Cholelithiasis

胆石症
  • 文章类型: Journal Article
    在消化系统疾病中,末梢细胞与组织平滑肌动力学的调节密切相关。它们广泛分布于胆道系统,并通过CCK的调节及其对平滑肌细胞的电生理作用等机制对胆道运动产生影响。探讨端粒细胞与良性胆道疾病的关系,如胆囊结石疾病和胆道扩张综合征,我们对受这些条件影响的组织进行了组织病理学分析。此外,我们进行了端粒细胞的免疫组织化学和免疫荧光双重染色实验。结果表明,与对照组相比,病理条件下胆囊和胆管中的端粒细胞数量明显减少。这揭示了端粒细胞数量减少与胆囊运动受损和胆道纤维化之间的密切关系。此外,进一步的研究表明,胆固醇胆结石中的端细胞与胆囊收缩素-A受体(CCK-AR)之间存在相关性,表明胆固醇水平升高可能会损害端细胞,导致CCK-AR的数量减少,并最终导致胆囊运动受损。因此,我们假设端粒细胞可能在维持胆道稳态中起关键作用,它们的缺乏可能与良性胆道疾病的发展有关,包括胆结石疾病和胆道扩张。
    Telocytes are closely associated with the regulation of tissue smooth muscle dynamics in digestive system disorders. They are widely distributed in the biliary system and exert their influence on biliary motility through mechanisms such as the regulation of CCK and their electrophysiological effects on smooth muscle cells. To investigate the relationship between telocytes and benign biliary diseases,such as gallbladder stone disease and biliary dilation syndrome, we conducted histopathological analysis on tissues affected by these conditions. Additionally, we performed immunohistochemistry and immunofluorescence double staining experiments for telocytes. The results indicate that the quantity of telocytes in the gallbladder and bile duct is significantly lower in pathological conditions compared to the control group. This reveals a close association between the decrease in telocyte quantity and impaired gallbladder motility and biliary fibrosis. Furthermore, further investigations have shown a correlation between telocytes in cholesterol gallstones and cholecystokinin-A receptor (CCK-AR), suggesting that elevated cholesterol levels may impair telocytes, leading to a reduction in the quantity of CCK-AR and ultimately resulting in impaired gallbladder motility.Therefore, we hypothesize that telocytes may play a crucial role in maintaining biliary homeostasis, and their deficiency may be associated with the development of benign biliary diseases, including gallstone disease and biliary dilation.
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  • 文章类型: Journal Article
    流行病学研究表明,饮食习惯可以影响胆石症的风险,但是这种关系还不清楚。我们使用了一项全面的孟德尔随机(MR)研究来探讨饮食习惯与胆石症之间的关系。
    18种饮食习惯分为6类:肉类食品,谷物,蔬菜,水果,乳制品,饮料,和调味品。胆石病数据来自GWAS荟萃分析和FinnGen联盟。逆方差加权(IVW),加权中位数(WM),MR-Egger方法被用作主要的MR分析方法。此外,进行了多敏感性分析和荟萃分析以验证结果的稳健性.
    干果摄入量[比值比(OR)=0.568;95%置信区间(CI),0.405-0.797;p=0.001]被发现可以降低胆石症的风险。敏感性分析和荟萃分析显示了干果摄入量与胆石症之间关系的可靠结果。
    我们的研究发现,干果摄入量是胆石症发展的保护因素。然而,行动机制需要进一步探索。
    UNASSIGNED: Epidemiological studies show dietary habits can have an impact on the risk of cholelithiasis, but the relationship is still unclear. We used a comprehensive Mendelian randomization (MR) study to explore the relationship between dietary habits and cholelithiasis.
    UNASSIGNED: The 18 dietary habits were divided into six categories: meat foods, cereals, vegetables, fruits, dairy products, beverages, and condiments. Cholelithiasis data came from a GWAS meta-analysis and the FinnGen consortium. The inverse variance weighted (IVW), the weighted median (WM), and MR-Egger approaches were used as the main MR analysis methods. In addition, multiple sensitivity analysis and meta-analysis were performed to verify the robustness of the results.
