Kim Ae Hee, Son Da-Hye, Moon Mid-Eum, Jeon Soyoung, Lee Hye Sun, Lee Yong-Jae
Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
Cardiovasc Diabetol. 2024 Mar 11;23(1):92. doi: 10.1186/s12933-024-02182-6.
Research on identifiable risks for metabolic syndrome (MetS) is ongoing, and growing evidence suggests that bilirubin is a potent antioxidant and cytoprotective agent against MetS. However, there have been conflicting results on the association between bilirubin and MetS. Our study aimed to validate the association by separately stratifying data for men and women in a longitudinal prospective study.
Data were derived from the Korean Genome Epidemiology Study provided by the Korea Centers for Disease Control and Prevention. Data from 5,185 adults aged 40-69 years (3,089 men and 2,096 women) without MetS were analyzed. The participants were divided according to sex-specific quartiles of serum total bilirubin levels and followed up biennially for 16 years (until 2018). The log-rank test was used for obtaining the Kaplan-Meier curves of cumulative incidence of MetS according to sex-specific serum total bilirubin quartiles, and the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident metabolic syndrome were analyzed with a multiple Cox proportional hazard regression analysis model, after propensity score matching for removing differences at baseline.
With increasing serum total bilirubin quartiles, the incidence rate per 1000 person-years proportionally decreased in both men and women. After propensity score matching and adjusting for confounding variables, the HRs (95% CIs) for MetS of the highest quartile in reference to the lowest quartile were 1.00 (0.80-1.24) for men and 0.80 (0.65-0.99) for women. Higher quartiles of serum total bilirubin showed significantly lower cumulative incidence of MetS in women (log-rank test p = 0.009), but not in men (log-rank test p = 0.285).
Serum total bilirubin levels were significantly inversely associated with MetS in women, but there was no significant association observed in men. Sex differences in the effects of serum total bilirubin should be noted when predicting incident MetS by sex in clinical settings.
关于代谢综合征（MetS）可识别风险的研究正在进行中，越来越多的证据表明胆红素是一种有效的抗氧化剂和针对MetS的细胞保护剂。然而，关于胆红素与MetS之间的关联存在相互矛盾的结果。我们的研究旨在通过在一项纵向前瞻性研究中分别对男性和女性的数据进行分层来验证这种关联。
数据来源于韩国疾病控制与预防中心提供的韩国基因组流行病学研究。对5185名年龄在40 - 69岁且无MetS的成年人（3089名男性和2096名女性）的数据进行分析。参与者根据血清总胆红素水平的性别特异性四分位数进行分组，并每两年随访一次，共随访16年（直至2018年）。采用对数秩检验来获取根据性别特异性血清总胆红素四分位数划分的MetS累积发病率的Kaplan-Meier曲线，并在进行倾向得分匹配以消除基线差异后，使用多元Cox比例风险回归分析模型分析新发代谢综合征的风险比（HRs）及95%置信区间（CIs）。
随着血清总胆红素四分位数的增加，男性和女性每1000人年的发病率均成比例下降。在进行倾向得分匹配并调整混杂变量后，最高四分位数相对于最低四分位数的MetS的HRs（95% CIs），男性为1.00（0.80 - 1.24），女性为0.80（0.65 - 0.99）。血清总胆红素较高的四分位数在女性中显示出显著较低的MetS累积发病率（对数秩检验p = 0.009），但在男性中未显示出显著差异（对数秩检验p = 0.285）。
血清总胆红素水平与女性的MetS呈显著负相关，但在男性中未观察到显著关联。在临床环境中按性别预测新发MetS时，应注意血清总胆红素作用的性别差异。
