Acalovschi M V, Blendea D, Pascu M, Georoceanu A, Badea R I, Prelipceanu M
Third Medical Clinic University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Am J Gastroenterol. 1997 Jan;92(1):127-31.
Obesity is a rather documented risk factor for the formation of gallstones (GS) in women. The magnitude of the increased risk and the rates of GS occurrence, however, have not been well quantified, except for two studies on the risk of symptomatic stones in obese women. We analyzed the incidence of GS in 157 moderately obese women (body mass index, 31.4 +/- 3.6 kg/ m2) followed up prospectively by ultrasound for 2-6 yr (mean 3.95 yr). Women with morbid obesity (body mass index > 40 kg/m2) were excluded from the study, as well as patients having diseases with lithogenic risk. All the enrolled women had normal cholecystosonogram results at the beginning of the study. Age, family history of GS or obesity, parity, age of obesity onset, hyperlipoproteinemia type, plasma cholesterol (total, HDL, LDL), and triglycerides were assessed. The Student's t, the Mann-Whitney rank sum and the Fisher's exact tests were used, as well as the multiple logistic regression for the multivariate analysis. During the survey, 16 of 157 women (10.2%) developed GS. GS were asymptomatic in 11 persons (68.8%). The cumulative incidence of both asymptomatic and symptomatic GS was 2.6 cases/100 obese women.year. During the follow-up, most of the detected GS were asymptomatic, and this explains the higher GS incidence rate found compared with that previously calculated for symptomatic GS. The following risk factors were associated with GS formation: age (p = 0.002), family history of GS (p = 0.011), early obesity onset (p = 0.003), and hyperlipoproteinemia type IV (p = 0.011). A high risk class might be thus identified among obese women, offering a more realistic approach for the primary prophylaxis of GS.
肥胖是女性胆结石（GS）形成的一个有充分文献记载的风险因素。然而，除了两项关于肥胖女性有症状结石风险的研究外，风险增加的程度和GS的发生率尚未得到很好的量化。我们分析了157名中度肥胖女性（体重指数，31.4±3.6kg/m²）的GS发生率，通过超声对其进行了2至6年（平均3.95年）的前瞻性随访。病态肥胖（体重指数>40kg/m²）的女性以及有结石形成风险疾病的患者被排除在研究之外。所有纳入研究的女性在研究开始时胆囊超声检查结果均正常。评估了年龄、GS或肥胖家族史、产次、肥胖发病年龄、高脂蛋白血症类型、血浆胆固醇（总胆固醇、高密度脂蛋白、低密度脂蛋白）和甘油三酯。使用了Student's t检验、Mann-Whitney秩和检验和Fisher精确检验，以及多元分析的多重逻辑回归。在调查期间，157名女性中有16名（10.2%）患上了GS。11人（68.8%）的GS无症状。无症状和有症状GS的累积发病率为2.6例/100肥胖女性·年。在随访期间，大多数检测到的GS无症状，这就解释了与之前计算的有症状GS相比发现的更高的GS发病率。以下风险因素与GS形成相关：年龄（p = 0.002）、GS家族史（p = 0.011）、肥胖早发（p = 0.003）和IV型高脂蛋白血症（p = 0.011）。因此，在肥胖女性中可能识别出一个高风险类别，为GS的一级预防提供更现实的方法。