    UNASSIGNED: Dried fruit intake [odds ratio (OR) = 0.568; 95% confidence interval (CI), 0.405-0.797; p = 0.001] was discovered to reduce the risk of cholelithiasis. The sensitivity analysis and meta-analysis showed reliable results for the relationship between dried fruit intake and cholelithiasis.
    UNASSIGNED: Our study found that dried fruit intake is a protective factor in the development of cholelithiasis. However, the mechanisms of action need to be further explored.
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  • 文章类型: Journal Article
    胆石症是一种常见的胆道疾病。然而,胆结石形成的确切机制尚不清楚.粘蛋白在胆固醇和色素结石的核形成和生长中起着至关重要的作用。粘蛋白分泌过多可导致胆汁淤积和胆囊活动减少,进一步促进结石的形成和生长。此外,胆结石可能导致炎症和炎症因子的分泌,可以进一步增加粘蛋白的表达和分泌,促进胆结石的生长。本文系统地总结和分析了粘蛋白在胆结石发生发展中的作用及其相关机制,为结石形成或复发的干预探索新思路。
    Cholelithiasis is a common biliary tract disease. However, the exact mechanism underlying gallstone formation remains unclear. Mucin plays a vital role in the nuclear formation and growth of cholesterol and pigment stones. Excessive mucin secretion can result in cholestasis and decreased gallbladder activity, further facilitating stone formation and growth. Moreover, gallstones may result in inflammation and the secretion of inflammatory factors, which can further increase mucin expression and secretion to promote the growth of gallstones. This review systematically summarises and analyses the role of mucins in gallstone occurrence and development and its related mechanisms to explore new ideas for interventions in stone formation or recurrence.
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  • 文章类型: Journal Article
    接触环境化学物质的混合物可能会导致胆结石,但证据仍然模棱两可.本研究旨在探讨邻苯二甲酸盐代谢产物与胆结石的关系,探索他们的调解人。
    对2017-2018年美国成年人(≥20岁)的国家健康和营养调查数据进行了分析,以通过采用调查加权逻辑回归来探索邻苯二甲酸酯代谢物与胆结石之间的关联。限制三次样条(RCS),加权分位数和(WQS)回归,和贝叶斯核机回归(BKMR)。中介分析检查了氧化应激标志物的作用,炎症标志物,代谢综合征,身体成分,糖尿病,和胰岛素。
    当前研究包括1,384名参与者,代表200.6亿美国成年人。我们的结果表明邻苯二甲酸酯代谢物之间存在显著关联,特别是高分子量代谢物,如邻苯二甲酸二(2-乙基己基)酯(DEHP)和1,2-环己烷二羧酸二异壬酯(DINCH),和胆结石。此外,调解分析表明,邻苯二甲酸酯代谢物可能通过影响胰岛素分泌在胆结石的发展中起作用。亚组分析未显示显著的相互作用。
    接触邻苯二甲酸盐与胆结石发生之间的关联,从具有全国代表性的流行病学角度来看,可能由高胰岛素血症介导。这些见解有助于更好地理解增塑剂对健康的潜在影响。强调需要采取积极的管理措施。
    UNASSIGNED: Exposure to a mixture of environmental chemicals may cause gallstone, but the evidence remains equivocal. The current study aims to investigate the association between phthalate metabolites and gallstones, and to explore their mediators.
    UNASSIGNED: Data from the National Health and Nutrition Examination Survey 2017-2018 on U.S. adults (≥20 years) were analyzed to explore the association between phthalate metabolites and gallstones by employed survey-weighted logistic regression, restricted cubic spline (RCS), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). Mediation analyses examined the role of oxidative stress markers, inflammatory markers, metabolic syndrome, body composition, diabetes, and insulin.
    UNASSIGNED: The current study included 1,384 participants, representing 200.6 million U.S. adults. Our results indicated a significant association between phthalate metabolites, particularly high molecular weight metabolites such as Di(2-ethylhexyl) phthalate (DEHP) and 1,2-Cyclohexane dicarboxylic acid diisononyl ester (DINCH), and gallstones. Furthermore, mediation analyses indicated that phthalate metabolites may play a role in the development of gallstones by influencing insulin secretion. Subgroup analyses did not reveal significant interaction.
