胆石症对心血管疾病发病的影响

目的 探讨胆石症对心血管疾病（cardiovascular disease，CVD）发病的影响。方法 采用前瞻性队列研究方法分析2006、2008年度首次参加开滦总医院健康体检的共计126 847名职工，收集其体检资料。最终纳入118 516例观察对象，分为胆石症组（n=2 901）和非胆石症组（n=115 615），随访并收集两组人群CVD发病情况。用寿命表法计算各组CVD的累积发病率，并用Log-rank检验比较两组中CVD累积发病率的差异，采用Cox比例风险模型分析胆石症对CVD发病风险的影响。按性别进行分层，分析不同性别CVD的风险比和95%可信区间。结果 与非胆石症组相比，胆石症组年龄、男性比例、体质指数（BMI）、甘油三酯（TG）、体育锻炼率、吸烟率、饮酒率、高血压率，组间差异具有统计学意义（P＜0.05）。在平均10.03年的随访期间内，共发生CVD 7 205例，其中心肌梗死1 674例，脑卒中5 695例，脑卒中合并心肌梗死164例；其中缺血性脑卒中4 772例，出血性脑卒中1 101例，出血性脑卒中合并发生缺血性脑卒中的178例。胆石症组CVD、心肌梗死、脑卒中、缺血性脑卒中、出血性脑卒中累积发病率分别为7.98%、1.96%、6.24%、5.01%、1.46%；非胆石症组CVD、心肌梗死、脑卒中、缺血性脑卒中、出血性脑卒中累积发病率分别为5.48%、1.32%、4.28%、3.54%、0.8%，经Log-rank检验，两组间差异均有统计学意义（P＜0.05）。Cox比例风险模型结果显示，校正了混杂因素后，胆石症组发生CVD的HR值（95%CI）为1.31（1.15～1.49），发生心肌梗死的HR值（95%CI）为1.25（0.95～1.64），发生脑卒中的HR值（95%CI）为1.32（1.14～1.52），发生缺血性脑卒中的HR值（95%CI）为1.28（1.09～1.51），发生出血性脑卒中的HR值（95%CI）为1.43（1.05～1.96）。男性胆石症患者CVD、脑卒中、缺血性脑卒中的发病风险要低于女性胆石症患者。结论 胆石症是心血管疾病发病的独立危险因素。

The effect of gallstone disease on the incidence of cardiovascular disease

Objective To investigate the effect of gallstone on the incidence of cardiovascular diseases(CVD).Methods A prospective cohort study was conducted to analyze a total of 126847 employees who participated in the health checkup of the Kailuan Hospital for the first time in 2006 and 2008,and collected their physical examination data.The population was divided into gallstone group(n=2901)and non-gallstone group(n=115615).The incidence of CVD in each group was followed-up and collected.The cumulative incidence of CVD in different groups was calculated by life table method,and the difference of cumulative incidence of CVD between the two groups was compared by Log-rank test.Cox proportional risk model was used to analyze the effect of gallstone on CVD risk.The risk ratio and 95%confidence interval of CVD by gender were analyzed.Results There were significant differences in age,male ratio,body mass index(BMI),triglyceride(TG),physical exercise,smoking,alcohol consumption,and hypertension between the gallstone group and the nongallstone group(P<0.05).During the average follow-up period of 10.03 years,a total of CVD 7205 cases occurred,including 1674 cases of myocardial infarction,5695 cases of stroke,164 cases of stroke complicated with myocardial infarction,4772 cases of ischemic stroke and 1101 cases of hemorrhagic stroke,178 cases of hemorrhagic stroke complicated with ischemic stroke.The cumulative incidences of CVD,myocardial infarction,stroke,ischemic stroke and hemorrhagic stroke in gallstone group were 7.98%,1.96%,6.24%,5.01%and 1.46%,respectively.In the non-gallstone group,the cumulative incidences of CVD,myocardial infarction,stroke,ischemic stroke and hemorrhagic stroke were 5.48%,1.32%,4.28%,3.54%and 0.80%,respectively.Logrank test showed that there were significant differences between the two groups(P<0.05).The results of Cox proportional risk model showed that after adjusting for confounding factors,the HR(95%CI)of CVD in gallstone group was 1.31(1.15~1.49),the HR(95%CI)of myocardial infarction was 1.25(0.95~1.64),the HR(95%CI)of stroke was 1.32(1.14~1.52),the HR(95%CI)of ischemic stroke was 1.28(1.09~1.51),the HR value(95%CI)of hemorrhagic stroke was 1.43(1.05~1.96).The risk of cvd,stroke and ischemic stroke in male patients with gallstone was lower than that in female patients with gallstone.Conclusion Gallstone disease is an independent risk factor for the incidence of cardiovascular diseases.