Kev Koom Tes Ntawm Kev Siv Cov Tshuaj Tiv Thaiv Qhov Ncauj (OC) Thiab Qhov tshwm sim ntawm Gout
Mar 21, 2022
Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com
Kev sib koom ua ke ntawm poj niam yug me nyuam Tshawb xyuas cov xwm txheej tshiab thiab cov kab mob gout: kev tshawb fawb thoob teb chaws-raws li kev tshawb fawb ntawm 1 lab tus poj niam postmenopausal
Yeong hee Eun, In-Young Kim & et al.
Abstract
Keeb Kwm: Cov kev tshawb fawb yav dhau los tau qhia tias qhov xwm txheej thiab kev pheej hmoo ntawmgouttxawv raws li kev sib deev. Txawm li cas los xij, kev tshawb fawb me me tau ua tiav ntawm kev sib koom ua ke ntawm kev ua me nyuam thiabgout. Peb tau ua ib qho kev ntsuam xyuas ntawm cov pej xeem nyob thoob plaws lub tebchaws raws li cov poj niam postmenopausal los txiav txim seb puas muaj kev sib koom ua ke ntawm kev ua me nyuam.bthiab qhov tshwm sim ntawmgout.
Txoj Kev: Tag nrho ntawm 1,076,378 tus poj niam tom qab yug menyuam hnub nyoog 40-69 xyoo uas tau koom nrog hauv kev tshuaj xyuas kev noj qab haus huv hauv tebchaws xyoo 2009 tau suav nrog hauv txoj kev tshawb no. Qhov tshwm sim yog qhov tshwm sim ntawm qhov xwm txheejgout, uas tau txhais siv CD-10 code ntawmgout(M1O) nyob rau hauv daim ntawv thov database. Cox proportional hazard qauv tau siv rau kev soj ntsuam thiab kev soj ntsuam stratified raws li lub cev qhov ntsuas qhov ntsuas (BMI) thiab qhov muaj / tsis muaj kab mob raum (CKD) tau ua.
Cov txiaj ntsig: Qhov nruab nrab ncua sij hawm rov qab yog 8.1 xyoo, thiab qhov xwm txheej tshwm sim ntawmgoutyog 64.052 (qhov xwm txheej 7.31 rau 1000 tus neeg-xyoo). Tom qab menarche, ua ntej menopause, thiab luv luv kev ua me nyuam tau cuam tshuam nrog kev pheej hmoo siab ntawmgout. Tsis muaj kev sib raug zoo ntawm parity thiabgoutpom tshwm sim. Kev siv ntawmQhov ncauj contraceptives (OC)thiab kev kho tshuaj hormone hloov pauv (HRT) tau cuam tshuam nrog kev pheej hmoo ntau ntxivgout. Kev sib koom ua ke ntawm cov khoom tsim tawm thiabgouttsis tau txheeb xyuas qhov tseem ceeb hauv pawg BMI siab. Cov teebmeem ntawm OC (tshuaj tiv thaiv qhov ncauj) thiab siv HRT raugouttsis tseem ceeb hauv pawg CKD.
Xaus: luv luv raug rau endogenous estrogen tau txuam nrog kev pheej hmoo siab ntawmgout. Hloov pauv, raug rau exogenous estrogens xws li OC (tshuaj tiv thaiv qhov ncauj)thiab HRT tau cuam tshuam nrog kev pheej hmoo ntau ntxivgout.
Taw qhia
Goutyog qhov mob caj dab feem ntau hauv cov neeg laus, thiab nws qhov xwm txheej tau nce ntxiv nyob rau xyoo tsis ntev los no[1].Goutyog 3-10 zaug ntau dua hauv cov txiv neej dua li poj niam [2]. Txawm li cas los xij, qhov tshwm sim ntawmgoutnce hauv cov poj niam postmenopausal, hos cov poj niam premenopausal tiv thaiv los ntawm uricosuric nyhuv ntawm estrogen [3,4].
Cov kev tshawb fawb epidemiological yav dhau los tau tshawb fawb txog kev sib koom ua ke ntawm kev ua me nyuam thiabgout. Ib qho kev soj ntsuam hla ntawm 1530 cov poj niam tau pom tias cov xwm txheej tom qab yug me nyuam, hnub nyoog ntxov ntawm menarche, thiab keeb kwm ntawmtshuaj tiv thaiv qhov ncaujKev siv (OC) tau cuam tshuam nrog cov ntshav siab uric acid concentration [5]. Kev tshawb nrhiav rov qab los ntawm kev tswj hwm ntawm 13,489 tus poj niam xwm txheejgoutCov neeg mob laus dua 45 xyoo tau pom tias tam sim no siv cov tshuaj estrogen tsis zoo cuam tshuam nrog qhov tsis sib xws ntawm qhov xwm txheej.gout[6]. Hauv Kev Tshawb Fawb Txog Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv, thaum ntxov menopause tau cuam tshuam nrog kev pheej hmoo ntawm qhov xwm txheejgout, thiab kev kho tshuaj hormone hloov pauv (HRT) tau cuam tshuam nrog kev pheej hmoo tsawggout[7]. Txawm li cas los xij, muaj qhov tsis sib haum xeeb tau tshaj tawm hauv lwm cov kev tshawb fawb. Hauv kev tshawb fawb luam tawm xyoo 2008 uas tau txheeb xyuas cov ntaub ntawv los ntawm US National Health and Nutrition Examination Survey (NHANES) los ntawm 1988 txog 1994, nws tau raug tshaj tawm tias menopause yog txuam nrog cov ntshav uric acid ntau dua, thaum HRT cuam tshuam nrog qis uric acid. Qib [8].Qhov sib txawv, ib txoj kev tshawb fawb uas tau txheeb xyuas NHANES cov ntaub ntawv los ntawm 1999 txog 2010 tau hais tias qhov kev pheej hmoo ntawm hyperuricemia tsis cuam tshuam txog kev mob ntshav qab zib lossis kev siv HRT tam sim no [9].
