1684例无症状胆囊结石患者病情进展影响因素分析

Analysis of influencing factors of disease progression in 1684 patients with asymptomatic gallstones

目的探讨无症状胆囊结石患者随访期间出现临床症状的影响因素,为无症状胆囊结石患者随访和治疗提供选择依据。方法回顾性分析2019年1月至2020年12月1684例无症状胆囊结石患者临床资料,根据随访期间是否出现临床症状分为进展组(n=173)和无进展组(n=1511),数据采用SPSS 23.0软件进行统计学分析,单因素和多因素分析采用Logistics回归模型。以P<0.05为差异有统计学意义。结果1684例患者随访期间内173例出现临床症状,发生率为10.3%。单因素分析发现进展组中女性、糖尿病、熬夜、饮食不规律、结石≤5 mm、结石多发、高脂血症患者比例高于无进展组(P<0.05),多因素分析发现糖尿病、饮食不规律、结石≤5 mm、多发结石是无症状性胆囊结石出现临床表现的危险因素(P<0.05)。进展组中,74例(42.8%)胆囊结石数量增多、31例(17.9%)结石直径增大、19例(11.0%)结石数量增多且结石增大、49例(28.3%)结石数量和大小无变化;106例(61.3%)表现为胆囊炎、42例(24.2%)表现为胆管炎、25例(14.4%)表现为胆源性胰腺炎;接受手术治疗患者155例(89.6%)、拒绝手术治疗患者18例(10.4%)。结论糖尿病、饮食不规律、结石≤5 mm、多发结石是无症状性胆囊结石患者病情进展的危险因素,对于这类患者可以考虑早期手术治疗,避免出现严重临床表现,耽误治疗。

Objective To explore the influencing factors of clinical symptoms in patients with asymptomatic cholecystolithiasis during the follow-up period,and to provide a basis for the follow-up and treatment of patients with asymptomatic cholecystolithiasis.Methods Clinical data of 1684 patients with asymptomatic cholecystolithiasis from January 2019 to December 2020 were retrospectively analyzed,and divided into progressive group(n=173)and non-progressive group(n=1511)according to whether clinical symptoms occurred during the follow-up period.Data were statistically analyzed using SPSS 23.0 software.Logistics regression model was used for univariate and multivariate analysis.P<0.05 was considered to be statistically significant.Results During the follow-up period,173 of 1684 patients showed clinical symptoms,with an incidence of 10.3%.Univariate analysis found that the proportion of women,diabetes,staying up late,irregular diet,stones≤5 mm,multiple stones,and hyperlipidemia in the progressive group was higher than that in the non-progressive group(P<0.05),and multivariate analysis found diabetes,irregular diet,stones≤5 mm and multiple calculi were risk factors for clinical manifestations of asymptomatic gallstones(P<0.05).In the progressive group,74 patients(42.8%)had increased gallstone number,31 patients(17.9%)had increased stone diameter,19 patients(11.0%)had increased stone number and increased stone size,and 49 patients(28.3%)had no change in stone number and size.106 cases(61.3%)showed cholecystitis,42 cases(24.2%)cholangitis and 25 cases(14.4%)biliary pancreatitis.155 patients(89.6%)received surgery and 18 patients(10.4%)refused surgery.Conclusions Diabetes,irregular diet,stones≤5 mm,and multiple stones are risk factors for the progression of asymptomatic cholecystolithiasis.For these patients,early surgical treatment can be considered to avoid serious clinical manifestations and delay of treatment.