血清胆红素与衰老及死亡率的关联。
Association of serum bilirubin with aging and mortality.
作者信息
Boland Brigid S, Dong Mamie H, Bettencourt Ricki, Barrett-Connor Elizabeth, Loomba Rohit
机构信息
Division of Gastroenterology, Department of Medicine, University of California, San Diego, 92093 CA, USA.
Division of Gastroenterology, Department of Medicine, Kaiser Permanente, San Diego, 92093 CA, USA.
出版信息
J Clin Exp Hepatol. 2014 Mar;4(1):1-7. doi: 10.1016/j.jceh.2014.01.003. Epub 2014 Jan 20.
BACKGROUND AND AIMS
Bilirubin, a breakdown product of heme metabolism, has been shown to be protective against cardiovascular mortality; however, it is also a marker of liver function. There are limited data on the longitudinal changes in bilirubin with aging in a population-based cohort of older adults. This study was designed to determine whether serum bilirubin changes with age in older adults, and to evaluate whether age attenuates the association between bilirubin and mortality.
METHODS
This is a prospective cohort study of 2364 participants with a mean age of 70 years, who completed a research clinic visit from 1984 to 1987, and 1703 participants who returned for a second research visit approximately 8 years later. Cross-sectional and longitudinal multivariable-adjusted analyses were performed to examine the association between serum bilirubin, aging, and mortality.
RESULTS
In cross-sectional analyses, when the cohort was divided into quartiles of age, higher baseline serum bilirubin levels were associated with older age in analyses adjusted for sex, body mass index (BMI), alanine aminotransferase (ALT), albumin, and metabolic traits (P-value <0.001). In longitudinal analyses, among the subset of participants who had two research visits, aging remained significantly associated with an increase in bilirubin in multivariable-adjusted models (P-value <0.0001). When the longitudinal cohort was divided into bilirubin quartiles, Kaplan-Meier analysis showed an incremental reduction in survival with higher bilirubin levels (P-value = 0.002); however, this association between bilirubin quartile and mortality was no longer significant after adjusting for age (P-value 0.30), suggesting higher bilirubin in older age does not confer survival advantage.
CONCLUSIONS
Serum bilirubin levels gradually increase with age in older adults. Elevated bilirubin in older individuals is not associated with improved survival as previously reported in middle-aged populations.
背景与目的
胆红素是血红素代谢的分解产物，已被证明对心血管疾病死亡率具有保护作用；然而，它也是肝功能的一个指标。在以社区为基础的老年人群队列中，关于胆红素随年龄增长的纵向变化的数据有限。本研究旨在确定老年人血清胆红素是否随年龄变化，并评估年龄是否会削弱胆红素与死亡率之间的关联。
方法
这是一项前瞻性队列研究，共有2364名平均年龄为70岁的参与者，他们在1984年至1987年期间完成了一次研究门诊就诊，另有1703名参与者在大约8年后返回进行第二次研究就诊。进行了横断面和纵向多变量调整分析，以检验血清胆红素、衰老和死亡率之间的关联。
结果
在横断面分析中，当将队列按年龄四分位数划分时，在对性别、体重指数（BMI）、丙氨酸转氨酶（ALT）、白蛋白和代谢特征进行调整的分析中，较高的基线血清胆红素水平与较高年龄相关（P值<0.001）。在纵向分析中，在进行了两次研究就诊的参与者子集中，在多变量调整模型中，衰老仍然与胆红素升高显著相关（P值<0.0001）。当将纵向队列按胆红素四分位数划分时，Kaplan-Meier分析显示，胆红素水平越高，生存率逐渐降低（P值 = 0.002）；然而，在对年龄进行调整后，胆红素四分位数与死亡率之间的这种关联不再显著（P值0.30），这表明老年时较高的胆红素水平并不能带来生存优势。
结论
老年人血清胆红素水平随年龄逐渐升高。老年人胆红素升高与生存率改善无关，这与之前在中年人群中的报道不同。
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