Raws li pom, cov txiaj ntsig ntawm kev sib koom ua ke ntawmgoutthiab poj niam muaj me nyuam yam tseem ceeb heev yog inconclusive. Ntawm cov kev tshawb fawb txog niaj hnub no, cov qauv loj tshaj plaws yog 120, 000 cov ntsiab lus [7, thiab ntau cov kev tshawb fawb tau ua nyob rau hauv cov ntaub ntawv-tswj los yog cross-sectional yam [6-9]. Tsis tas li ntawd, ntau yam kev yug me nyuam tsis tau suav nrog. Hauv cov poj niam ua ntej thiab postmenopausal, qhov cuam tshuam ntawm kev ua me nyuam ntawm cov kab mob tshwm sim yuav txawv [10], thiab cov kev hloov pauv xws li hnub nyoog ntawm cov poj niam cev xeeb tub, kev loj hlob, thiab HRT tsuas yog raug soj ntsuam hauv cov poj niam postmenopausal. Yog li ntawd, nyob rau hauv txoj kev tshawb no, peb tau tshawb xyuas qhov kev koom tes ntawm ntau yam poj niam yug me nyuam yam thiab tshwm sim ntawmgoutnyob rau hauv ib lub teb chaws pejxeem-raws li pawg ntawm cov poj niam postmenopausal.
KEV PAB CUAM CISTANCHE TUBULOSA
Methods Data Resources
Lub Korean National Health Insurance Service (NHIS) yog tsoomfwv cov ntawv pov hwm them nqi ze li 97 feem pua ntawm cov pej xeem nyob hauv Kaus Lim Kauslim. Qhov seem 3 feem pua ntawm cov pej xeem, uas nyob hauv cov nyiaj tau los qis tshaj plaws, kuj tau them los ntawm NHIS los ntawm kev pab kho mob. NHIS cov ntaub ntawv suav nrog cov ntaub ntawv hais txog kev hloov pauv hauv zej zog, kev siv kev noj qab haus huv, kev tshuaj xyuas kev noj qab haus huv, thiab kev tuag ntawm tag nrho cov pejxeem ntawm Kaus Lim Qab Teb [1l, 12]. NHIS muab kev tshuaj ntsuam xyuas kev noj qab haus huv rau txhua tus neeg Kauslim uas muaj hnub nyoog tshaj 40 xyoo thiab txhua tus neeg ua haujlwm tsis hais hnub nyoog li cas txhua xyoo, los ntawm cov ntaub ntawv tshuaj ntsuam xyuas kev noj qab haus huv tau sau. Tsis tas li ntawd, raws li ib feem ntawm National Cancer Screening Program (NCSP), NHIS muab kev kuaj mob qog noj ntshav mis txhua xyoo rau txhua tus poj niam laus dua 40 xyoo. Cov poj niam koom nrog hauv txoj haujlwm kuaj mob qog noj ntshav mis yuav tsum teb rau daim ntawv nug txog lawvkev yug me nyuamkeeb kwm, uas yog sau los ntawm NHIS. NHIS cov ntaub ntawv thiab nws cov ntaub ntawv tshuaj ntsuam xyuas kev noj qab haus huv tau siv dav hauv kev tshawb fawb txog kab mob kis yav dhau los los kawm txog cov txiaj ntsig ntawm poj niam kev yug me nyuam ntawm ntau yam kab mob [13, 14].
Txoj kev tshawb no ua raws li Kev Tshaj Tawm ntawm Helsinki thiab tau txais kev pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Tshawb Fawb ntawm Samsung Medical Center (IRB File No. SMC 2021-01-011), uas tau zam qhov yuav tsum tau ua ntawv tso cai ntawm cov kev kawm, vim tias lawv cov ntaub ntawv yog muaj nyob rau pej xeem thiab tsis qhia npe.
Kawm cov pej xeem
Ntawm 2,721,252 tus poj niam hnub nyoog 40-69 xyoo uas tau koom nrog kev kho mob plawv thiab kev kuaj mob qog noj ntshav hauv lub mis xyoo 2009, 1,369,022 yog postmenopausal. Ntawm lawv, cov ncauj lus uas muaj ib lossis ntau cov ntaub ntawv ploj lawm rau qhov sib txawv ntawm kev txaus siab (n=258,029), cov ntsiab lus uas tau kuaj pomgout(International Classification of Disease 10th revision [ICD-10] code M10) ua ntej kev kuaj mob (n=30,186), thiab cov neeg uas tau kuaj mobgoutlos yog leej twg tuag hauv 1 xyoo ntawm hnub kuaj xyuas kev noj qab haus huv (n=4429) raug tshem tawm los ntawm txoj kev tshawb no. Tag nrho ntawm 1,076,378 cov ntsiab lus thaum kawg suav nrog hauv kev tshuaj xyuas (Daim duab 1).
