女性流产次数对代谢综合征的影响研究
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摘要
背景近年来,代谢综合征的患病率呈上升趋势,然而代谢综合征病因尚未明确,目前认为是多基因和多种环境因素相互作用的结果。目前关于流产史与代谢综合征的流行病学研究非常有限。目的探讨女性流产次数对代谢综合征的影响。方法选取2014—2016年参与泸州地区2型糖尿病流行病学调查的2 829例资料完整的女性,问卷调查一般资料,记录体格检查、实验室检查结果。采用Logistic回归分析流产次数对代谢综合征的影响。结果 2 829人中发生代谢综合征1 089人(38.49%)。发生代谢综合征与未发生代谢综合征流产次数分布、人工流产次数分布比较,差异均有统计学意义(P<0.05);发生代谢综合征者年龄、体质指数(BMI)、腰围、臀围、收缩压、舒张压、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、肌酐水平高于未发生代谢综合征者,饮酒率、高密度脂蛋白胆固醇(HDL-C)水平低于未发生代谢综合征者(P<0.05)。多因素Logistic回归分析显示,在控制年龄、饮酒、BMI、腰围、臀围、收缩压、舒张压、FPG、2 hPG、HbA1c、TC、TG、HDL-C、LDL-C、ALT、AST、GGT、肌酐水平等影响后,有1次、2次、3次及>3次流产史女性发生代谢综合征分别是无流产史女性的1.582[95%CI(1.096,2.284),P=0.014]、1.680[95%CI(1.148,2.456),P=0.008]、2.259[95%CI(1.440,3.545),P<0.001]、2.266[95%CI(1.355,3.789),P=0.002]倍;有1次、2次、3次及>3次人工流产史女性发生代谢综合征分别是无人工流产史女性的1.465[95%CI(1.026,2.091),P=0.035]、1.689[95%CI(1.156,2.469),P=0.007]、2.151[95%CI(1.369,3.380),P=0.001]、1.947[95%CI(1.144,3.315),P=0.014]倍。结论女性流产次数及人工流产次数与代谢综合征的发生有相关性,并且随着女性流产次数的增加,代谢综合征的发生风险增高。
Backgroud In recent years,the prevalence of metabolic syndrome(MS)is on the rise.However,the etiology of MS is not yet clear,it is now believed to be the result of interaction between multiple genes and multiple environmental factors.The epidemiological studies on the association between number of abortions and the prevalence of MS are very limited now.Objective To investigate the association between number of abortions and the prevalence of MS.Methods Totaled 2 829 women with complete data who participated in the epidemiological investigation of type 2 diabetes in Luzhou region from 2014 to 2016 were selected.Clinical data were collected through a questionnaire survey.All of them underwent physical examination and laboratory test and the results were recorded.Multivariate Logistic regression was used to investigate the association between the number of abortions and the prevalence of MS.Results Of the 2 829 participants,1 089 had MS(38.49%).There were significant differences in distribution of number of abortions and artificial abortions between patients with MS and those without MS(P<0.05).Compared with those without MS,the average age,average body mass index(BMI),waist circumference(WC),hip circumference(HC),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT) and creatinine levels increased but the prevalence of alcohol drinking and average highdensity lipoprotein cholesterol(HDL-C) levels decreased significantly in those with MS(P<0.05).Multivariate Logistic regression analysis showed that,after adjusting for age,drinking,BMI,WC,HC,SBP,DBP,FPG,2 hPG,HbA1 c,TC,TG,HDL-C,LDL-C,ALT,AST,GGT and creatinine levels,the prevalence of MS in women with one,two,three,more than three times of abortion increased by a factor of 1.582[95%CI(1.096,2.284),P=0.014],1.680[95%CI(1.148,2.456),P=0.008],2.259[95%CI(1.440,3.545),P<0.001],2.266[95%CI(1.355,3.789),P=0.002],respectively,compared with those without a history of abortion.The prevalence of MS in women with one,two,three,more than three times of artificial abortion increased by a factor of 1.465[95%CI(1.026,2.091),P=0.035],1.689[95%CI(1.156,2.469),P=0.007],2.151[95%CI(1.369,3.380),P=0.001],1.947[95%CI(1.144,3.315),P=0.014],respectively,compared with those without a history of artificial abortion.Conclusion History of abortion/artificial abortion is strongly associated with an increased risk of MS,and the association is number-dependent.
