血清高密度脂蛋白胆固醇与新发胆石症的关系

Association of serum high-density lipoprotein cholesterol with new-onset cholelithiasis

目的探讨血清高密度脂蛋白胆固醇(HDL-C)水平对新发胆石症的影响。方法 采用前瞻性队列研究的方法,收集2006年7月-2015年12月开滦集团健康体检的在职及离退休职工87 891人的体检资料,并纳入统计分析。正态分布的计量资料多组间比较采用单因素方差分析,偏态分布的计量资料多组间比较采用Kruskal-Wallis H 检验,计数资料组间比较采用χ 2 检验。将观察对象依据HDL-C四分位数分为4组,计算各组胆石症的发病密度,采用寿命表法计算各组胆石症的累积发病率,并采用 log-rank 检验比较组间差异;采用Cox回归模型分析不同HDL-C水平对新发胆石症的影响。结果 4组观察对象的临床特征比较:性别、年龄、BMI、LDL-C、HDL-C、FBG、hs-CRP、TG、TC、高血压病、糖尿病、饮酒、吸烟及体育锻炼比例差异均有统计学意义( P 值均<0.05)。在平均(8.19±0.85)年的随访期间,新发胆石症2881例,各组的胆石症发病密度分别为4.36/千人年、3.81/千人年、3.96/千人年、3.90/千人年,各组的累积发病率分别为6.49%、6.01%、6.36%、6.16%,经log-rank检验,差异有统计学意义(χ 2 =25.34, P <0.05)。在Cox比例风险回归模型中,校正了可能存在的混杂因素后,结果显示:与HDL-C第1分位数组相比,第2、3、4分位数组影响胆石症发病的风险比及95%可信区间分别为0.84(0.75~0.93)、0.86(0.78~0.96)、0.78(0.70~0.86)( P for trend<0.05)。结论 血清高水平HDL-C是新发胆石症的独立保护因素,胆石症发病风险随着HDL-C的升高而降低。

Objective To investigate the influence of serum high-density lipoprotein cholesterol (HDL-C) level on new-onset cholelithiasis. Methods A prospective cohort study was conducted. The physical examination data of 87 891 on-the-job and retired workers in Kailuan Group were collected from July 2006 to December 2015 and were included in the statistical analysis. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups, and the chi-square test was used for comparison of categorical data between groups. The subjects were divided into four groups according to HDL-C quartiles, and the incidence density of cholelithiasis was calculated for each group. The life-table method was used to calculate the cumulative incidence rate of cholelithiasis in each group, the log-rank test was used for comparison between groups, and the Cox regression model was used to analyze the influence of HDL-C level on new-onset cholelithiasis. Results There were significant differences between the four groups in sex, age, body mass index, low-density lipoprotein cholesterol, HDL-C, fasting blood glucose, high-sensitivity C-reactive protein, triglyceride, total cholesterol, hypertension, diabetes, drinking, smoking, and physical exercise (all P <0.05). During the mean follow-up time of 8.19±0.85 years, a total of 2881 cases of new-onset cholelithiasis were observed, and the incidence density of cholelithiasis in the four groups was 4.36 per 1000 person-years, 3.81 per 1000 person-years, 3.96 per 1000 person-years, and 3.90 per 1000 person-years, respectively. The cumulative incidence rates in the four groups were 6.49%, 6.01%, 6.36%, and 6.16%, respectively, and the log-rank test showed a significant difference between groups (χ 2 =25.34, P <0.05). In the Cox proportional hazards regression model, after the adjustment for possible confounding factors, the results showed that compared with the first quartile group of HDL-C, the second, third, and fourth quartile groups had hazard ratios (95% confidence interval) for gallstone disease of 0.84 (0.75-0.93), 0.86 (0.78-0.96), and 0.78 (0.70-0.86), respectively ( P for trend <0.05). Conclusion A high serum level of HDL-C is an independent protective factor against new-onset cholelithiasis, and the risk of cholelithiasis decreases with the increase in HDL-C.