Tshawb nrhiav cov txiaj ntsig thiab ua raws
Qhov kawg ntawm qhov kev tshawb fawb yog qhov xwm txheejgout, txhais tau tias yog ob qhov kev mus ntsib tus neeg mob sab nraud lossis ib qho kev mus pw hauv tsev kho mob nrog tus lej kuaj mob ntawmgout(ICD-10 code M10). Cov pab pawg tau ua raws li 1 xyoos tom qab hnub kuaj xyuas kev noj qab haus huv mus txog rau hnub tshwm sim, tuag, lossis qhov kawg ntawm txoj kev tshawb no (Lub Kaum Ob Hlis 31, 2018), qhov twg los ua ntej.
TSEEM CEEB CISTANCHE DESERTICOLA
Cov ntaub ntawv khaws tseg
Information on health-related behaviors and reproductive factors was collected through a self-administered questionnaire during health screening and breast cancer screening programs. Age at menarche and age at menopause were collected as continuous variables. Age at menarche was categorized as ≤12years, 13-14years, 15-16years, or>16 xyoo, thiab hnub nyoog ntawm menopause tau categorized li<40years,40-44years,45-49years, 50-54years,="" or≥55years.="" each="" variable="" was="" categorized="" according="" to="" the="" distribution="" of="" the="" korean="" women.="" reproductive="" span="" was="" calculated="" as="" the="" interval="" between="" age="" at="" menarche="" and="" age="" at="" menopause.="" the="" duration="" of=""> (tshuaj tiv thaiv qhov ncauj)siv tau categorized li yeej tsis,
Kev haus luam yeeb raug cais raws li tsis tau, ex-, lossis tus neeg haus luam yeeb tam sim no. Kev haus dej cawv raug cais raws li tsis muaj (0g/hnub), mos (<30g ay),="" or="" heavy="" (≥30g/day).="" regular="" exercise="" was="" defined="" as="" moderate="" physical="" activity="" for="" ≥30min="" at="" least="" 5="" times="" per="" week,="" or="" vigorous="" physical="" activity="" ≥20min="" at="" least="" 3="" times="" per="" week.="" body="" mass="" index(bmi)="" was="" calculated="" using="" the="" body="" weight="" and="" height="" measured="" at="" the="" health="" examination,="" and="" was="" categorized="" as=""><18.5kg ²）,="" nor-mal="" (18.5-23kg/m),="" overweight="" (23-25="" kg/m),="" obese="" （25-30kg/m²）,="" or="" severely="" obese（≥30kg/m²）according="" to="" the="" asia-pacific="" criteria="" of="" the="" world="" health="" organization.="" estimated="" glomerular="" filtration="" rate="" (egfr)="" was="" calculated="" using="" the="" modification="" of="" diet="" in="" renal="" dis-ease="" formula="" using="" the="" creatinine="" measured="" on="" the="" day="" of="" the="" health="" examination="" and="" the="" patient's="" age="" at="" the="" time.="" chronic="" kidney="" disease(ckd)="" was="" defined="" as="" an="" egfr=""><60ml in/1.73m²,="" and="" baseline="" comorbidities="" such="" as="" hypertension,="" diabetes,="" and="" hyperlipidemia="" were="" identified="" through="" a="" combination="" of="" the="" past="" medical="" history="" section="" of="" the="" questionnaire,="" icd-10="" code,="" and="" prescription="" history.="" income="" level="" was="" categorized="" into="" quartiles="" based="" on="" information="" on="" income-based="" premiums="" charged="" by="" health="">
Fig. 1 Flowchart ntawm cov neeg kawm
Kev txheeb cais
Cov kev hloov pauv tsis tu ncua nrog kev faib tawm ib txwm tau qhia raws li qhov nruab nrab ± tus qauv sib txawv (SD), thiab qhov sib txawv ntawm pawg tau qhia raws li tus lej thiab feem pua. Qhov xwm txheej ntawmgouttau suav los ntawm kev faib cov xwm txheej tshwm sim los ntawm tag nrho lub sijhawm ua raws. Cox proportional hazard model tau siv los xam cov kev phom sij txaus ntshai (HRs) thiab 95 feem pua ntawm kev ntseeg siab (CIs) rau kev pheej hmoo ntawm qhov xwm txheejgoutraws li ntau yam kev ua me nyuam. Qauv 1 yog tus qauv tsis hloov kho, thiab Qauv 2 yog tus qauv sib txawv xws li hnub nyoog, hnub nyoog ntawm menarche, hnub nyoog ntawm menopause, lub sijhawm ntawm OC (tshuaj tiv thaiv qhov ncauj)siv, ntev HRT, parity, lub sijhawm pub niam mis, BMI, haus luam yeeb, haus cawv, ua haujlwm tsis tu ncua, kub siab, ntshav qab zib mellitus, hyperlipidemia, mob raum, thiab cov nyiaj