enzyme method was used to measure FPG. Subjects were asked to complete a questionnaire that enquired about the information on demographic data, age, gender, histories of diabetes mellitus, hypertension, and chronic liver disease and so on. Metabolic syndrome was diagnosed according to the Adult Treatment Panel III (ATP III) criteria. Gallstones were defined by the presence of strong intraluminal echoes that were gravity-dependent or attenuated ultrasound transmission.
RESULTS
Among the 7570 subjects, the prevalence of the gallstone disease was 12.1% (13.1% in men and 10.2% in women). BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose and serum triglyceride (TG) in cases group were higher than in controls, while serum high-density lipid was lower than in controls. There were significant differences in the waist circumference, blood pressure, FPG and TG between cases and controls. In an age-adjusted logistic regression model, metabolic syndrome was associated with gallstone disease. The age-adjusted odds ratio of MetS for GSD in men was 1.29 [95% confidence interval (CI), 1.09-1.52; P = 0.0030], and 1.68 (95% CI, 1.26-2.25; P = 0.0004) in women; the overall age-adjusted odds ratio of MetS for GSD was 1.42 (95% CI, 1.23-1.64; P < 0.0001). The men with more metabolic disorders had a higher prevalence of gallstone disease, the trend had statistical significance (P < 0.0001). The presence of 5 components of the MetS increased the risk of gallstone disease by 3.4 times (P < 0.0001). The prevalence of GSD in women who had 5 components of MetS was 5 times higher than in those without MetS component. The more the components of MetS, the higher the prevalence of GSD (P < 0.0001). The presence of 5 components of the MetS increased the risk of gallstone disease by 4.0 times.
CONCLUSION
GSD appears to be strongly associated with MetS, and the more the components of MetS, the higher the prevalence of GSD.
目的
探讨代谢综合征（MetS）与胆石病（GSD）发展之间的关系。
方法
对医院体检中心的 7570 名受试者（45.0±8.8 岁男性 4978 人，45.3±9.5 岁女性 2592 人）进行横断面研究。受试者包括 918 例胆石症患者（653 例男性和 265 例女性）和 6652 例无胆石症的健康对照者（4325 例男性和 2327 例女性）。测量体重指数（BMI）、腰围、血压、空腹血糖（FPG）和血清脂质及脂蛋白水平。采用比色法测定胆固醇、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）。采用葡萄糖氧化酶法测定 FPG。要求受试者完成一份问卷，询问其人口统计学资料、年龄、性别、糖尿病、高血压和慢性肝病等病史。根据成人治疗小组 III（ATP III）标准诊断代谢综合征。胆石症通过存在重力依赖性强腔内回声或衰减超声传输来定义。
结果
在 7570 名受试者中，胆石病的患病率为 12.1%（男性 13.1%，女性 10.2%）。病例组的 BMI、腰围、收缩压、舒张压、空腹血糖和血清甘油三酯（TG）高于对照组，而高密度脂蛋白则低于对照组。病例组与对照组在腰围、血压、FPG 和 TG 方面存在显著差异。在年龄调整的 logistic 回归模型中，代谢综合征与胆石病相关。男性代谢综合征对胆石病的年龄调整比值比（OR）为 1.29（95%置信区间[CI]，1.09-1.52；P=0.0030），女性为 1.68（95% CI，1.26-2.25；P=0.0004）；代谢综合征对胆石病的总体年龄调整 OR 为 1.42（95% CI，1.23-1.64；P<0.0001）。患有更多代谢紊乱的男性患胆石病的患病率更高，趋势具有统计学意义（P<0.0001）。代谢综合征 5 项指标的存在使胆石病的风险增加了 3.4 倍（P<0.0001）。患有 5 项代谢综合征的女性胆石病的患病率是没有代谢综合征的女性的 5 倍。代谢综合征的指标越多，胆石病的患病率越高（P<0.0001）。代谢综合征 5 项指标的存在使胆石病的风险增加了 4.0 倍。
结论
GSD 似乎与 MetS 密切相关，且代谢综合征的指标越多，GSD 的患病率越高。
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