    UNASSIGNED: The association between exposure to phthalates and the occurrence of gallstones, potentially mediated by hyperinsulinemia from a nationally representative epidemiological perspective. These insights contribute to a better understanding of the potential health implications of plasticizers, emphasizing the need for proactive management measures.
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  • 文章类型: Journal Article
    胆总管结石,作为一种胆石症,是一种容易急性腹痛的良性胆道梗阻,内镜逆行胰胆管造影术(ERCP)通常是临床治疗的首选。然而,治疗后患者复发率的增加困扰着临床医生和患者。为预防ERCP术后复发,没有指南提供明确的药物方案,然而,基于“肠-肝-胆汁酸轴”的中药在治疗肝脏相关疾病方面取得了一些成果。在此基础上,探讨中药预防ERCP术后胆总管结石(CBDS)的可能性,并期望在今后的临床和科研中,为预防CBDS的复发和中医药治疗胆石症相关疾病提供新的思路。
    Common bile duct stones, as a type of cholelithiasis, are a benign biliary obstruction that easily acute abdominalgia, and Endoscopic Retrograde Cholangiopancreatography (ERCP) is usually the first choice for clinical treatment. However, the increasing recurrence rate of patients after treatment is troubling clinicians and patients. For the prevention of recurrence after ERCP, there is no guideline to provide a clear drug regimen, traditional Chinese medicine however has achieved some result in the treatment of liver-related diseases based on the \"gut-liver-bile acid axis\". On the basis of this, this article discusses the possibility of traditional Chinese medicine to prevent common bile duct stones (CBDS) after ERCP, and we expect that this article will provide new ideas for the prevention of recurrence of CBDS and for the treatment of cholelithiasis-related diseases with traditional Chinese medicine in future clinical and scientific research.
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  • 文章类型: Review
    胆石症是消化系统的常见疾病。胆石症的危险因素已在已发表的文献中多次报道和总结,主要集中在横断面研究上。由于研究设计的固有局限性,报告的结果仍需要在其他纵向研究中进行验证.此外,近年来发现了许多新的胆石症危险因素,比如减肥手术,乙型肝炎病毒感染,丙型肝炎病毒感染,肾结石,结肠切除术,骨质疏松,等。这些新发现尚未包含在已发表的评论中。在这里,我们回顾了101个胆石症相关的危险因素,通过基于纵向调查的研究,包括队列研究,随机对照试验,和嵌套病例对照研究。与胆石症发病机制相关的危险因素分为不可改变和可改变的因素。不可改变的因素包括年龄,性别,种族,和家族史,而可改变的因素包括37个生物环境因素,25个社会环境因素,和35个理化环境因素。本研究为胆石症发病机制的研究提供了深入全面的思路,为确定高危人群和制定相关预防策略提供依据。
    Cholelithiasis is a common disease of the digestive system. The risk factors for cholelithiasis have been reported and summarized many times in the published literature, which primarily focused on cross-sectional studies. Due to the inherent limitations of the study design, the reported findings still need to be validated in additional longitudinal studies. Moreover, a number of new risk factors for cholelithiasis have been identified in recent years, such as bariatric surgery, hepatitis B virus infection, hepatitis C virus infection, kidney stones, colectomy, osteoporosis, etc. These new findings have not yet been included in published reviews. Herein, we reviewed the 101 cholelithiasis-associated risk factors identified through research based on longitudinal investigations, including cohort studies, randomized controlled trials, and nested case control studies. The risk factors associated with the pathogenesis of cholelithiasis were categorized as unmodifiable and modifiable factors. The unmodifiable factors consist of age, sex, race, and family history, while the modifiable factors include 37 biological environmental factors, 25 socioenvironmental factors, and 35 physiochemical environmental factors. This study provides thorough and comprehensive ideas for research concerning the pathogenesis of cholelithiasis, supplying the basis for identifying high-risk groups and formulating relevant prevention strategies.