tau los. Rau kev tsom xam ntawm covkev yug me nyuamspan, hloov kho version ntawm Model 2- nyob rau hauv uas muaj hnub nyoog ntawm menarche thiab lub hnub nyoog ntawm menopause tau hloov los ntawm reproductive span - yog siv. Txhawm rau tshuaj xyuas qhov cuam tshuam ntawm txhua qhov kev ua me nyuam ntawmgout, cais kev soj ntsuam raws li qhov kev txiav txim ntawm lub sijhawm nruab nrab ntawm cov txheej txheem kev xeeb tub tau ua tiav, txij li cov qauv tsim tshwj xeeb ntawm cov txheej txheem ua me nyuam tseem tsis tau paub meej. Statistical tseem ceeb tau teeb tsa ntawm p<0.05. all="" statistical="" analyses="" were="" performed="" using="" sas="" version="" 9.4(sas="" institute="" inc.,="" cary,="" nc,="">
CISTANCHE EXTRACT
Cov txiaj ntsig
Cov yam ntxwv ntawm lub hauv paus
Cov yam ntxwv tseem ceeb ntawm cov pej xeem txoj kev tshawb fawb stratified los ntawm muaj/tsis muajgoutmuaj nyob rau hauv Table 1. Qhov nruab nrab hnub nyoog ntawm cov kev kawm uas muajgoutthiab tsis muajgoutyog 59.0xyoo thiab 58.5years, feem. Cov poj niam kuaj mob gout muaj BMI siab dua thiab feem pua ntawm cov kab mob sib kis ntau dua li cov poj niam tsis muajgout. Txawm hais tias qhov sib txawv tsis tseem ceeb (tus qauv txhais tau tias sib txawv<0.1), subjects="" diagnosed="" with="">gouttau lig menarche, thaum ntxov menopause, thiab luv luv kev ua me nyuam, thiab muaj ntau dua ntawm kev siv OC. (tshuaj tiv thaiv qhov ncauj), HRT, thiab pub niam mis rau ntau dua lossis sib npaug ntawm lyear piv rau cov ntsiab lus tsis muajgout.
Kev sib koom ntawm qhov xwm txheejgoutthiab endogenous estrogen-txog yam
Qhov nruab nrab ncua sij hawm yog 8.14 ± 1.2 xyoo. Thaum lub sijhawm kawm, 64,052 tus neeg tau kuaj pom tshiabgout(qhov xwm txheej 7.31/1000 tus neeg-xyoo). Hauv cov qauv sib txawv, cov hnub nyoog lig ntawm menarche, lub hnub nyoog thaum ntxov ntawm menopause, thiab luv luv kev ua me nyuam tau cuam tshuam nrog kev pheej hmoo siab ntawmgout(Table 2). Cov poj niam uas muaj menarche tom qab hnub nyoog 16 xyoo muaj kev pheej hmoo siab duagout(hloov HR [aHR] 1.10,95 feem pua CI 1.02-1.19) dua li cov poj niam uas raug mob menarche ua ntej hnub nyoog 12. Piv rau cov poj niam uas muaj hnub nyoog 50-54 xyoo ntawm cov poj niam cev xeeb tub, qhov kev pheej hmoo ntawmgoutyog siab dua rau cov poj niam uas muaj menopause ua ntej hnub nyoog 50 xyoo (<40years [ahr="" 1.12,95%="" ci="" 1.06-1.19],="" 40-44="" year="" [ahr="" 1.06,="" 95%ci="" 1.02-1.10]="" and="" 45-49years="" [ahr="" 1.03,95%="" ci="" 1.01-1.04])="" and="" lower="" in="" women="" who="" had="" menopause="" after="" the="" age="" of="" 55="" (ahr="" 0.97,95%="" ci="" 0.94-0.99).="" when="" compared="" to="" women="" with="" a="" reproductive="" span="" ≥40years,="" those="" with="" a="" reproductive="" span=""><35years had="" a="" higher="" risk="" of="">gout:<30years(ahr 1.10,95%="" ci1.06-1.14)="" and="" 30-34years="" (ahr="" 1.06,95%ci="" 1.02-1.09)="">
Kev sib koom ntawm qhov xwm txheejgoutthiab exogenous estrogen-txog yam
Kev pheej hmoo ntawm qhov xwm txheejgouttau siab dua hauv cov neeg siv OC (tshuaj tiv thaiv qhov ncauj)piv rau cov poj niam uas tsis tau siv OC (tshuaj tiv thaiv qhov ncauj) (aHR 1.03, 95 feem pua CI 1.00-1.06 hauv cov neeg siv OC<1year vs.ahr="" 1.05,95%="" ci="" 1.02-1.08="" in="" those="" who="" used="" oc≥lyear).="" the="" use="" of="" hrt="" was="" also="" associated="" with="" an="" increased="" risk="" of="">gout, and the risk was highest among those who used HRT for>5years(aHR 1.19,95 feem pua CI1.14-1.23).
Kev sib koom ntawm qhov xwm txheejgoutthiab muaj feem cuam tshuam txog kev xeeb tub
Parity tsis cuam tshuam qhov kev pheej hmoo ntawmgout. Piv nrog rau cov neeg uas tsis tau pub niam mis, cov uas tau pub niam mis rau<6months had="" a="" lower="" risk="" of="">gout(aHR {{0}}.93,95 feem pua CI 0.89-0.97). Txawm li cas los xij, cov neeg uas pub niam mis rau ntau dua lossis sib npaug li 6 lub hlis tsis muaj kev cuam tshuam nrog kev pheej hmoogout(aHR {{0}}.98, 95 feem pua CI 0. },95 feem pua CI 0.
