The association between metabolic syndrome and the risk of gallstones among premenopausal and postmenopausal women
WU Shui-lin and QIN Jia-li contributed equally to this article
More Information
-
摘要:
目的 分析金昌队列中女性人群胆结石发病率，探索绝经前后女性代谢综合征及其各组分与胆结石发病的关系。 方法 采用前瞻性队列研究方法，以队列人群基线资料中未患胆结石的女性为研究对象，分析代谢综合征及其各组分对胆结石发病的影响。 结果 本研究共纳入4 196人，随访结束时有胆结石者195例，占比4.65%。在绝经后女性人群中，有代谢综合征者胆结石发病率为10.91%，高于无代谢综合征者(5.68%，χ2 ＝19.982，P < 0.001)。随着异常组分个数的增加，胆结石发病率逐渐增高(χ2 趋势＝30.340，P < 0.001)，且在有多个代谢组分异常时达到最大，为12.24%。当调整混杂因素后，在绝经后女性人群中，多个代谢组分异常的胆结石发病风险是各代谢组分均正常人群的6.839倍(95% CI：1.665~28.084，P＝0.008)。在绝经后女性人群中，腰围、TG、HDL-C、血压和FPG异常者胆结石的发病率均高于正常者(均有P < 0.05)。当调整混杂因素后，绝经后女性人群中腰围(HR=1.805，95% CI：1.204~2.704，P＝0.004) 和HDL-C(HR=1.451，95% CI：1.071~1.965，P＝0.016)异常者胆结石的发病风险仍高于正常者。在代谢综合征有无分组、代谢综合征异常个数分组以及各组分正常或异常分组中，绝经后女性人群胆结石的发病率均高于绝经前(均有P < 0.05)。 结论 绝经后女性人群中胆结石发病与代谢综合征有关，且女性人群中胆结石发病率受绝经状态的影响。 Abstract:Objective To analysis the incidence of gallstones among women in Jingchang cohort, and explore the relationship of metabolic syndrome and its components with the risk of gallstones among premenopausal and postmenopausal women. Methods A prospective cohort study was conducted to investigate the effects of metabolic syndrome and its components on the incidence of gallstones in women who did not have gallstones from baseline data. Results A total of 4 196 women were included in this study, and 195 (4.65%) had gallstones in follow-up. The incidence of gallstones in postmenopausal women with metabolic syndrome (10.91%) was higher than that in women without metabolic syndrome (5.68%, χ2 ＝19.982, P < 0.001). With the increase of the number of abnormal components, the incidence of gallstones gradually increased (χ2 trend＝30.340, P < 0.001), and reached the maximum when multiple metabolic components were abnormal (12.24%). After adjusting for confounding factors, the risk of gallstones in postmenopausal women with multiple metabolic abnormalities was 6.839 times higher than that in the normal population (95% CI: 1.665-28.084, P＝0.008). The incidence of gallstones in people with abnormal waist circumference, TG, HDL-C, FPG were higher than those in normal subjects among postmenopausal women (all P < 0.05). After adjusting for confounding factors, the risk of gallstones in postmenopausal women with abnormal waist circumference (HR=1.805, 95% CI: 1.204-2.704, P＝0.004) and HDL-C (HR=1.451, 95%CI: 1.071-1.965, P＝0.016) were still higher than that in the normal population. In the grouping of metabolic syndrome, the abnormal number of metabolic syndrome and the normal or abnormal grouping of each component, the incidence of gallstones in postmenopausal women was higher than that in premenopausal women (all P < 0.05). Conclusion The incidence of gallstones in postmenopausal women is related to metabolic syndrome, and the incidence of gallstones in women is affected by menopausal status. -
