胆囊结石相关危险因素的探讨

目的 探索胆囊结石发生的相关危险因素，为防治胆囊结石提供理论依据。方法 回顾性分析北京协和医院2007年1月至2010年5月间体检者的临床资料，对其中的4087例胆囊结石患者（病例组）和20 435例无胆囊结石体检者（对照组）按照年龄、性别进行1∶5配比以作病例对照研究。对计数资料采用x2检验，计量资料采用t检验；对相关危险因素先用单因素条件Logistic回归分析方法筛选出有统计学意义的可疑危险因素，再用多因素条件Logistic回归法进行分析。结果单因素分析显示，糖尿病、收缩压、舒张压、甘油三酯、高密度脂蛋白胆固醇及体重指数6个因素在病例组与对照组之间差异有统计学意义(P＜o.05)。多因素分析证实，去除了年龄、性别的影响后，糖尿病、收缩压、高密度脂蛋白胆固醇及体重指数仍与胆囊结石显著相关，其比值（95％可信区间）分别为0.825 (0.736～0.925)、0.908 (0.828～0.996)、1.211 (1.056～1.389)和0.746 (0.691～0.805)。总胆固醇、低密度脂蛋白胆固醇在病例组与对照组间之差异无统计学意义(P＞0.05)。结论 糖尿病、收缩压增高、高密度脂蛋白胆固醇降低及肥胖是胆囊结石形成的独立危险因素。因此，应该通过控制糖尿病、减轻体重、控制血压、调整血脂等措施来预防胆囊结石的发生。

The risk factors of gallstones

Objective To determine the risk factors of gallstones. Methods A case-control study was conducted on 4087 patients with gallstones (the study group) and 20435 individuals without gallstones (the control group) at the Health Center of Peking Union Medical College Hospital (PUMCH) between January 2007 to May 2010. Using age and sex, the study and the control groups were matched in 1 : 5 ratio. Data were statistically analyzed using Chi-square test and conditional logistic regression. Results Univariate analysis showed significant differences in diabetic mellitus (DM), systolic blood pressure (SBP), diastalic blood pressure (DBP), triglyceride (TG), high density lipoprotein cholesterol (HDL-CH) and body mass index (BMI) between the study and the control groups (P＜0.05). Multivariate analysis confirmed that DM, SBP, HDL-CH and BMI were associated with gallstones, and their adjusted odds ratio (95％ confidence interval) were 0. 825 (0. 736 ～0. 925), 0. 908 (0. 828～0. 996), 1. 211 (1. 056～1. 389) and 0. 746 (0. 691～0. 805), respectively.The incidences of total cholesterol (TCH) and low deasity dipoprotein cholesterol (LDL-CH) were not significantly different between the two groups (P＞0.05). Conclusions DM、SBP、HDL-CH and BMI were found to be the risk factors for gallstones. To prevent gallstones, weight reduction, blood pressure control and normalization of blood lipid are important measures.