Kev tsom xam stratified
Table 3 qhia txog qhov cuam tshuam ntawm kev ua menyuam yaus ntawm qhov kev pheej hmoo ntawm qhov xwm txheejgoutHauv cov poj niam stratified los ntawm lawv cov BMI. Kev sib raug zoo ntawm lub hnub nyoog ntawm menarche thiab xwm txheejgouttxawv raws li pawg BMI (p rau Interac-tion=0.0033). Lub hnub nyoog lig ntawm menarche tau pom meej meej nrog kev pheej hmoo ntawmgoutin the overweight group (aHR 1.30, 95% CI 1.09-1.55 in those aged 13-14years vs.aHR 1.30,95% CI 1.09-1.54 in those aged 15-16years vs.aHR 1.34,95% CI 1.13-1.60 in those>16 xyoo). Qhov kev pheej hmoo tsis yog qhov tseem ceeb hauv cov pab pawg ib txwm muaj thiab tsis muaj zog, tab sis qhov kev pheej hmoo ntawm kev pheej hmoo nrog hnub nyoog ntawm menarche tseem tau pom. Txawm li cas los xij, hauv pawg rog rog thiab rog rog hnyav, tsis muaj kev sib koom ua ke ntawm hnub nyoog ntawm menarche thiab kev pheej hmoo ntawmgout. Kev sib raug zoo ntawm lwm yam kev yug me nyuam thiab qhov xwm txheejgoutwas not affected by BMI(p for interaction >0.05).
Nyob rau hauv ib qho kev soj ntsuam stratified raws li muaj/tsis muaj CKD, lub koom haum ntawm lub hnub nyoog ntawm menarche, hnub nyoog ntawm menopause, reproductive span, parity, thiabgoutrisk did not differ between the groups (Table 4). Breast-feeding for >6 lub hlis hauv pawg CKD tau cuam tshuam nrog kev pheej hmoo tsawggout(aHR {{0}}}86,95 feem pua CI 0.77-0.97 hauv cov uas tau pub niam mis rau 6-12 hli vs. aHR { {10}}.89,95 feem pua CI 0. OC (tshuaj tiv thaiv qhov ncauj) use for>1year (aHR 1.05,95 feem pua CI 1.01-1.08) thiab HRT(aHR 1.17,95 feem pua CI 1.14-1.20 nrog kev siv rau<2years vs.ahr="" 1.18,95%="" ci="" 1.13-1.22="" with="" usage="" for="" 2-5years="" vs.="" ahr="" 1.23,95%="" ci="" 1.17-1.28="" with="" usage="" for="" ≥5years)showed="" a="" high="" risk="" of="" incident="">gouttsuas yog hauv pab pawg tsis muaj CKD.
CISTANCHE MATERIAL
Kev sib tham
Nyob rau hauv lub teb chaws loj no cov pej xeem-raws li pawg ntawm cov poj niam postmenopausal, lig menarche, thaum ntxov menopause, thiab luv luv kev loj hlob ncua sij hawm yog txuam nrog muaj feem xyuam rau qhov teeb meem.gout. Kev siv OC (tshuaj tiv thaiv qhov ncauj)thiab HRT kuj tseem cuam tshuam nrog kev pheej hmoo ntxiv ntawmgout. Kev sib koom ua ke ntawm cov khoom tsim tawm thiabgoutCov poj niam rog rog tsawg heev thiab cov poj niam uas muaj CKD.
Peb cov txiaj ntsig tau zoo ib yam nrog cov Kws Saib Xyuas Kev Noj Qab Haus Huv Kev Tshawb Fawb, uas tau pom tias thaum ntxov menopause tau cuam tshuam nrog kev pheej hmoo ntawm qhov xwm txheej.gout[7]. Estrogen tuaj yeem ua lub luag haujlwm tiv thaiv hauv hyperuricemia thiabgoutlos ntawm kev txhawb nqa lub raum tshem tawm ntawm uric acid [3,15]. Ib txoj kev tshawb nrhiav ntu ntu hauv tebchaws Yelemes kuj tau pom tias muaj hnub nyoog ntxov ntawm menarche thiab postmenopausal xwm txheej muaj feem xyuam rau cov ntshav uric acid ntau dua [5]. Hauv kev tshawb nrhiav ntu ntu ntawm 58,870 cov poj niam hnub nyoog nruab nrab Kauslim, qhov tshwm sim ntawm hyperuricemia tau nce ntxiv nrog rau kev hloov pauv ntawm tus neeg laus [16. Qhov no qhia tau hais tias qib premenopausal ntawm estrogen ua rau cov ntshav uric acid thiab txo qhov kev pheej hmoo ntawmgout. Tsis tas li ntawd, txij li thaum estrogen txhawb txoj kev loj hlob ntawm macrophages mus rau IL10- nyob ntawm qhov tau txais kev ua haujlwm tsis zoo thiab tej zaum yuav muaj kev tiv thaiv kab mob, kev hloov hauv cov tshuaj estrogen tuaj yeem cuam tshuam rau qhov pib ntawm cov kab mob xws ligout[17].
