胆囊结石与糖脂代谢关系的探讨

目的 探讨糖脂代谢在胆囊结石形成中的作用。方法 收集1998年1－4月25例胆囊结石患者和25例自愿者，并应用性别和年龄进行了个体配对（1：1），测量所有研究对象的体重指数（BMI）和腰臀比（W／H），并采空腹静脉血测定血糖、糖化血红蛋白（HbA1C)、胰岛素、C肽以及全脂全套指标，采血后研究对象立即口服75g葡萄糖，2小时后再测定血糖、胰岛素、C肽。结果 结石组与对照组的BMI和W／H无明显统计学差异。两组空腹血糖、HbA1C及2小时血糖差异无统计学意义（P＞0．05、P＞0．2、P＞0．1）。结石组中糖代谢异常10例，占40％（7例糖尿病，3例糖耐量减低），对照组糖代谢异常4例（1例糖尿病3例糖耐量减代），差异有显著性意义（P＜0．05）。结石组空腹及2小时胰岛素平均浓度明显高于对照组（P＜0．02，P＜0．05），结石组空腹C肽亦高于对照组（P＜0．05）。结石组中高胰岛素血症14例，对照组2例，差异有显著性意义（P＜0．01）。两组血脂各项指标（TG、TC、HDL－C、LDL－C、VLDL－C）无统计学差异。结论 糖尿病和胰岛素水平升高在胆囊结石形成中可能有重要作用。

RELATIONSHIP BETWEEN GALLBLADDER STONE AND LIPOROGLUCOSE METABOLISM

Objective　To study the effects of glucose and lipid metabolism on gallstone formation. Methods　Twenty five patients with gallstones and 25 normal volunteer controls were studied from January to April in 1998. The patients were well matched the control with sex and age (1∶1). In the study, Body Mass Index (BMI) and Waist-to-Hip circumference ratio (W/H) were measured. Blood glucose, glucosylated hemoglobin (HbA1C), insulin, C peptide and all parameters of lipids were detected at fasting state. The glucose,insulin, C peptide were detected again at 2-hour after taking 75g glucose orally. Results　The result showed there was no difference on BMI and W/H between the patients and controls. HbA1C、mean fasting and 2-hour glucose concentration were not in significantly different between the two groups (P>0.05, P>0.2, P>0.1 respectively). There were 10 patients with abnormal glucose metabolism (7 with NIDDM, 3 with IGT), but only 4 controls were abnoumal (one with NIDDM, three with IGT). The difference was significant (P<0.05). Furthermore, the mean fasting and 2-hour insulin concentration of gallstone group was higher than that of the control (P<0.02, P<0.05). And the gallstone group had a higher fasting C peptide concentration than control (P<0.05). There was no statistical difference on the parameters of plasma lipid between the tow groups. Conclusion　The study suggests that diabetes mellious and hyperinsulinemia acted as an important role on gallstone formation.