Backgroud In recent years,the prevalence of metabolic syndrome(MS)is on the rise.However,the etiology of MS is not yet clear,it is now believed to be the result of interaction between multiple genes and multiple environmental factors.The epidemiological studies on the association between number of abortions and the prevalence of MS are very limited now.Objective To investigate the association between number of abortions and the prevalence of MS.Methods Totaled 2 829 women with complete data who participated in the epidemiological investigation of type 2 diabetes in Luzhou region from 2014 to 2016 were selected.Clinical data were collected through a questionnaire survey.All of them underwent physical examination and laboratory test and the results were recorded.Multivariate Logistic regression was used to investigate the association between the number of abortions and the prevalence of MS.Results Of the 2 829 participants,1 089 had MS(38.49%).There were significant differences in distribution of number of abortions and artificial abortions between patients with MS and those without MS(P<0.05).Compared with those without MS,the average age,average body mass index(BMI),waist circumference(WC),hip circumference(HC),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT) and creatinine levels increased but the prevalence of alcohol drinking and average highdensity lipoprotein cholesterol(HDL-C) levels decreased significantly in those with MS(P<0.05).Multivariate Logistic regression analysis showed that,after adjusting for age,drinking,BMI,WC,HC,SBP,DBP,FPG,2 hPG,HbA1 c,TC,TG,HDL-C,LDL-C,ALT,AST,GGT and creatinine levels,the prevalence of MS in women with one,two,three,more than three times of abortion increased by a factor of 1.582[95%CI(1.096,2.284),P=0.014],1.680[95%CI(1.148,2.456),P=0.008],2.259[95%CI(1.440,3.545),P<0.001],2.266[95%CI(1.355,3.789),P=0.002],respectively,compared with those without a history of abortion.The prevalence of MS in women with one,two,three,more than three times of artificial abortion increased by a factor of 1.465[95%CI(1.026,2.091),P=0.035],1.689[95%CI(1.156,2.469),P=0.007],2.151[95%CI(1.369,3.380),P=0.001],1.947[95%CI(1.144,3.315),P=0.014],respectively,compared with those without a history of artificial abortion.Conclusion History of abortion/artificial abortion is strongly associated with an increased risk of MS,and the association is number-dependent.
引文
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[28]TURKDOGAN K A,AKPINAR O,KARABACAK M,et al.Association between oxidative stress index and serum lipid levels in healthy young adults[J].J Pak Med Assoc,2014,64(4):379-381.
[29]MENDOZA-Nú?EZ V M,SáNCHEZ-RODRíGUEZ M A,CORREA-MU?OZ E.Undernutrition and oxidative stress as risk factors for high blood pressure in older Mexican adults[J].AnnNutrMetab,2009,54(2):119-123.DOI:10.1159/000209270.
[30]REMENNICK L I.Induced abortion as cancer risk factor:a review of epidemiological evidence[J].J Epidemiol Community Health,1990,44(4):259-264.
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[3]SONG Q B,ZHAO Y,LIU Y Q,et al.Sex difference in the prevalence of metabolic syndrome and cardiovascular-related risk factors in urban adults from 33 communities of China:the CHPSNE study[J].Diab Vasc Dis Res,2015,12(3):189-198.DOI:10.1177/1479164114562410.
[4]RANASINHAS,JOHAMAE,NORMANRJ,etal.The association between Polycystic Ovary Syndrome(PCOS)and metabolic syndrome:a statistical modelling approach[J].Clin Endocrinol(Oxf),2015,83(6):879-887.DOI:10.1111/cen.12830.