Table 1 Cov yam ntxwv tseem ceeb ntawm cov pej xeem txoj kev kawm stratified los ntawm qhov muaj / tsis muaj gout
OC (tshuaj tiv thaiv qhov ncauj)kev siv tau txuam nrog kev pheej hmoo siab ntawmgout. Hauv kev kawm KORA F4, kev siv OC tam sim no (tshuaj tiv thaiv qhov ncauj)tsis cuam tshuam rau qib uric acid, tab sis yav dhau los siv OC (tshuaj tiv thaiv qhov ncauj)muaj feem xyuam rau qhov siab uric acid concentration [5]. Txij li thaum peb txoj kev tshawb fawb suav nrog tsuas yog cov poj niam postmenopausal, tag nrho cov kev kawm uas siv OC (tshuaj tiv thaiv qhov ncauj)sib raug rau cov neeg siv yav dhau los ntawm OC (tshuaj tiv thaiv qhov ncauj). Qhov no zoo ib yam nrog cov txiaj ntsig ntawm kev tshawb fawb yav dhau los. Kev tshawb fawb ntxiv yog xav tau los soj ntsuam seb qhov kev raug exogenous estrogen thaum muaj hnub nyoog li cas yog txuam nrog nce ntxiv.goutKev pheej hmoo thiab qib uric acid hauv cov poj niam postmenopausal.
Hauv txoj kev tshawb no, HRT tau nce qhov kev pheej hmoo ntawm qhov xwm txheejgout. Qhov no cuam tshuam cov txiaj ntsig ntawm Kev Tshawb Fawb Kev Noj Qab Haus Huv, uas tau qhia tias kev siv HRT tam sim no cuam tshuam nrog kev txo qis ntawm qhov xwm txheej.gout[7], thiab Kev Tshawb Fawb Txog Lub Plawv thiab Estrogen-Progestin Hloov [18] thiab kev tshawb fawb rov qab tsis ntev los no [19], cov uas tau pom tias cov tshuaj estrogen ntxiv rau kev kho progestin cuam tshuam nrog kev txo qis hauv uric acid. Cov kev tshawb fawb yav dhau los tau faib HRT siv tsis tau, yav dhau los, thiab siv tam sim no, yog li nws tsis tuaj yeem ncaj qha piv nrog peb txoj kev tshawb fawb, uas tau faib HRT los ntawm lub sijhawm siv. Txawm li cas los xij, qhov sib txawv no yuav tshwm sim vim tias muaj cov xwm txheej tsis zoo, xws li kev hloov pauv lipid ntsig txog kev siv HRT, tuaj yeem cuam tshuam qhov tshwm sim.gout. Raws li lwm qhov ua tau, txij li cov neeg siv HRT raug kev txom nyem los ntawm estrogen deficiency, lawv ncegoutQhov kev pheej hmoo tuaj yeem yog vim qhov cuam tshuam ntawm estrogen tsis txaus thiab tsis yog HRT. Vim tias muaj qhov sib txawv hauv lub luag haujlwm ntawm HRT ntawmgoutnruab nrab ntawm cov kev tshawb fawb yav dhau los thiab peb txoj kev tshawb fawb, yuav tsum tau ceev faj txog kev txhais cov txiaj ntsig ntawm peb txoj kev tshawb fawb, thiab cov txiaj ntsig kev tshawb fawb ntxiv yuav tsum tau ua kom paub tseeb tias qhov cuam tshuam ntawm HRT ntawm gout.
Hauv peb txoj kev tshawb fawb, kev sib luag tsis cuam tshuam nrog qhov xwm txheejgout. Qhov no yuav raug txhais raws li txoj kev tshawb fawb KORA F4, uas tau qhia tias tsis muaj kev koom tes ntawm hyperuricemia thiab parity nyob rau hauv 1530 cov poj niam hnub nyoog 32-81 xyoo nyob rau yav qab teb lub teb chaws Yelemees [5]. Cov kev tshawb fawb yav dhau los tau qhia tias kev sib luag yog txuam nrog kev pheej hmoo ntawm ntau yam kab mob xws li kab mob plawv thiab cov tshuaj hormonal thiab metabolic cuam tshuam txog kev xeeb tub yog cov txheej txheem ua tau rau qhov no [20, 21]. Nyob rau hauv cov ntaub ntawv ntawmgout, kev tshawb fawb-nrog rau peb-tau qhia tias tsis muaj kev sib koom ua ke ntawmgoutthiab parity, tab sis kev tshawb fawb ntxiv yog xav tau kom paub meej qhov no. Thaum cev xeeb tub, niam txiv plasma estradiol qib nce zuj zus [22]. Cov tshuaj estrogen yog tsim nyob rau hauv lub corpus luteum ua ntej cev xeeb tub thiab nyob rau hauv thaum ntxov ua sawv ntawm cev xeeb tub, tab sis tom qab 9 lub lis piam ntawm cev xeeb tub thaum lub hormonal zes qe menyuam hloov mus rau hauv lub placenta hloov, lub placenta yog lub ntsiab ntau lawm qhov chaw ntawm estrogen [23]. Nyob rau hauv thaum ntxov postpartum lub sij hawm tom qab cev xeeb tub, lub zes qe menyuam muaj nuj nqi yog suppressed, thiab nyob rau hauv feem ntau cov poj niam uas tsis yog lactating, ovulation tsis tshwm sim txog 6 lub lis piam tom qab yug me nyuam [24]. Ib txoj kev tshawb fawb hla ntu tau pom tias cov poj niam uas yug hauv 3 xyoos tau qis dua cov zis estradiol metabolite ntau dua piv rau cov poj niam nulliparous [25]. Muaj ib txoj kev tshawb fawb qhia tias parity yog inversely txuam nrog dawb estradiol qib nyob rau hauv cov poj niam postmenopausal [26]. Cov kev tshawb pom no qhia tias kev sib luag muaj feem cuam tshuam nrog kev cuam tshuam rau qib siab endogenous estrogen thaum cev xeeb tub, tab sis tej zaum yuav cuam tshuam nrog kev txo qis rau cov tshuaj estrogen tom qab ntawd. Muaj peev xwm piav qhia txog qhov tsis muaj kev sib koom ua ke ntawm kev sib luag thiab qhov xwm txheejgoutHauv peb txoj kev tshawb fawb yog tias qhov kev hloov pauv hauv qib estrogen vim qhov sib luag tsis txaus los cuam tshuam qhov tshwm sim ntawmgout, los yog qhov sib txawv ntawm lwm yam cuam tshuam txog kev sib luag, xws li kev coj cwj pwm kev noj qab haus huv cuam tshuam txog kev sib luag thiab kev yug me nyuam, lossis kev kho mob ntawm cov poj niam parous, ua raws li qhov tsis txaus ntseeg hauv qhov tshwm sim ntawmgout.
