中老年2型糖尿病患者无症状胆囊结石的患病率及相关危险因素分析

Prevalence and risk factors of asymptomatic gallstones in middle-aged and elderly patients with type 2 diabetes mellitus

目的本研究主要调查中老年2型糖尿病患者无症状胆囊结石的患病率，分析与无症状胆囊结石相关的危险因素。方法研究对象来自于上海闵行区江川街道的中老年常住人口，年龄59—89岁。排除有胆囊切除手术史、有胆道相关症状的患者、以及其他属于排除标准的患者，进一步选取具有明确2型糖尿病病史及经口服葡萄糖耐量试验新诊断的2型糖尿病患者。收集病史、年龄、性别、体重指数、腰围、相关生化代谢指标及超声检查明确脂肪肝。按《中国成人血脂异常防治指南（2007年）》中糖尿病患者低密度脂蛋白胆固醇（LDL-C）及总胆固醇（TC）的控制目标值，将中老年2型糖尿病患者分别分成：LDL-C〈2．6mmol／L组和LDL-C≥2．6mmol／L组；TC〈4．14mmol／L组和TC≥4．14mmol／L组。结果共有788例中老年2型糖尿病患者纳入分析，无症状胆囊结石的患病率为13．5％。女性患者无症状胆囊结石患病率明显高于男性患者（16．4％对9．9％，P=0．008）。TC≥4．14mmol／L患者无症状胆囊结石的患病率高于TC〈4．14mmol／L患者（14．3％对3．4％，P=0．019）。有脂肪肝的患者无症状胆囊结石的患病率显著高于无脂肪肝患者（16．9％对10．1％，P=0．005）。条件logistic回归方程显示女性性别（OR=1．84，95％CI1．19-2．83，P=0．006）、TC（OR=4．71，95％CI 1．15-19．74，P=0．044）和脂肪肝（OR=1．80．95％CI1．11-2．81，P=0．010）均与中老年2型糖尿病患者无症状胆囊结石的发生相关。结论中老年2型糖尿病患者无症状胆囊结石患病率较高，女性、TC、脂肪肝是其危险因素。

Objective To investigate the prevalence of asymptomatic gallstones and the risk factors in middle-aged and elderly patients with type 2 diabetes mellitus. Methods The participants were middle-aged and elderly permanent residents of Jiangchuan Community, Minhang District, Shanghai, aged 59 to 89 years. The patients with a history of gallbladder surgery, or with biliary symptoms, or others belong to exclusion criteria were ruled out. The patients with a clear history of type 2 diabetes and the newly diagnosed type 2 diabetes by oral glucose tolerance test were selected. The history, age, sex, body mass index, waist circumference, relevant biochemical metabolism index were collecteds, and fatty liver was diagnosed by ultrasound~ According to the control target of low density lipoprotein-cholesterol （LDL-C） and total cholesterol （TC） in patients with diabetes by Chinese adult dyslipidemia prevention guideline （2007）, the subjects were divided into LDL-C 〈 2.6 mmol/L and LDL-C ≥2.6 mmol/L groups as well as TC〈4.14 mmol/L and TC ≥4.14 mmol/L groups. Results A total of 788 middle-aged and elderly patients with type 2 diabetes were included and the overall prevalence of asymptomatic gallstone was 13.5%. The prevalence of asymptomatic gallstones in female patients was higher than that in male patients （16. 4% vs 9.9% ,P= 0. 008）, and that in TC ≥. 14 mmol/L patients was higher than that in TC〈4. 14 mmol/L patients （ 14.3% vs 3. 4%, P = 0. 019 ）. The prevalence of asymptomatic gallstones in patients with fatty liver was significantly higher than that in the patients without fatty liver （ 16.9% vs 10.1%, P = 0. 005 ）. Conditional logistic regression equation showed that gender （ OR= 1.84,95% CI 1.1%2.83 ,P=0. 006）, TC （ 0R=4.71,95% CI 1.15- 19.74,P=0. 044）, and fatty liver （ OR= 1.80,95% CI 1.11-2.81 ,P=0. 010） were correlated with asymptomatic gallstones. Conclusion The prevalence of asymptomatic gallstones in middle-aged and elderly patients with type 2diabetes mellitus is high. Female, TC, and fatty liver disease were risk factors for asymptomatic gallstones in middle- aged and eXderly patients with type 2 diabetes mellitus.