基于两水平Logistic回归分析模型分析我国成人尿石症影响因素

  目的  探讨我国成人尿石症患病的影响因素。  方法  于2013年5月-2014年7月，采用多阶段分层整群随机抽样，在全国随机抽7个省/直辖市，14个区/县的11个社区和19个自然村进行面对面问卷调查，包括泌尿系超声检查、血常规、尿常规和血液生化检查等。  结果  有效问卷9 310例中，尿石症患者1 447例，患病率为15.5%(1 447/9 310)；在14个地区之间的患病率有差异(χ2=711.523，P < 0.001)，最低为山西农村(0.76%)，最高为广东农村(35.99%)。零模型结果显示各地区尿石症患病有统计学聚集性(t=2.48，P=0.027)，且组内相关系数ICC=48.74%。随机效应模型结果显示男性(OR=1.235，95%CI:1.082~1.411，P=0.005)、年龄增长(OR=1.101，95%CI:1.047~1.158，P=0.001)、糖尿病史(OR=1.411，95%CI:1.192~1.670，P=0.001)、结石家族史(OR=1.867，95%CI:1.500~2.323，P < 0.001)、低密度脂蛋白(low density lipoprotein，LDL)(OR=1.150，95%CI:1.050~1.260，P=0.006)、饮咖啡(OR=1.352，95%CI:1.065~1.716，P=0.017)、饮碳酸饮料(OR=1.547，95%CI:1.203~1.990，P=0.002)等为尿石症发生的危险因素，食醋酸(OR=0.567，95%CI:0.498~0.645，P < 0.001)和适量食用豆类(OR=0.726，95%CI:0.628~0.839，P < 0.001)等为尿石症发生的保护因素。  结论  尿石症患病具有地方聚集性，生活环境和饮食习惯影响尿石症的形成。

Analysis on the associated factors of adult urolithiasis in China based on two-level Logistic regression model

  Objective  To investigate the risk factors of adult urolithiasis in China.  Methods  14 areas including 11 communities and 19 villages were randomly selected from 7 provinces of China by multi-stage stratified cluster sampling method during the period of May 2013 to July 2014. Individuals were investigated by a face-to-face questionnaire and a physical examination including urinary tract ultrasonographic examinations, routine blood and urine tests and blood biochemical examination ect.  Results  In total, 1 447 participants were found with the urolithiasis among 9 310 individuals and the overall prevalence was 15.5% (1 447/9 310). The prevalence of urolithiasis was significantly different among 14 areas (χ2=711.523, P < 0.001), the lowest was the village in Shanxi (0.76%) and the highest was the village in Guangdong(35.99%). The intercept-only model further indicated the reginal aggregation for the individuals of urolithiasis (t=2.48, P=0.027) and the ICC was 48.74%. The two-level Logistic regression model showed that the gender (OR=1.235, 95% CI: 1.082-1.411, P=0.005), age (OR=1.101, 95% CI: 1.047-1.158, P=0.001), diabetes mellitus (OR=1.411, 95%CI: 1.192-1.670, P=0.001), family history of urinary calculi (OR=1.867, 95% CI: 1.500-2.323, P < 0.001), LDL (OR=1.150, 95% CI: 1.050-1.260, P=0.006), drinking coffee (OR=1.352, 95% CI: 1.065-1.716, P=0.017) and drinking sodas (OR=1.547, 95% CI: 1.203-1.990, P=0.002) were the risk factors for urolithiasis. By contrast, consumed more fermented vinegar (OR=0.567, 95% CI: 0.498-0.645, P < 0.001) and had a amount of legume (OR=0.726, 95% CI: 0.628-0.839, P < 0.001) were protective factors of urolithiasis.  Conclusion  The prevalence of urolithiasis among adults reveal an aggregation in area-level, influenced by life environment and dietary habits of individual.