性别、年龄和体重指数对血清碳酸氢盐的影响。

Effects of sex, age, and body mass index on serum bicarbonate.

作者信息

Duan Daisy, Perin Jamie, Osman Adam, Sgambati Francis, Kim Lenise J, Pham Luu V, Polotsky Vsevolod Y, Jun Jonathan C

机构信息

Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.

出版信息

Front Sleep. 2023;2. doi: 10.3389/frsle.2023.1195823. Epub 2023 Jul 20.

DOI:10.3389/frsle.2023.1195823

PMID:37736141

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10512520/

Abstract

RATIONALE

Obesity hypoventilation syndrome (OHS) is often underdiagnosed, with significant morbidity and mortality. Bicarbonate, as a surrogate of arterial carbon dioxide, has been proposed as a screening tool for OHS. Understanding the predictors of serum bicarbonate could provide insights into risk factors for OHS. We hypothesized that the bicarbonate levels would increase with an increase in body mass index (BMI), since the prevalence of OHS increases with obesity.

METHODS

We used the TriNetX Research Network, an electronic health record database with de-identified clinical data from participating healthcare organizations across the United States, to identify 93,320 adults without pulmonary or advanced renal diseases who had serum bicarbonate and BMI measurements within 6 months of each other between 2017 and 2022. We used linear regression analysis to examine the associations between bicarbonate and BMI, age, and their interactions for the entire cohort and stratified by sex. We also applied a non-linear machine learning algorithm (XGBoost) to examine the relative importance of age, BMI, sex, race/ethnicity, and obstructive sleep apnea (OSA) status on bicarbonate.

RESULTS

This cohort population was 56% women and 72% white and 80% non-Hispanic individuals, with an average () age of 49.4 (17.9) years and a BMI of 29.1 (6.1) kg/m. The mean bicarbonate was 24.8 (2.8) mmol/L, with higher levels in men (mean 25.2 mmol/L) than in women (mean 24.4 mmol/L). We found a small negative association between bicarbonate and BMI, with an expected change of -0.03 mmol/L in bicarbonate for each 1 kg/m increase in BMI ( < 0.001), in the entire cohort and both sexes. We found sex differences in the bicarbonate trajectory with age, with women exhibiting lower bicarbonate values than men until age 50, after which the bicarbonate levels were modestly higher. The non-linear machine learning algorithm similarly revealed that age and sex played larger roles in determining bicarbonate levels than the BMI or OSA status.

CONCLUSION

Contrary to our hypothesis, BMI is not associated with elevated bicarbonate levels, and age modifies the impact of sex on bicarbonate.

摘要

理论依据

肥胖低通气综合征（OHS）常常未得到充分诊断，具有较高的发病率和死亡率。碳酸氢盐作为动脉二氧化碳的替代指标，已被提议作为OHS的筛查工具。了解血清碳酸氢盐的预测因素可以为OHS的危险因素提供见解。我们假设碳酸氢盐水平会随着体重指数（BMI）的增加而升高，因为OHS的患病率随肥胖而增加。

方法

我们使用了TriNetX研究网络，这是一个电子健康记录数据库，包含来自美国各地参与医疗保健机构的去识别化临床数据，以识别93320名无肺部或晚期肾脏疾病的成年人，他们在2017年至2022年期间彼此间隔6个月内进行了血清碳酸氢盐和BMI测量。我们使用线性回归分析来检查整个队列以及按性别分层后的碳酸氢盐与BMI、年龄及其相互作用之间的关联。我们还应用了一种非线性机器学习算法（XGBoost）来检查年龄、BMI、性别、种族/民族和阻塞性睡眠呼吸暂停（OSA）状态对碳酸氢盐的相对重要性。

结果

该队列人群中女性占56%，白人占72%，非西班牙裔占80%，平均（）年龄为49.4（17.9）岁，BMI为29.1（6.1）kg/m²。平均碳酸氢盐水平为24.8（2.8）mmol/L，男性（平均25.2 mmol/L）高于女性（平均24.4 mmol/L）。我们发现整个队列以及男女两性中，碳酸氢盐与BMI之间存在微小的负相关，BMI每增加1 kg/m²，碳酸氢盐预期变化为 -0.03 mmol/L（P < 0.001）。我们发现碳酸氢盐轨迹随年龄存在性别差异，50岁之前女性的碳酸氢盐值低于男性，50岁之后碳酸氢盐水平略有升高。非线性机器学习算法同样显示，在确定碳酸氢盐水平方面，年龄和性别比BMI或OSA状态发挥的作用更大。