Sahi T, Paffenbarger R S, Hsieh C C, Lee I M
Department of Public Health, University of Helsinki, Finland.
Am J Epidemiol. 1998 Apr 1;147(7):644-51. doi: 10.1093/oxfordjournals.aje.a009505.
Despite the high prevalence of gallbladder disease in industrialized countries, little is known about the predictors of the disease, especially in men. The authors prospectively studied 16,785 alumni of Harvard University, aged 15-24 years, who were followed for up to 61 years. The health characteristics of these men were ascertained from their college entrance physical examination done in 1916-1950, and updated via mailed questionnaires in 1962 or 1966 (1962/1966). Alumni subsequently self-reported physician-diagnosed gallbladder disease on further mailed questionnaires in 1972 or 1977. Between college time and 1962/1966, 371 gallbladder disease cases occurred. An additional 314 cases occurred after 1962/1966. With respect to college characteristics, after adjustment for potential confounders, the authors found that body mass index (BMI), smoking, physical activity, blood pressure, and consumption of alcohol, coffee, or tea were unrelated to risk. However, BMI in 1962/1966 was directly related to risk of subsequent gallbladder disease, as was BMI gain since college (p, trend = 0.002 and 0.013, respectively). Compared with men with BMI < 22.0, men with BMI > or = 27.0 had a rate ratio of 2.71 (95% confidence interval (CI) 1.57-4.66) for risk of contracting the disease. Men who gained > or = 6.0 BMI units since college had a rate ratio of 1.46 (95% CI 0.86-2.46) compared with men who gained -0.9 to +0.9 BMI units. Compared with never smokers, men who smoked pipes or cigars or < 1 pack of cigarettes daily in 1962/1966 had a rate ratio of 1.43 (95% CI 1.00-2.06), while heavier cigarette smokers had a rate ratio of 1.52 (95% CI 1.03-2.24). Neither physical activity nor physician-diagnosed hypertension or diabetes mellitus in 1962/1966 predicted risk.
尽管在工业化国家胆囊疾病的患病率很高，但对于该疾病的预测因素却知之甚少，尤其是在男性中。作者对16785名年龄在15至24岁之间的哈佛大学毕业生进行了前瞻性研究，随访时间长达61年。这些男性的健康特征通过他们在1916年至1950年进行的大学入学体检确定，并在1962年或1966年（1962/1966）通过邮寄问卷进行更新。校友们随后在1972年或1977年通过进一步邮寄问卷自我报告医生诊断的胆囊疾病。在大学时期至1962/1966年期间，发生了371例胆囊疾病病例。1962/1966年之后又发生了314例病例。关于大学时期的特征，在对潜在混杂因素进行调整后，作者发现体重指数（BMI）、吸烟、身体活动、血压以及酒精、咖啡或茶的摄入量与患病风险无关。然而，1962/1966年的BMI与随后患胆囊疾病的风险直接相关，自大学以来的BMI增加量也与患病风险直接相关（p趋势分别为0.002和0.013）。与BMI<22.0的男性相比，BMI≥27.0的男性患该病的风险率比为2.71（95%置信区间（CI）1.57 - 4.66）。自大学以来BMI增加≥6.0个单位的男性与BMI增加 -0.9至 +0.9个单位的男性相比，风险率比为1.46（95%CI 0.86 - 2.46）。与从不吸烟的男性相比，1962/1966年吸烟斗或雪茄或每天吸烟<1包的男性风险率比为1.43（95%CI 1.00 - 2.06），而吸烟量更大的男性风险率比为1.52（95%CI 1.03 - 2.24）。1962/1966年的身体活动以及医生诊断的高血压或糖尿病均不能预测患病风险。