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  • 文章类型: Journal Article
    背景:胆石症是最常见的肝胆系统疾病之一。肠道细菌可能参与胆结石形成过程,因此被认为是胆石症预测的潜在目标。
    目的:揭示胆石症与肠道细菌的相关性。
    方法:收集湖州市中心医院100例胆石症和250例健康个体的粪便样本;使用第三代Pacbio测序平台对粪便样本中肠道细菌的16SrRNA进行测序;使用Mothurv.1.21.1分析肠道细菌的多样性;Wilcoxon秩和检验和线性判别分析的效应图(LEfSe)进行分析。
    结果:胆石症和健康个体的肠道细菌丰度存在差异,但是他们的社区多样性没有差异。Costridia的丰度增加,福氏埃希氏菌,在胆石症中发现了肺炎克雷伯菌,而细菌,Phocaeicola,在健康个体中,Phocaeicolavulgatus更为丰富。与胆石症最密切相关的前4种细菌是福氏大肠杆菌,痢疾大肠杆菌,唾液链球菌和大肠杆菌。基于CatBoost算法的胆石症模型预测效果最好(灵敏度:90.48%,特异性:88.32%,AUC:0.962).
    结论:特征性肠道细菌的鉴定可能为胆结石筛查提供新的预测靶点。随着预测模型的筛选,胆石症高危人群可以确定是否需要进一步检测,从而实现胆石症的早期预警。
    BACKGROUND: Cholelithiasis is one of the most common disorders of hepatobiliary system. Gut bacteria may be involved in the process of gallstone formation and are, therefore considered as potential targets for cholelithiasis prediction.
    OBJECTIVE: To reveal the correlation between cholelithiasis and gut bacteria.
    METHODS: Stool samples were collected from 100 cholelithiasis and 250 healthy individuals from Huzhou Central Hospital; The 16S rRNA of gut bacteria in the stool samples was sequenced using the third-generation Pacbio sequencing platform; Mothur v.1.21.1 was used to analyze the diversity of gut bacteria; Wilcoxon rank-sum test and linear discriminant analysis of effect sizes (LEfSe) were used to analyze differences in gut bacteria between patients suffering from cholelithiasis and healthy individuals; Chord diagram and Plot-related heat maps were used to analyze the correlation between cholelithiasis and gut bacteria; six machine algorithms were used to construct models to predict cholelithiasis.
    RESULTS: There were differences in the abundance of gut bacteria between cholelithiasis and healthy individuals, but there were no differences in their community diversity. Increased abundance of Costridia, Escherichia flexneri, and Klebsiella pneumonae were found in cholelithiasis, while Bacteroidia, Phocaeicola, and Phocaeicola vulgatus were more abundant in healthy individuals. The top four bacteria that were most closely associated with cholelithiasis were Escherichia flexneri, Escherichia dysenteriae, Streptococcus salivarius, and Phocaeicola vulgatus. The cholelithiasis model based on CatBoost algorithm had the best prediction effect (sensitivity: 90.48%, specificity: 88.32%, and AUC: 0.962).
    CONCLUSIONS: The identification of characteristic gut bacteria may provide new predictive targets for gallstone screening. As being screened by the predictive model, people at high risk of cholelithiasis can determine the need for further testing, thus enabling early warning of cholelithiasis.
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  • 文章类型: Journal Article
    胆结石疾病在世界范围内变得越来越普遍。膳食微量矿物质已被证明与许多代谢性疾病密切相关,这项研究旨在探索膳食微量矿物质(铜,铁,硒,和锌)和胆石病(GSD)。使用2017年至2018年的国家健康和营养检查调查(NHANES),通过24小时召回和诊断问卷获得了膳食微量矿物质和GSD数据的摄入量。分别。使用加权逻辑回归模型来确定膳食微量矿物质的摄入量与GSD患病率之间的关联。结果以比值比(OR)和95%置信区间(95%CI)表示.共有4077名参与者被纳入最终分析,其中456名参与者有GSD,3621名参与者作为对照组。GSD与膳食微量矿物质摄入量之间没有显著关联(铁,硒,和锌)被发现。然而,在调整所有协变量后,膳食铜(Cu)摄入量与GSD显著相关(OR=0.66,95%CI=0.45~0.98).在进行加权分位数逻辑回归后,膳食铜摄入量与最高GSD四分位数(Q4)之间也存在显著负相关(OR=0.45,95%CI=0.26-0.80).在上述研究之后,没有发现膳食微量矿物质(铁,硒,和锌)和GSD;然而,膳食Cu摄入量和GSD之间呈线性负相关.