Table 2 Hazard ratios thiab 95 feem pua ntawm kev ntseeg siab rau qhov xwm txheej gout raws li ntau yam kev ua me nyuam
Rau peb txoj kev paub, peb txoj kev tshawb fawb yog thawj zaug tshawb fawb txog kev sib raug zoo ntawm kev pub niam mis thiabgout, thiab peb cov txiaj ntsig tau qhia tias kev pub niam mis rau<6months is="" associated="" with="" a="" low="" risk="" of="" incident="">gout. Tsis muaj kev koom tes tseem ceeb nrog kev pheej hmoo ntawmgoutwhen the breastfeeding period was>6 hli. Qhov ua tau mechanisms rau qhov txawv los ntawmgoutnyob ntawm lub sijhawm pub niam mis yog raws li hauv qab no. Txij li thaum pub niam mis txhawb kev poob phaus tom qab yug menyuam, kev pub niam mis rau lub sijhawm luv luv tuaj yeem ua lub luag haujlwm tiv thaiv kev loj hlob ntawmgoutlos ntawm kev poob phaus [27]. Kev pub niam mis mus ntev inhibits ovulation thiab ua rau gonadotropin inhibition, ua rau txo qis hauv plasma estradiol ntau lawm [28]. Estrogen kuj tseem ua lub luag haujlwm tiv thaiv hauv hyperuricemia, yog li kev pub niam mis ntev ntev yuav tsis muaj kev tiv thaiv raugout. Txawm li cas los xij, qib ntawm kev sib koom ua ke ntawm kev pub niam mis thiab gout tsis muaj zog hauv peb txoj kev tshawb fawb, thiab thaum lwm yam kev yug me nyuam tau raug kho rau, lub koom haum zoo li tsis muaj zog. Yog li ntawd, nws muaj peev xwm hais tias lwm yam uas tsis tau hloov kho rau tej zaum yuav ua rau lub luag haujlwm tsis meej pem.
Ib qho kev soj ntsuam stratified tau pom tias muaj kev sib koom ua ke ntawm kev ua me nyuam thiabgoutkuj tsis muaj zog nyob rau hauv cov rog hnyav thiab CKD pawg. Kev rog rog thiab CKD yog qhov paub zoo txog kev pheej hmoo raugout[29-31], thiab nws muaj peev xwm hais tias cov kev ua me nyuam muaj feem cuam tshuam me me raugouttshwm sim nyob rau hauv cov poj niam uas muaj tej yam txaus ntshai. Tsis tas li ntawd, txij li cov ntaub so ntswg adipose metabolizes thiab secretes poj niam txiv neej cov tshuaj hormones [32], nws muaj peev xwm hais tias estrogen deficiency nyob rau hauv cov poj niam postmenopausal yog kuj alleviated nyob rau hauv cov neeg mob rog rog thiab hais tias cov nyhuv ntawm cov me nyuam yug me nyuam.
