胆囊息肉样病变的临床流行病学特点及其易感性因素

Clinical epidemiological characteristics and correlative factors of polypoid lesions of the gallbladder

目的:探讨青岛地区胆囊息肉样病变(polypoid lesion of gallbladder,PLG)的临床流行病学特点及其易感性因素.方法:选择2009/01-2009/12在本院健康体检中心体检的27400人作为调查对象,采用分层随机整群抽样法,对1678例超声诊断PLG患者进行临床流行病学调查,并抽取1700人非PLG者作为对照组.采用多因素非条件Logistic回归分析生活方式、行为因素、空腹血糖(FPG)、三酰甘油(TG)、胆固醇(CHO)和体质量指数(BMI)、脂肪肝、胆囊炎、胆囊结石和胆囊癌等,以OR值为PLG易感性因素.分析PLG直径>10mm行胆囊切除术219例患者的超声病理学特点以及手术治疗良性非肿瘤性PLG合理性.结果:27400人健康体检中,资料完整27301人,应答率为99.64%.经超声诊断PLG者1678例,发病率6.15%,其中男性59.95%(1006/1678),女性40.05%(672/1678),男女比例1.5∶1;30-59岁占64.96%(1090/1678).P L G单发37.72%(633/1678),多发62.28%(1045/1678);直径≤10mm占86.95%(1459/1678).胆固醇性息肉(cholesterol polyps,CPs)占79.14%(1328/1678);良性非C P s占17.76%(298/1678);恶性P L G占3.10%(52/1678).多因素非条件Logistic回归分析:PLG组与对照组在生活方式、行为因素、BMI、TG、FPG、胆囊结石中比较无明显差异(χ2=4.346-5.264,P>0.05),经OR值分析在年龄、性别、CHO、脂肪肝和胆囊炎中,PLG组明显高于对照组(χ2=7.163-9.865,P<0.05).219例PLG直径>10mm行切除胆囊术,占同期超声诊断的13.05%;临床病理学诊断良性PLG167例,占同期手术的76.26%,恶性PLG52例(胆囊癌34例,腺瘤癌变8例,腺瘤样增生癌变8例,腺肌瘤癌变2例)占23.74%,均为单发,基底宽,57.69%(30/52)CED显示血流信号.结论:青岛地区PLG发病率为6.15%,70%以上为CPs,男性多于女性,30-59岁为高发年龄段.CHO代谢异常、脂肪肝和胆囊炎是PLG的易感性因素.对直径≤10mm的PLG应慎重施行胆囊切除,可超声随访观察.

AIM： To investigate the clinical epidemiological characteristics and correlative factors of polypoid lesions of the gallbladder （PLG） in Qingdao, China. METHODS： A total of 27？400 people who underwent health examination from January 2009 to December 2009 at our hospital were included in the study. Stratified random sampling was adopted to select 1？678 patients who were diagnosed with PLG by ultrasound to conduct an epidemiological survey, and 1？700 people without PLG were used as controls. Multifactor unconditional Logistic regression analyses were performed to investigate the relationship of life styles, behavior factors, blood sugar （FPG）, triglycerides （TG）, total cholesterol （CHO）, fatty liver, cholecystitis and gallbladder stone with PLG. The clinical pathological characteristics and rationality of cholecystectomy were analyzed in 219 patients who had PLG with a diameter of 10 mm and underwent cholecystectomy. RESULTS： Of 2？7400 people, 27？301 （99.64%） had complete data. The prevalence of PLG was 6.15% （1？678/27？301）. The male to female ratio was 1.5∶1. The majority （64.96%） of patients ranged in age between 30 and 59 years. Solitary PLG and multiple PLG accounted for 37.72% and 62.28%, respectively. The majority （86.95%） of PLG were smaller than 10 mm in diameter. Cholesterol polyps （CPs）, benign non-CPs and malignant gallbladder diseases accounted for 79.14%, 17.76% and 3.10%, respectively. Multifactor unconditional Logistic regression analyses revealed that life styles, behavior factors, TG, FPG, and gallbladder stone had no significant association with PLG （all P 0.05）, while age, sex, CHO, fatty liver, and cholecystitis were significantly correlated with PLG （all P 0.05）. Of 219 （13.05%） patients who had PLG with a diameter of 10 mm and underwent cholecystectomy, 76.26% had benign PLG and 23.74% had malignant disease. CONCLUSION： The incidence of PLG was 6.15% in Qingdao. Abnormal CHO metabolism, fatty liver and cholecystitis were correlative factors for PLG. Cholecystectomy should be cautiously selected in patients who had PLG with a diameter ≤10 mm.