BMI纵向轨迹对新发胆石症的影响

Influence of longitudinal trajectories of body mass index on new-onset gallstone disease

目的探究连续变化的BMI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,选取2006、2008、2010年度的44 168例参加开滦研究健康体检者作为观察对象,收集BMI等数据资料,每2年进行1次健康体检,并随访胆石症的发病情况。根据观察对象BMI轨迹情况,将观察对象分为低-稳定组(14 888例)、中-稳定组(22 334例)、高-稳定组(6948例)。正态性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。计数资料组间比较用χ~2检验。采用Kaplan-Meier法计算各组人群累积发病率,并比较累积发病率间的差异。通过Cox比例风险回归模型分不同BMI轨迹分组对胆石症发病的影响。结果在平均5.41年的随访过程中,共发生胆石症902例,低-稳定组、中-稳定组、高-稳定组观察对象累积发病率分别为4.80%、5.25%、9.45%,经log-rank检验,累积发病率存在差异(χ~2=81.86,P <0.01)。在Cox模型中校正各混杂因素后,与低-稳定组相比,中-稳定组、高-稳定组发生胆石症的风险分别增加1.55倍(95%CI:1.31~1.84)、2.29倍(95%CI:1.86~2.80)。结论 BMI轨迹升高是胆石症发病的独立危险因素。

Objective To investigate the effect of longitudinal trajectories of body mass index(BMI)on new-onset gallstone disease.Methods A prospective cohort study was conducted for 44168 employees who underwent physical examination in Kailuan General Hospital in 2006,2008,and 2010,and related data,including BMI,were collected.Physical examination was performed once every two years,and the employees were followed up to observe the onset of gallstone disease.According to the longitudinal trajectories of BMI,the employees were divided into low-stable group with 14888 employees,medium-stable group with 22334 employees,and high-stable group with 6948 employees.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups;the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to calculate the cumulative incidence rate of gallstone disease in each group,and the log-rank test was used for comparison between groups.The Cox proportional-hazards regression model was used to analyze the influence of longitudinal trajectories of BMI on the onset of gallstone disease.Results the mean follow-up of 5.41 years,a total of 902 patients with gallstone disease were observed,and the cumulative incidence rates of gallstone disease in the low-stable group,the medium-stable group,and the high-stable group were 4.80%,5.25%,and 9.45%,respectively,with a significant difference between groups based on the log-rank test(χ2=81.86,P<0.01).After adjustment for confounding factors in the Cox proportional hazards model,compared with the low-stable group,the medium-stable group and the high-stable group had a risk of gallstone disease increased by 1.55 times(95%confidence interval[CI]:1.31-1.84)and 2.29 times(95%CI:1.86-2.80),respectively.Conclusion The ncreased longitudinal trajectory of BMI is an independent risk factor for the onset of gallstone disease.