    The gallstone disease is becoming increasingly prevalent worldwide. Dietary trace minerals have been proven to be closely related to many metabolic diseases, and this study aims to explore the association between intakes of dietary trace minerals (copper, iron, selenium, and zinc) and gallstone disease (GSD). Using the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2018, intakes of dietary trace minerals and GSD data were obtained through a 24-hour recall and diagnostic questionnaire, respectively. Weighted logistic regression models were used to identify the association between intakes of dietary trace minerals and the prevalence of GSD, and the results were presented as odds ratios (OR) and 95% confidence intervals (95% CI). A total of 4077 participants were included in the final analysis, of which 456 participants had GSD and 3621 participants serving as the control group. No significant associations between GSD and intakes of dietary trace minerals (iron, selenium, and zinc) were found. However, after adjusting for all covariates, significant association was demonstrated between dietary copper (Cu) intake and GSD (OR = 0.66, 95% CI = 0.45-0.98). After conducting a weighted quantile logistic regression, a significant negative correlation was also found between dietary Cu intake and highest GSD quartile (Q4) (OR = 0.45, 95% CI = 0.26-0.80). Following the research outlined above, no association was found between intakes of dietary trace minerals (iron, selenium, and zinc) and GSD; however, a linear negative association was identified between dietary Cu intake and GSD.
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  • 文章类型: Journal Article
    目标:遗传和生活方式导致胆石症,但坚持健康生活方式对胆石症风险的影响仍不确定.我们旨在评估合并的生活方式因素和多基因风险评分的胆石症事件。
    方法:我们利用了来自FinnGen研究的胆石症全基因组关联研究(GWAS)数据,构建不同的多基因风险评分(PRS),并将其应用于317,640英国生物银行参与者。与六个公认的生活方式风险因素相关的胆石症事件的相对和绝对风险,按PRS进行评估和分层(低风险[五分之一],中等风险[五分之一2-4]和高风险[五分之一5])。生活方式得分也被归类为有利的,中间,不利群体。
    结果:源自13个单核苷酸多态性(p≤5×10-6,r2<0.001)的PRS表现出最佳性能。在多基因风险评分的五分之一中观察到胆石症风险的显着增加(p<0.001)。与低遗传风险的参与者相比,具有中等或较高遗传风险的人群发生胆石症的风险分别高10%(95%置信区间[CI]=1.05~1.17)和24%(95%CI=1.16~1.32).不利的生活方式与有利的生活方式相比,胆石症的风险高约50%。与低遗传风险和良好生活方式的参与者相比,具有高遗传风险和不良生活方式的参与者患胆石症的风险高98%(危害比[HR]:1.98;95%CI:1.67-2.35)。
    结论:我们的研究强调了生活方式行为干预对胆石症风险的重要性,无论白人欧洲人群的遗传风险如何。
    OBJECTIVE: Genetic and lifestyles contribute to cholelithiasis, but the impact of adhering to healthy lifestyle on cholelithiasis risk remains uncertain. We aimed to assess combined lifestyle factors and a polygenic risk score on incident cholelithiasis.
    METHODS: We utilized cholelithiasis genome-wide association study (GWAS) data from FinnGen study, constructing varied polygenic risk score (PRS), and applied them to 317,640 UK Biobank participants. The relative and absolute risk of incident cholelithiasis associated with six well-established lifestyle risk factors, was evaluated and stratified by PRS (low risk [quintile 1], intermediate risk [quintiles 2-4] and high risk [quintile 5]). Lifestyle score was also categorized into favorable, intermediate, and unfavorable groups.
    RESULTS: The PRS derived from 13 single nucleotide polymorphisms (p ≤ 5 × 10-6, r2 < 0.001) showed the best performance. A significant gradient of increase in risk of cholelithiasis was observed across the quintiles of the polygenic risk score (p < 0.001). Compared to participants with low genetic risk, those with intermediate or high genetic risk had a 10% (95% confidence interval [CI] = 1.05-1.17) and 24% (95% CI = 1.16-1.32) higher risk of cholelithiasis. An unfavorable lifestyle was associated with an approximately 50% higher risk of cholelithiasis than a favorable lifestyle. Participants with high genetic risk and an unfavorable lifestyle had 98% (Hazard ratio [HR]: 1.98; 95% CI: 1.67-2.35) higher risk of cholelithiasis than those with low genetic risk and a favorable lifestyle.
