Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark.
Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Glostrup, Denmark.
Andrology. 2017 Sep;5(5):931-938. doi: 10.1111/andr.12391. Epub 2017 Jul 13.
Age and female sex have repeatedly been identified as gallstone determinants but the underlying mechanisms are not clarified. The objectives of this study were to determine if changes with age in physiology, lifestyle, or reproductive hormones were associated with incident gallstones. A cohort study of a general population random sample (N = 2366) aged 30-60 years was performed. Participants were ultrasound screened for gallstones in 1982-84 and again in 1993-94. Lifestyle data and blood samples were obtained and re-analyzed in 2004. Changes with age in physiology (body mass index, blood pressure, blood lipids, self-rated health), lifestyle (smoking, alcohol and coffee consumption, dietary habits, physical activity level), and indices of reproductive function (number of births, oral contraceptive use, hormone replacement therapy, male reproductive hormones) were explored in females and males separately. Adjusted logistic regression analyses were performed. Incident gallstones (gallstones and cholecystectomy) at ultrasound examination in participants initially free of gallstones at baseline occurred in 9.9% of the study population. In females, increasing alcohol consumption (odds ratio (OR) 0.94, 95% confidence interval (CI) [0.90; 0.98]) and the cessation of hormone replacement therapy (OR 0.29, 95% CI [0.10; 0.83]) inversely determined incident gallstones. In males, increasing levels of SHBG (OR 0.97, 95% CI [0.94; 0.998]) inversely determined incident gallstones. Other changes with age in physiology, lifestyle, or reproductive hormones were not associated. High baseline free testosterone determined incident gallstones in males (OR 1.15, 95% CI [1.02; 1.30]). To conclude, changes with age in alcohol consumption in females and in reproductive hormones determined incident gallstones. Male reproductive hormones seem to have an impact on incident gallstones. Sex differences should be explored further in future studies.
年龄和性别已被反复确定为胆结石的决定因素，但潜在机制尚不清楚。本研究的目的是确定生理、生活方式或生殖激素随年龄的变化是否与新发生的胆结石有关。对一个年龄在 30-60 岁的普通人群随机样本（N=2366）进行了队列研究。在 1982-84 年和 1993-94 年对参与者进行了超声筛查胆结石。获得了生活方式数据和血液样本，并在 2004 年进行了重新分析。分别对女性和男性的生理（体重指数、血压、血脂、自我评估健康）、生活方式（吸烟、饮酒和咖啡摄入、饮食习惯、身体活动水平）和生殖功能指标（生育次数、口服避孕药使用、激素替代疗法、男性生殖激素）随年龄的变化进行了探讨。进行了调整后的逻辑回归分析。在基线时无胆结石的参与者中，在超声检查中发现新发生的胆结石（胆结石和胆囊切除术）占研究人群的 9.9%。在女性中，饮酒量增加（比值比（OR）0.94，95%置信区间（CI）[0.90；0.98]）和停止激素替代疗法（OR 0.29，95%CI [0.10；0.83]）与新发生的胆结石呈负相关。在男性中，SHBG 水平升高（OR 0.97，95%CI [0.94；0.998]）与新发生的胆结石呈负相关。生理、生活方式或生殖激素随年龄的其他变化与胆结石无关。基线时游离睾丸激素水平较高的男性新发生胆结石（OR 1.15，95%CI [1.02；1.30]）。总之，女性饮酒量随年龄的变化和生殖激素的变化与新发生的胆结石有关。男性生殖激素似乎对新发生的胆结石有影响。未来的研究应进一步探讨性别差异。