Peb txoj kev tshawb fawb muaj ntau yam kev txwv. Ua ntej, cov ntaub ntawv hais txog kev yug me nyuam tau sau tom qab hnub nyoog 40 xyoo, yog li muaj peev xwm rov qab tsis ncaj ncees lawm. Qhov thib ob, vim hais tias cov ntaub ntawv tau raug sau ua ntej los ntawm daim ntawv nug uas muab los ntawm qhov kev pab cuam tshuaj ntsuam xyuas kev noj qab haus huv hauv tebchaws, kev faib cov khoom raug txwv, thiab cov ntaub ntawv xws li hom lossis koob tshuaj HRT thiab OC. (tshuaj tiv thaiv qhov ncauj)yuav tsis tau. Hauv OC (tshuaj tiv thaiv qhov ncauj), vim tsuas yog ua ke OCs (tshuaj tiv thaiv qhov ncauj)yog siv nyob rau hauv Kauslim tsuas yog thaum sawv ntxov-tom qab ntsiav tshuaj, nws tuaj yeem kwv yees tias feem ntau OC (tshuaj tiv thaiv qhov ncauj)cov neeg siv tau ua ke OC (tshuaj tiv thaiv qhov ncauj)cov neeg siv. Txawm li cas los xij, rau HRT, ntau yam tshuaj, cov qauv tsim, thiab cov khoom xyaw xws li cov tshuaj sib xyaw ua ke ntawm estrogen thiab progestin lossis estrogen-tsuas yog siv, thiab muaj cov kev tshawb fawb yav dhau los uas pom muaj qhov sib txawv ntawm cov uric acid nyob ntawm cov khoom xyaw [6,19]. Yog li qhov tsis muaj peev xwm suav nrog HRT cov ntaub ntawv ntxaws hauv kev tshuaj xyuas yog ib qho kev txwv tseem ceeb ntawm peb txoj kev tshawb fawb. Thib peb, txij li qib uric acid tsis suav nrog hauv cov khoom kuaj xyuas kev noj qab haus huv, qhov cuam tshuam ntawm kev ua me nyuam ntawm qib uric acid tsis tuaj yeem tshawb xyuas. Plaub, kev suav nrog ntau yam kev yug me nyuam hauv tus qauv yuav qhia txog kev pheej hmoo ntawm kev sib tsoo thiab kev tsis sib haum xeeb. Txawm li cas los xij, thaum qhov kev hloov pauv hloov pauv hloov pauv (VIF), uas yog qhov ntsuas ntawm tus lej ntawm ntau qhov sib txawv, tau suav, txhua qhov kev hloov pauv hloov pauv muaj VIF qhov tseem ceeb ntawm 1.0 lossis 1.1, sib xws rau VIF<2.5, which="" is="" a="" conservative="" level="" without="" concern="" of="" multicollinearity.="" also,="" when="" separate="" analyzes="" according="" to="" variables="" were="" performed="" according="" to="" the="" time="" order="" of="" reproductive="" factors,="" the="" association="" between="" reproductive="" factors="" and="" incident="">gouttau pom nyob rau hauv tib txoj kev (Table Ntxiv S1-S5). Txawm hais tias cov kev txwv no, peb txoj kev tshawb fawb tseem ceeb uas peb tau kawm txog kev koom tes ntawm qhov tshwm simgoutthiab ntau yam kev ua me nyuam hauv ib lub teb chaws loj-raws li cov poj niam postmenopausal.
Peb txoj kev tshawb fawb tau pom qhov tsis sib haum xeeb hauv qhov raug rau cov poj niam endogenous poj niam txiv neej cov tshuaj hormones txo qhov kev pheej hmoo ntawmgout, thaum raug cov tshuaj hormones exogenous ua rau muaj kev pheej hmoo ntawmgout. Txawm hais tias qhov ua rau ntawm qhov no tsis tuaj yeem piav qhia meej, nws xav tias cov tshuaj hormones endogenous thiab exogenous muaj qhov sib txawv ntawm lub cev ntawm lub cev. Cov txiaj ntsig ntawm kev tshawb fawb tau qhia tias lub cev muaj zog thiab OC (tshuaj tiv thaiv qhov ncauj)cuam tshuam rau lub raum electrolyte tuav txawv [33] thiab qhov exogenous progesterone inhibits hypothalamic-pituitary-adrenal axis (tsis zoo li endogenous progesterone) [34] nce kev ntseeg tau ntawm qhov kev piav qhia no. Kev tshawb fawb ntxiv yog xav tau ntawm yuav ua li cas endogenous thiab exogenous cov tshuaj hormones yuav ua txawv nrog rau uric acid metabolism thiab kev loj hlob ntawmgout.
Fig. 2 Kho qhov xwm txheej txaus ntshai thiab 95 feem pua ntawm kev ntseeg siab (CIs) rau qhov tshwm sim ntawm gout raws li kev ua me nyuam.
Cov qauv sib txawv muaj xws li hnub nyoog, kev loj hlob, kev siv tshuaj tiv thaiv kab mob hauv qhov ncauj, kev kho tshuaj hormone hloov, kev sib luag, kev pub niam mis, lub cev qhov hnyav, kev haus luam yeeb, haus dej cawv, kev tawm dag zog tsis tu ncua, kub siab, ntshav qab zib mellitus, hyperlipidemia, mob raum, thiab cov nyiaj tau los.
Cov lus xaus
Peb pom tias luv luv raug rau endogenous estrogen cuam tshuam nrog kev pheej hmoo ntawm qhov xwm txheejgout. Exogenous estrogens, xws li OC (tshuaj tiv thaiv qhov ncauj)thiab HRT, tau cuam tshuam nrog kev pheej hmoo siab ntawm qhov xwm txheejgout. Txawm li cas los xij, lub koom haum no tsis muaj zog hauv cov poj niam rog rog thiab cov poj niam uas muaj CKD. Cov kev tshawb fawb tom ntej yog xav tau los txheeb xyuas ntxiv cov txheej txheem los ntawm cov txheej txheem kev xeeb tub cuam tshuam rau txoj kev loj hlobgout.
DRAGON HERB: CISTANCHE
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