[5]YU H F,CHEN H S,RAO D P,et al.Association between polycystic ovary syndrome and the risk of pregnancy complications:a PRISMA-compliant systematic review and meta-analysis[J].Medicine(Baltimore),2016,95(51):e4863.DOI:10.1097/MD.0000000000004863.
[6]PETERS S A E,YANG L,GUO Y,et al.Pregnancy,pregnancy loss,and the risk of cardiovascular disease in Chinese women:findings from the China Kadoorie Biobank[J].BMC Med,2017,15(1):148.DOI:10.1186/s12916-017-0912-7.
[7]RANTHE M F,DIAZ L J,BEHRENS I,et al.Association between pregnancy losses in women and risk of atherosclerotic disease in their relatives:a nationwide cohort study[J].Eur Heart J,2016,37(11):900-907.DOI:10.1093/eurheartj/ehv549.
[8]LIU Y,LU J,XU M,et al.Association between history of abortion and nonalcoholic fatty liver disease in middle-aged and elderly Chinese women[J].Ann Epidemiol,2013,23(3):119-123.DOI:10.1016/j.annepidem.2012.12.002.
[9]KHARAZMI E,DOSSUS L,ROHRMANN S,et al.Pregnancy loss and risk of cardiovascular disease:a prospective populationbased cohort study(EPIC-Heidelberg)[J].Heart,2011,97(1):49-54.DOI:10.1136/hrt.2010.202226.
[10]ALLISON B J,KAANDORP J J,KANE A D,et al.Divergence of mechanistic pathways mediating cardiovascular aging and developmental programming of cardiovascular disease[J].FASEB J,2016,30(5):1968-1975.DOI:10.1096/fj.201500057.
[11]ALBERTI K G,ECKEL R H,GRUNDY S M,et al.Harmonizing themetabolicsyndrome:ajointinterimstatementofthe 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.
[12]LU J,WANG L,LI M,et al.Metabolic syndrome among adults in China:the 2010 China noncommunicable disease surveillance[J].J Clin Endocrinol Metab,2017,102(2):507-515.DOI:10.1210/jc.2016-2477.
[13]HURTADO-ROCA Y,BUENO H,FERNANDEZ-ORTIZ A,et al.Oxidized LDL is associated with metabolic syndrome traits independently of central obesity and insulin resistance[J].Diabetes,2017,66(2):474-482.DOI:10.2337/db16-0933.
[14]RANI V,DEEP G,SINGH R K,et al.Oxidative stress and metabolic disorders:pathogenesis and therapeutic strategies[J].LifeSci,2016,148(11):183-193.DOI:10.1016/j.lfs.2016.02.002.
[15]YOUN J Y,SIU K L,LOB H E,et al.Role of vascular oxidative stress in obesity and metabolic syndrome[J].Diabetes,2014,63(7):2344-2355.DOI:10.2337/db13-0719.
[16]CARRIER A.Metabolic syndrome and oxidative stress:a complex relationship[J].Antioxid Redox Signal,2017,26(9):429-431.DOI:10.1089/ars.2016.6929.
[17]MARYAM K,BOUZARI Z,BASIRAT Z,et al.The comparison of insulin resistance frequency in patients with recurrent early pregnancy loss to normal individuals[J].BMC Res Notes,2012,5(1):1-5.DOI:10.1186/1756-0500-5-133.
[18]HONG Y,XIE Q X,CHEN C Y,et al.Insulin resistance in first-trimester pregnant women with pre-pregnant glucose tolerance and history of recurrent spontaneous abortion[J].J Biol Regul Homeost Agents,2013,27(1):225-231.
[19]DAGLARK,BIBEROGLUE,KIRBASA,etal.The cellular immunity and oxidative stress markers in early pregnancy loss[J].J Matern Fetal Neonatal Med,2016,29(11):1840-1843.DOI:10.3109/14767058.2015.1064886.
