胆囊结石的发病规律和危险因素分析

Analysis of the pathogenesis and risk factors of gallstone

目的探讨胆囊结石形成的发病规律和危险因素。方法回顾性收集2012年1月至2021年12月首都医科大学宣武医院体检中心体检者的肝胆超声检查结果及相关资料。共98344名体检者纳入研究,男性48241名,女性50103名,男女比例为1∶1.03,年龄(42.0±15.6)岁(范围:14~97岁)。收集体检者的性别、年龄、体重指数、腰围、收缩压、舒张压、ALT、AST、总胆红素、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白、高密度脂蛋白、受试者静坐10 min后血压、禁食8~12 h后晨起空腹静脉血实验室检查结果。根据超声检查结果是否存在胆囊结石,将体检者分为研究组和对照组。分别采用秩和检验、χ^(2)检验对数据进行分析,并通过Logistic回归分析探讨胆囊结石形成的危险因素。结果本研究中体检者胆囊结石的发生率为5.42%(5333/98344)。其中60岁及以上人群胆囊结石的发生率较60岁以下人群明显增高[15.31%(2348/15334)比3.60%(2985/83010),χ^(2)=3473.46,P<0.05]。按照年龄段进行分组,每10岁为一组,结果显示,胆囊结石发生率有随年龄增长而增加的趋势。女性胆囊结石发生率为5.68%(2844/50103),高于男性的5.16%(2489/48241)(χ^(2)=11.81,P<0.05)。其中1478例因胆囊结石行胆囊切除,手术率为27.71%,60~<70岁手术率达到高峰,70岁以后手术率下降。多因素分析结果显示,女性(OR=1.38,P<0.01)、年龄大(OR=1.58,P<0.01)、体重指数≥24 kg/m2(OR=1.31,P<0.01)、腰围≥85 cm(OR=1.24,P<0.01)、空腹血糖>6.1 mmol/L(OR=1.18,P<0.01)、总胆固醇≥5.18 mmol/L(OR=0.87,P=0.019)、低密度脂蛋白≥3.37 mmol/L(OR=1.15,P=0.001)是胆囊结石形成的危险因素;而高密度脂蛋白≥1.55 mmol/L(OR=0.87,P<0.01)是胆囊结石形成的保护因素。结论男性和女性人群胆囊结石的发病率随着年龄的增长而增加。性别、年龄、体重指数、腰围、空腹血糖、总胆固醇、低密度脂蛋白、高密度脂蛋白与胆囊结石的形成相关。

Objective To explore the pathogenesis and risk factors of gallstone formation.Methods The findings of hepatobiliary ultrasound and related data were collected from healthy subjects who underwent a physical examination at Xuanwu Hospital of Capital Medical University from January 2012 to December 2021.A total of 98344 healthy subjects were included in the study,including 48241 males and 50103 females,with a ratio of 1∶1.03,aged(42.0±15.6)years(range:14 to 97 years).The gender,age,body mass index,waist circumference,systolic pressure,diastolic pressure,ALT,AST,total bilirubin,fasting blood glucose,triglyceride,total cholesterol,low-density lipoprotein,high-density lipoprotein were collected.Healthy subjects were required to sit for at least 10 minutes before blood pressure was measured.Rresults of fasting venous blood were collected after 8 to 12 hours on an empty stomach.According to the presence of gallstones by ultrasound results,healthy subjects were divided into study group and control group.Data were analyzed by rank-sum tests andχ^(2) test,and risk factors for gallstone formation were explored by Logistic regression analysis.Results The incidence of gallstones in this study was 5.42%(5333/98344).Among them,the incidence of gallstones in people aged 60 years and above was significantly higher than that in people under 60 years old(15.31%(2348/15334)vs.3.60%(2985/83010),χ^(2)=3473.46,P<0.05).The healthy subjects were divided by age for every 10 years,and the results showed that the incidence of gallstones increased with age.The incidence of gallstones in females was 5.68%(2844/50103),greater than 5.16%(2489/48241)in males(χ^(2)=11.81,P<0.05).Among them,1478 cases underwent gallbladder surgical resection due to gallstones,and the operation rate was 27.71%.The operation rate reached the peak between 60 and<70 years old,and decreased after 70 years old.The results of the multivariate analysis showed that,female(OR=1.38,P<0.01),age(OR=1.58,P<0.01),body mass index≥24 kg/m2(OR=1.31,P<0.01),waist circumference≥85 cm(OR=1.24,P<0.01),fasting blood glucose>6.1 mmol/L(OR=1.18,P<0.01),total cholesterol≥5.18 mmol/L(OR=0.87,P=0.019),low-density lipoprotein≥3.37 mmol/L(OR=1.15,P=0.001)were the risk factors for gallstone formation;high-density lipoprotein≥1.55 mmol/L(OR=0.87,P<0.01)was a protective factor for gallstone formation.Conclusions The incidence of gallstones increases with age in male and female.Gender,age,body mass index,waist circumferenc,fasting blood glucose,total cholesterol,LDL,and HDL are related factors with gallstone formation.