胆囊结石与糖脂代谢关系的探讨

RELATIONSHIP BETWEEN GALLBLADDER STONE AND LIPOROGLUCOSE METABOLISM

目的探讨糖脂代谢在胆囊结石形成中的作用。方法收集１９９８年１～４月２５例胆囊结石患者和２５例自愿者，并应用性别和年龄进行个体配对（１：１），测量所有研究对象的体重指数（ＢＭＩ）和腰臀比（Ｗ／Ｈ），并采空腹静脉血测定血糖、糖化血红蛋白（ＨｂＡ１Ｃ）、胰岛素、Ｃ肽以及血脂全套指标，采血后研究对象立即口服７５ｇ葡萄糖，２小时后再测定血糖、胰岛素、Ｃ肽。结果结石组与对照组的 ＢＭＩ和 Ｗ／Ｈ无明显统计学差异。两组空腹血糖、ＨｂＡ１Ｃ及 ２ 小时血糖差异无统计学意义（Ｐ＞０．０５、Ｐ＞０．２、Ｐ＞０．１）。结石组中糖代谢异常１０例，占４０％（７例糖尿病，３例糖耐量减低），对照组糖代谢异常４例（１例糖尿病，３例糖耐量减低），差异有显著性意义（Ｐ＜０．０５）。结石组空腹及２小时胰岛素平均浓度明显高于对照组（Ｐ＜０．０２，Ｐ＜０．０５），结石组空腹Ｃ肽亦高于对照组（Ｐ＜０．０５）。结石组中高胰岛素血症１４例，对照组２例，差异有显著性意义（Ｐ＜０．０１）。两组血脂各项指标（ＴＧ、ＴＣ、ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＶＬＤＬ－Ｃ）无统计学差异。结论糖尿病和胰岛素水平升高在胆囊结石形成中可能有重要作用。

Objective To study the effects of glucose and lipid metabolism on gallstone formation. Methods Twenty five patients with gallstones and 25 normal volunteer controls were studied from January to April in 1998. The patients were well matched the control with sex and age (1: 1). In the study, Body Mass index (BMI) and Waist-to-Hip circumference ratio (W/H) were measured. Blood glucose, glucosylated hemoglobin (HbA1 C), insulin, C peptide and all parameters of lipids were detected at fasting state. The glucose, insulin, C peptide were detected again at 2-hour after taking 75g glucose orally. Results The result showed there was no difference on BMI and W/H between the patients and controls. HbA1 C. mean fasting and 2-hour glucose concentration were not in significantly different between the two groups (P>0.05, P>0.2, P>0.1 respectively). There were 10 patients with abnormal glucose metabolism (7 with NIDDM, 3 with IGT), but only 4 controls were abnoumal (one with NIDDM, three with IGT). The difference was significant (P＜0.05). Furthermore, the mean fasting and 2-hour insulin concentration of gallstone group was higher than that of the control (P<0.02, P<0.05). And the gallstone group had a higher fasting C peptide concentration than control (P<0.05). There was no statistical difference on the parameters of plasma lipid between the tow groups. Conclusion The study suggests that diabetes mellious and hyperinsulinemia acted as an important role on gallstone formation.