Key words:
- Jinchang cohort /
- Gallstone /
- Metabolic syndrome
-
表 1 金昌队列女性人群基本特征a
Table 1. Basic characteristics of female population in Jinchang cohort a
变量 有胆结石 无胆结石 女性总人群 χ2/t值 P值 总人数(人) 195(4.65) 4 001(95.35) 4 196(100.00) 年龄(岁) 175.966 < 0.001 ＜35 5(2.56) 508(12.70) 513(12.22) 35~＜45 8(4.10) 764(19.10) 772(18.40) 45~＜55 19(9.75) 1 126(28.14) 1 145(27.29) 55~＜65 79(40.51) 1 034(27.84) 1 113(26.53) ≥65 84(43.08) 569(14.22) 653(15.56) 家庭人均月收入(元) 45.583 < 0.001 ＜1 000 7(3.59) 66(1.65) 73(1.74) 1 000~＜2 000 124(63.59) 1 654(41.34) 1 778(42.37) 2 000~＜5 000 63(32.31) 2 205(55.11) 2 268(54.05) ≥5 000 1(0.51) 76(1.90) 77(1.84) 有吸烟行为b 3(1.54) 72(1.80) 75(1.79) < 0.001 ＞0.999 有饮酒行为c 4(2.05) 118(2.95) 122(2.91) 0.261 0.610 有体育锻炼d 175(89.74) 3 465(86.60) 3 640(86.75) 1.595 0.207 婚姻状况 23.410 < 0.001 未婚 2(1.03) 228(5.70) 230(5.48) 初婚 148(75.90) 3 161(79.00) 3 309(78.86) 再婚 3(1.54) 95(2.37) 98(2.34) 离异 6(3.08) 133(3.33) 139(3.31) 丧偶 36(18.46) 384(9.60) 420(10.01) 文化程度 145.314 < 0.001 小学及以下 117(60.00) 920(22.99) 1 037(24.71) 初中/高中 64(32.82) 1 843(46.06) 1 907(45.45) 大专及以上 14(7.18) 1 238(30.92) 1 252(29.84) BMI e (kg/m2) 49.058 < 0.001 异常 133(68.21) 1 709(42.71) 1 842(43.90) 正常 62(31.79) 2 292(57.29) 2 354(56.10) 腰围(cm) 83.30±7.74 78.14±8.22 78.38±8.27 -8.574 < 0.001 SBP(mm Hg) 139.79±22.49 122.37±21.36 123.17±21.72 -11.095 < 0.001 DBP(mm Hg) 83.49±13.09 77.24±12.55 77.53±12.64 -6.768 < 0.001 FPG(mmol/L) 5.97±2.19 5.25±1.18 5.28±1.26 -4.598 < 0.001 TG(mmol/L) 2.04±1.42 1.63±1.06 1.65±1.08 -3.969 < 0.001 HDL-C(mmol/L) 1.36±0.30 1.50±0.36 1.49±0.36 5.836 < 0.001 注：a总人数、年龄、家庭人均月收入、有吸烟行为、有饮酒行为、有体育锻炼、婚姻状况、文化程度以及BMI以频数(构成比)[n(%)]形式表示，χ2检验比较不同组间构成比的差异，腰围、SBP、DBP、FPG、TG及HDL-C数据以均数±标准差(x±s)形式表示，t检验比较不同组间均数差异; b有吸烟行为指每天至少吸一支烟，连续吸烟＞6个月；c有饮酒行为指每周至少饮酒一次，连续饮酒＞6个月; d有锻炼行为是指平均每周进行体育锻炼＞3次，每次锻炼＞30 min; e BMI正常指其范围在18.5~23.9 kg/m2之间，异常包括偏低(＜18.5 kg/m2)和偏高(≥24.0 kg/m2)。 
下载: 导出CSV
表 2 金昌队列女性人群代谢综合征与胆结石发病率
Table 2. Metabolic syndrome and gallstone incidence in Jinchang cohort of female population
代谢综合征 绝经前 绝经后 χ2值 P值 人数(N) 发病人数(n) 发病率(%) 人数(N) 发病人数(n) 发病率(%) 无 1 749 19 1.09 1 198 68 5.68 52.279 < 0.001 有 268 1 0.37 981 107 10.91 29.570 < 0.001 χ2值 1.204 19.982 P值 0.273 ＜0.001
下载: 导出CSV
表 3 金昌队列女性人群代谢综合征与胆结石发病风险的Cox分析
Table 3. Cox analysis of metabolic syndrome and the risk of gallstone in Jinchang cohort of female population
分组 单因素 多因素a HR(95% CI)值 P值 HR(95% CI)值 P值 绝经前 无代谢综合征 1.000 1.000 有代谢综合征 0.266(0.036~1.988) 0.197 0.272(0.033~2.246) 0.227 绝经后 无代谢综合征 1.000 1.000 有代谢综合征 1.952(1.440~2.646) ＜0.001 1.390(1.007~1.919) 0.045 注: a调整了家庭人均月收入、婚姻状况、文化程度、体育锻炼和BMI。
下载: 导出CSV
表 4 金昌队列女性人群不同代谢组分异常个数与胆结石发病率的关联
Table 4. The relationship between abnormal number of different metabolic components and incidence of gallstones in female population of Jinchang cohort