[20]CENGIZH,DAGDEVIRENH,KANAWATIA,etal.Ischemia-modified albumin as an oxidative stress biomarker in early pregnancy loss[J].J Matern Fetal Neonatal Med,2016,29(11):1754-1757.DOI:10.3109/14767058.2015.1061494.
[21]GRANCINIV,TROMBETTAM,LUNATIME,etal.Contributionofβ-celldysfunctionandinsulinresistance tocirrhosis-associateddiabetes:roleofseverityofliver disease[J].J Hepatol,2015,63(6):1484-1490.DOI:10.1016/j.jhep.2015.08.011.
[22]MARTINEZ-HERVAS S,ARTERO A,MARTINEZ-IBA?EZ J,et al.Increased thioredoxin levels are related to insulin resistance in familial combined hyperlipidaemia[J].Eur J Clin Invest,2016,46(7):636-642.DOI:10.1111/eci.12642.
[23]LEE B C,KIM M S,PAE M,et al.Adipose natural killer cells regulate adipose tissue macrophages to promote insulin resistance in obesity[J].Cell Metab,2016,23(4):685-698.DOI:10.1016/j.cmet.2016.03.002.
[24]NIZARJM,DONGW,MCCLELLANRB,etal.Na+-sensitive elevation in blood pressure is ENaC independent in diet-induced obesity and insulin resistance[J].Am J Physiol Renal Physiol,2016,310(9):F812-820.DOI:10.1152/ajprenal.00265.2015.
[25]MAFFEIS C,BANZATO C,BRAMBILLA P,et al.Insulin resistance is a risk factor for high blood pressure regardless of body size and fat distribution in obese children[J].Nutr Metab Cardiovasc Dis,2010,20(4):266-273.DOI:10.1016/j.numecd.2009.04.005.
[26]ITO J,NAKAGAWA K,KATO S,et al.The combination of maternal and offspring high-fat diets causes marked oxidative stress and development of metabolic syndrome in mouse offspring[J].LifeSci,2016,151(1):70-75.DOI:10.1016/j.lfs.2016.02.089.
[27]GERBERPA,RUTTERGA.Theroleofoxidativestress and hypoxia in pancreatic beta-cell dysfunction in diabetes mellitus[J].Antioxid Redox Signal,2017,26(10):501-518.DOI:10.1089/ars.2016.6755.
[28]TURKDOGAN K A,AKPINAR O,KARABACAK M,et al.Association between oxidative stress index and serum lipid levels in healthy young adults[J].J Pak Med Assoc,2014,64(4):379-381.
[29]MENDOZA-Nú?EZ V M,SáNCHEZ-RODRíGUEZ M A,CORREA-MU?OZ E.Undernutrition and oxidative stress as risk factors for high blood pressure in older Mexican adults[J].AnnNutrMetab,2009,54(2):119-123.DOI:10.1159/000209270.
[30]REMENNICK L I.Induced abortion as cancer risk factor:a review of epidemiological evidence[J].J Epidemiol Community Health,1990,44(4):259-264.
[31]XU B,ZHANG J,XU Y,et al.Association between history of abortion and metabolic syndrome in middle-aged and elderly Chinese women[J].Front Med,2013,7(1):132-137.DOI:10.1007/s11684-013-0250-x.
[32]PEDERSEN J M,LUND R,ANDERSEN I,et al.Psychosocial risk factors for the metabolic syndrome:a prospective cohort study[J].Int J Cardiol,2016,215(1):41-46.DOI:10.1016/j.ijcard.2016.04.076.
[33]SLAVICH G M,IRWIN M R.From stress to inflammation and major depressive disorder:a social signal transduction theory of depression[J].Psychol Bull,2014,140(3):774-815.DOI:10.1037/a0035302.
[34]EGEDELE,ELLISC.Diabetesanddepression:global perspectives[J].Diabetes Res Clin Pract,2010,87(3):302-312.DOI:10.1016/j.diabres.2010.01.024.
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