肥胖症与糖尿病对胆石症发病的交互作用

目的 探究肥胖症合并糖尿病对胆石症发病的交互作用。方法 从开滦总医院2006年度健康体验的职工中提取数据，共有76 131例观察对象纳入本队列研究，收集数据资料，每两年进行一次随访，分析胆石症的发病情况。根据是否有肥胖症或糖尿病对观察对象进行分组，采用K-M法计算各组累积发病率，并进行比较。通过Cox回归模型探究肥胖症与糖尿病对胆石症发病的联合作用，并分析两者是否存在交互作用。结果 在平均6.99年的随访过程中，共发生胆石症2 615例，非肥胖及非糖尿病组、肥胖合并非糖尿病组、非肥胖合并糖尿病组、肥胖合并糖尿病组累积发病率分别为4.75%、4.62%、6.98%、7.74%，经Log-rank检验，累积发病率存在差异（χ2 =87.06，P＜0.01）。在Cox模型中校正各混杂因素后，与非肥胖及非糖尿病组相比，肥胖合并非糖尿病组、非肥胖合并糖尿病组以及肥胖合并糖尿病组发生胆石症的风险分别增加1.36倍、1.26倍和1.45倍。肥胖症合并糖尿病对胆石症的发病存在交互作用。结论 肥胖症及糖尿病是胆石症发病的危险因素，并且两者间存在交互作用。

The synergistic effect of obesity and diabetes on gallstone disease

Objective To explore the synergistic effect of obesity and diabetes on new-set gallstone disease.Methods A prospective cohort study was conducted. A total of 76 131 employees who participated in the health checkup of the Kailuan General Hospital for the first time in 2006 were enrolled, and the incidence of gallstone disease was collected during the follow-up every two years. According to the status of obesity and diabetes, subjects were divided into 4 groups. The K-M method was used to calculate the cumulative incidence of gallstone disease in each group, and Log-rank test was used for comparison among 4 groups. The Cox regression model was used to analyze the influence of obesity and diabetes on gallstone disease, and the interaction between obesity and diabetes and gallstone disease was further analyzed. Results During the mean follow-up time of 6.99 years, a total of 2 615 cases of gallstone disease were observed. The cumulative incidence rates of gallstone disease was 4.75% in the non-obesity and non-diabetes group, 4.62% in the obesity and non-diabetes group, 6.98% in the non-obesity and diabetes group, and 7.74% in the obesity and diabetes group (χ2 =87.06, P<0.01). The results of Cox proportional risk model showed that after adjusting for confounding factors, compared with that of the non-obesity and non-diabetes group, the HR of the obesity and non-diabetes group, non-obesity and non-diabetes group, obesity and diabetes group was 1.36 times, 1.26 times and 1.5 times respectively. The interaction analysis showed that obesity and diabetes had positive multiplication and additive interaction on gallstone disease. Conclusion Obesity and diabetes are risk factors for gallstone disease, which have synergistic effects on gallstone disease.