异常数(个) 绝经前 绝经后 χ2值 P值 人数(N) 发病人数(n) 发病率(%) 人数(N) 发病人数(n) 发病率(%) 0 777 5 0.64 231 2 0.87 < 0.001 ＞0.999 1 586 9 1.54 437 24 5.49 12.550 < 0.001 2 386 5 1.30 530 42 7.92 20.163 < 0.001 ≥3 267 1 0.37 874 107 12.24 28.252 < 0.001 χ2趋势值 0.014 30.340 P值 0.904 ＜0.001
下载: 导出CSV
表 5 金昌队列女性人群不同代谢组分异常个数与胆结石发病风险的Cox分析
Table 5. Cox analysis of the abnormal number of different metabolic components and the risk of gallstone in female population of Jinchang cohort
分组 单因素 多因素a HR(95% CI)值 P值 HR(95% CI)值 P值 绝经前 正常 1.000 1.000 1组分异常 2.522(0.845~7.525) 0.097 2.815(0.913~8.680) 0.072 2组分异常 1.862(0.538~6.442) 0.326 2.024(0.533~7.682) 0.300 多组分异常 0.449(0.052~3.848) 0.465 0.497(0.052~4.797) 0.546 χ2趋势值 0.055 0.016 P值 0.815 0.900 绝经后 正常 1.000 1.000 1组分异常 6.020(1.423~25.474) 0.015 4.752(1.120~20.169) 0.035 2组分异常 8.476(2.052~35.017) 0.003 5.902(1.420~24.524) 0.015 多组分异常 12.136(2.996~49.160) ＜0.001 6.839(1.665~28.084) 0.008 χ2趋势值 26.417 8.810 P值 ＜0.001 0.003 注: a调整了家庭人均月收入、婚姻状况、文化程度、体育锻炼和BMI。
下载: 导出CSV
表 6 金昌队列女性人群代谢综合征各组分异常与胆结石发病率
Table 6. Abnormal components of metabolic syndrome and the incidence of gallstones in female population of Jinchang cohort
变量 绝经前 绝经后 χ2值 P值 人数(N) 发病人数(n) 发病率(%) 人数(N) 发病人数(n) 发病率(%) 腰围 正常 1 431 11 0.78 898 37 4.12 30.706 < 0.001 异常 586 9 1.54 1 281 138 10.77 47.294 < 0.001 χ2值 2.492 31.632 P值 0.114 ＜0.001 TG 正常 1 534 16 1.04 1 130 77 6.81 64.324 < 0.001 异常 483 4 0.83 1 049 98 9.34 37.218 < 0.001 χ2值 0.173 4.707 P值 0.678 0.030 HDL-C 正常 1 448 18 1.24 1 463 95 6.49 53.767 < 0.001 异常 569 2 0.35 716 80 11.17 60.351 < 0.001 χ2值 3.308 14.253 P值 0.069 ＜0.001 血压 正常 1 618 12 0.74 882 49 5.56 55.570 < 0.001 异常 399 8 2.00 1 297 126 9.71 24.925 < 0.001 χ2值 5.204 12.295 P值 0.023 ＜0.001 FPG 正常 1 804 20 1.10 1 492 100 6.70 72.835 < 0.001 异常 213 0 0.00 687 75 10.92 - < 0.001 χ2值 2.385 11.313 P值 0.122 0.001
下载: 导出CSV
表 7 金昌队列女性人群代谢综合征各组分异常与胆结石发病风险的Cox分析
Table 7. Cox analysis of the abnormal components of metabolic syndrome and the risk of gallstones in female population of Jinchang cohort
分组 单因素 多因素a HR(95% CI)值 P值 HR(95% CI)值 P值 绝经前 腰围 正常 1.000 1.000 异常 1.991(0.824~4.814) 0.126 2.698(1.000~7.277) 0.050 TG 正常 1.000 1.000 异常 0.757(0.253~2.265) 0.618 0.804(0.251~2.579) 0.714 HDL-C 正常 1.000 1.000 异常 0.286(0.066~1.235) 0.094 0.216(0.046~1.020) 0.053 血压 正常 1.000 1.000 异常 1.860(0.753~4.593) 0.178 2.613(0.980~6.971) 0.055 FPG b 正常 1.000 - 异常 0.039(0.000~11.170) 0.262 - - 绝经后 腰围 正常 1.000 1.000 异常 2.782(1.934~4.000) ＜0.001 1.805(1.204~2.704) 0.004 TG 正常 1.000 1.000 异常 1.309(0.971~1.764) 0.077 1.180(0.872~1.596) 0.284 HDL-C 正常 1.000 1.000 异常 1.816(1.349~2.445) ＜0.001 1.451(1.071~1.965) 0.016 血压 正常 1.000 1.000 异常 1.683(1.210~2.342) 0.002 1.375(0.982~1.925) 0.064 FPG 正常 1.000 1.000 异常 1.560(1.156~2.106) 0.004 1.315(0.971-1.779) 0.077 注: a调整了家庭人均月收入、婚姻状况、文化程度、体育锻炼和BMI; b在绝经前女性人群中，FBG异常者无胆结石新发病人。