    CONCLUSIONS: Our study highlights the importance of lifestyle behaviors intervention on cholelithiasis risk regardless of the genetic risk in White European population.
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  • 文章类型: Journal Article
    一般肥胖是胆石病(GSD)的公认危险因素,但中心性肥胖是否会导致额外的独立风险仍存在争议.我们旨在全面阐明体脂分布对GSD的影响。
    我们首先研究了中心性肥胖的观测关联,以腰臀比(WHR)为特征,使用英国生物银行的数据(N=472,050),具有GSD风险。然后,我们使用GSD(ncase=43,639,ncontrol=506,798)以及WHR的最大全基因组关联研究的汇总统计数据来探索遗传关系,有或没有调整体重指数(BMI)(WHR:n=697,734;WHRadjBMI:n=694,649)。
    观察性分析表明,随着WHR增加一个单位,GSD的风险增加(HR=1.18,95CI=1.14-1.21)。观察到WHR-GSD遗传相关(rg=0.41,P=1.42×10-52)。由BMI驱动,但与BMI无关(WHRadjBMI:rg=0.19,P=6.89×10-16)。跨性状荟萃分析确定了四个新的WHR和GSD基础多效性基因座,具有BMI以外的生物学机制。孟德尔随机化证实了一个稳健的WHR-GSD因果关系(OR=1.50,95CI=1.35-1.65),在调整BMI(OR=1.17,95CI=1.09-1.26)后,该因果关系减弱,但仍然显著。此外,观察性分析证实了一般肥胖与GSD之间的正相关,由共同的遗传基础(Rg=0.40,P=2.16×10-43)证实,多个新的多效性位点(N=11)和因果关系(OR=1.67,95CI=1.56-1.78)。
    观察和遗传分析一致地提供了中心性肥胖与GSD风险增加的关联的证据。独立于一般肥胖。我们的工作强调了在GSD的临床管理中同时考虑一般和中心性肥胖的必要性。
    UNASSIGNED: General obesity is a well-established risk factor for gallstone disease (GSD), but whether central obesity contributes additional independent risk remains controversial. We aimed to comprehensively clarify the effect of body fat distribution on GSD.
    UNASSIGNED: We first investigated the observational association of central adiposity, characterized by waist-to-hip ratio (WHR), with GSD risk using data from UK Biobank (N=472,050). We then explored the genetic relationship using summary statistics from the largest genome-wide association study of GSD (ncase=43,639, ncontrol=506,798) as well as WHR, with and without adjusting for body mass index (BMI) (WHR: n=697,734; WHRadjBMI: n=694,649).
    UNASSIGNED: Observational analysis demonstrated an increased risk of GSD with one unit increase in WHR (HR=1.18, 95%CI=1.14-1.21). A positive WHR-GSD genetic correlation (rg =0.41, P=1.42×10-52) was observed, driven by yet independent of BMI (WHRadjBMI: rg =0.19, P=6.89×10-16). Cross-trait meta-analysis identified four novel pleiotropic loci underlying WHR and GSD with biological mechanisms outside of BMI. Mendelian randomization confirmed a robust WHR-GSD causal relationship (OR=1.50, 95%CI=1.35-1.65) which attenuated yet remained significant after adjusting for BMI (OR=1.17, 95%CI=1.09-1.26). Furthermore, observational analysis confirmed a positive association between general obesity and GSD, corroborated by a shared genetic basis (rg =0.40, P=2.16×10-43), multiple novel pleiotropic loci (N=11) and a causal relationship (OR=1.67, 95%CI=1.56-1.78).
    UNASSIGNED: Both observational and genetic analyses consistently provide evidence on an association of central obesity with an increased risk of GSD, independent of general obesity. Our work highlights the need of considering both general and central obesity in the clinical management of GSD.
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