西藏工布江达县藏族农牧民胆结石发生情况及其影响因素调查研究

Investigation on the Occurrence of Gallstones and Its Influencing Factors among Tibetan Farmers and Herdsmen in Gongbujiangda County

目的:对西藏工布江达县藏族农牧民胆结石的发生情况进行调查,分析影响胆结石发生的危险因素,旨在为降低该地区胆结石发生率提供有价值的参考依据。方法:采用经预调查处理后采用统一自制的胆结石危险因素调查表对工布江达县18~90岁藏族农牧民进行调查问卷,并通过乡镇卫生院提前预约对全部居民进行肝胆B超检查,对已经实施胆结石手术的150例患者的空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、总胆红素(TBIL)以及结石成分进行分析研究,探讨西藏工布江达县藏族农牧民胆结石的发生情况及其危险因素。结果:工布江达县藏族农牧民总人口29 982人,7 245人进行B超检查,占24.2%,确诊胆结石855例,诊断率为11.8%,其中男289例,占33.8%,女566例,占66.2%。发生胆结石者与未发生胆结石者的性别、油腻饮食、高糖饮食、常食动物内脏、常食禽蛋、常食豆制品、口服避孕药史、胆道蛔虫病、胆囊炎史、糖尿病史、家族史、饮酒、肝炎肝硬化史、精神心理压力比较,差异均有统计学意义(P<0.05)。logistic多因素分析显示,女性胆结石发病率远高于男性,油腻饮食、高糖饮食、常食动物内脏、常食豆制品、长期口服避孕药、胆道蛔虫病史、胆囊炎史、糖尿病史、家族史以及饮酒是农牧民胆结石发病的危险因素,而常食禽蛋类是胆结石的保护因素(P<0.05)。术后,患者FBG、TG、TC以及TBIL均低于术前,差异均有统计学意义(P<0.05)。150例胆结石手术患者结石成分以胆固醇+胆红素钙、胆固醇为主,分别占45.3%和40.0%。结论:西藏工布江达县藏族农牧民胆结石发病率较高,胆结石成分以胆固醇+胆红素钙、胆固醇为主;油腻饮食、高糖饮食、常食动物内脏、常食豆制品、长期口服避孕药、胆道蛔虫病史、胆囊炎史、糖尿病史、家族史以及饮酒是胆结石发病率增高的危险因素。

Objective:To investigate the occurrence of gallstones in Tibetan farmers and herdsmen in Gongbujiangda County,Tibet,and to analyze the risk factors affecting gallstones,aiming to provide a valuable reference for reducing the incidence of gallstones in this area.Method:The questionnaire of 18-90 year-old Tibetan farmers and herdsmen in Gongbujiangda County was surveyed by using the self-made gallstone risk factor questionnaire after pre-investigation,and the liver and gallbladder B-ultrasound examination was conducted for all residents in advance through the township hospital.Fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),total bilirubin(TBIL)and stone composition were analyzed in 150 patients undergoing gallstone surgery,and the occurrence and risk factors of gallstones in Tibetan farmers and herdsmen in Gongbujiangda County,Tibet were discussed.Result:The total population of Tibetan farmers and herdsmen in Gongbujiangda County was 29982,and 7245 were B-ultrasound,accounting for 24.2%.Of the 855 cases diagnosed with gallstones,the diagnosis rate was 11.8%,of which 289 were male,accounting for 33.8%,and 566 were female,accounted for 66.2%.Comparison of gender,greasy diet,high sugar diet,animal viscera,eggs,bean products,oral contraceptives,biliary ascariasis,cholecystitis,diabetes,family history,drinking,hepatitis,liver cirrhosis,mental and psychological stress between patients with gallstones and those without gallstones,the differences were statistically significant(P<0.05).Logistic multivariate analysis showed that the incidence rate of gallstones in women was much higher than that in men,fatty diet,high sugar diet,common animal viscera,regular food products,long-term oral contraceptives,history of biliary Ascaris,history of cholecystitis,history of diabetes,family history and drinking were risk factors for choledocholy in farmers and herdsmen,while common poultry eggs were protective factors for gallstones(P<0.05).After operation,FBG,TG,TC and TBIL were lower than those before operation,the differences were statistically significant(P<0.05).The main components of gallstone were cholesterol+calcium bilirubin and cholesterol,accounting for 45.3%and 40.0%respectively.Conclusion:The rate incidence rate of gallstones in Tibetan farmers in Tibet is high.Gallstone components are mainly cholesterol+calcium bilirubin and cholesterol,fatty diet,high sugar diet,common animal viscera,regular food products,long-term oral contraceptives,history of biliary Ascaris,cholecystitis,diabetes,family history and drinking are risk factors for the incidence of gallstones.