下载: 导出CSV
-
[1] Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part Ⅲ: liver, biliary tract, and pancreas[J]. Gastroenterology, 2009, 136(4): 1134-1144. DOI: 10.1053/j.gastro.2009.02.038. [2] Lammert F, Gurusamy K, Ko CW, et al. Gallstones[J]. Nat Rev Dis Primers, 2016, 2: 16024. DOI: 10.1038/nrdp.2016.24. [3] Chen LY, Qiao QH, Zhang SC, et al. Metabolic syndrome and gallstone disease[J]. World J Gastroenterol, 2012, 18(31): 4215-4220. DOI: 10.3748/wjg.v18.i31.4215. [4] Naim A, Metin K, Bunyamin Y, et al. The metabolic syndrome is associated with complicated gallstone disease[J]. Can J Gastroenterol, 2011, 25(5): 274-276. DOI: 10.1155/2011/356761. [5] Lin IC, Yang YW, Wu MF, et al. The association of metabolic syndrome and its factors with gallstone disease[J]. BMC Fampract, 2014, 15(1): 138. DOI: 10.1186/1471-2296-15-138. [6] Yang JL, Huang JJ, Cheng N, et al. Sex-specific and dose-response relationship between the incidence of gallstones and components of the metabolic syndrome in Jinchang Cohort: a prospective study[J]. Biomed Environ Sci, 2020, 33(8): 633-638. DOI: 10.3967/bes2020.084. [7] Bai YN, Yang AM, Pu HQ, et al. Cohort profile: the China metal-exposed workers cohort study (Jinchang Cohort)[J]. Int J Epidemiol, 2017, 46(4): 1095-1096e. DOI: 10.1093/ije/dyw223. [8] Ding J, Chen X, Bao K, et al. Assessing different anthropometric indices and their optimal cutoffs for prediction of type 2 diabetes and impaired fasting glucose in Asians: the Jinchang Cohort study[J]. J Diabetes, 2020, 12(5): 372-384. DOI: 10.1111/1753-0407.13000. [9] Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity[J]. Circulation, 2009, 120(16): 1640-1645. DOI: 10.1161/CIRCULATIONAHA.109.192644. [10] Zhu Q, Sun X, Ji X, et al. The association between gallstones and metabolic syndrome in urban Han Chinese: a longitudinal cohort study[J]. Sci Rep, 2016, 6: 29937. DOI: 10.1038/srep29937. [11] Hsu HY, Huang CY, Hwang LC. Sex difference of the predictive value of BMI, waist circumference and percentage body fat mass for gallstone disease[J]. Br J Nutr, 2019, 121(8): 955-960. DOI: 10.1017/S000711451900028X. [12] 刘福东, 梁宏光. 胆囊结石患者绝经前后脂联素水平影响雌激素分泌及对胆结石形成的相关性分析[J]. 中国妇幼保健, 2014, 29(18): 2862-2863. DOI: 10.7620/zgfybj.j.issn.1001-4411.2014.18.11.Liu FD, Liang HG. The influence of adiponectin level on estrogen secretion and the correlation analysis of gallstone formation in patients with gallstone before and after menopause[J]. Maternal and Child Health Care in China, 2014, 29(18): 2862-2863. DOI: 10.7620/zgfybj.j.issn.1001-4411.2014.18.11. [13] Lin IC, Yang YW, Wu MF, et al. The association of metabolic syndrome and its factors with gallstone disease[J]. BMC Fam Pract, 2014, 15: 138. DOI: 10.1186/1471-2296-15-138. -
