上海地区胆囊结石病的流行病学调查

doi:10.16139/j.1007-9610.2018.03.014

摘要/Abstract

摘要： 目的: 研究上海地区居民胆囊结石病（以下简称胆石病）的患病情况及其相关的危险因素。方法: 2010年8月至2011年7月期间,对上海三个区部分20~79岁自然人群15 256人进行横断面调查。其中男8 617人,女6 639人。使用问卷调查、体格检查和实验室生化分析等方法收集参加者相关临床数据。胆囊疾病采用空腹B超检查确诊。采用t检验和Logistic逐步回归分析与胆石病相关的危险因素。结果: ①胆石病总体患病率为7.02%,女性（8.10%）略高于男性（6.19%）（P<0.05）。不论性别,胆石病的患病率随年龄递增（P<0.05）。②胆囊总体切除率为2.48%,女性（3.42%）是男性（1.75%）的约2倍（P<0.05）,也随年龄递增（P<0.05）。③Logistic逐步回归分析显示,女性、高龄、脂肪肝、胆石病家族史、高血压、体质量指数增加为胆石病相关的危险因素。结论: 本研究调查显示,当前上海地区人群总体胆石病患病率为7.02%,胆囊切除率为2.48%。性别、年龄、脂肪肝、胆石病家族史、高血压和体质量指数与胆石病发生密切相关。

关键词: 流行病学, 胆囊结石病, 胆囊切除, 患病率, 危险因素

Abstract: Objective: To investigate the prevalence of gallbladder stone disease(GSD) in Shanghai and analyze the risk factors associated with GSD. Methods: The cross-section survey was carried out from August 2010 to July 2011. We enrolled 15 256 habitants in three districts of Shanghai (8 617 male and 6 639 female), aged between 20-79 years old. The relevant clinical data of the subjects were collected by questionnaire, physical examination and biochemical analysis. GSD was diagnosed by type-B ultrasonography. T test and Logistic stepwise regression were performed to analyze the risk factors associated with GSD. Results: ① The prevalence of GSD was 7.02% in this survey, which was slight higher in females than in males (8.10% vs 6.19%, P<0.05) and increased with age (P<0.05). ② The rate of cholecystectomy was 2.48% in total, almost twice in females than in males (3.42% vs 1.75%, P<0.05), and increased with age as well (P<0.05). ③ Logistic stepwise regression analysis showed that female, older, presence of fatty liver disease, family history, hypertension and increased body mass index (BMI) were the risk factors for GSD. Conclusions: Our survey showed that the prevalence of GSD was 7.02% and the cholecystectomy rate was 2.48% in Shanghai population. Gender, age, fatty liver disease, family history, hypertension and BMI were the risk factors associated with GSD.

Key words: Epidemiology, Gallbladder stone disease, Cholecystectomy, Prevalence, Risk factors

中图分类号:

R657.4⁺2

王启晗, 张中文, 吴健, 蔡强, 孙海东, 蔡劬, 蒋兆彦, 韩天权, 张圣道. 上海地区胆囊结石病的流行病学调查[J]. 外科理论与实践, 2018, 23(03): 252-257.

WANG Qihan, ZHANG Zhongwen, WU Jian, CAI Qiang, SUN Haidong, CAI Qu, JIANG Zhaoyan, HAN Tianquan, ZHANG Shengdao. Epidemiology of gallbladder stone disease in Shanghai[J]. Journal of Surgery Concepts & Practice, 2018, 23(03): 252-257.

参考文献

[1] 顾倬云, 黄志强. 中国人胆结石的特点——全国11 342份胆结石手术病例临床调查[J]. 中华外科杂志,1987,25(6):321-329.
[2] 中华外科学会胆道外科学组. 我国胆石病十年来的变迁[J]. 中华外科杂志,1995,33(11):652-658.
[3] Portincasa P, Moschetta A, Palasciano G.Cholesterol gallstone disease[J]. Lancet,2006,368(9531):230-239.
[4] Nakeeb A, Comuzzie AG, Martin L, et al.Gallstones: genetics versus environment[J]. Ann Surg,2002,235(6):842-849.
[5] Chuang SC, Hsi E, Lee KT.Genetics of gallstone disease[J]. Adv Clin Chem,2013,60(2):143-185.
[6] Zhu L, Aili A, Zhang C, et al.Prevalence of and risk factors for gallstones in Uighur and Han Chinese[J]. World J Gastroentero,2014,20(40):14942-14949.
[7] Chen JY, Hsu CT, Liu JH, et al.Clinical predictors of incident gallstone disease in a Chinese population in Taipei, Taiwan[J]. BMC Gastroenterol,2014,14:83.
[8] Xu Q, Tao LY, Wu Q, et al.Prevalences of and risk factors for biliary stones and gallbladder polyps in a large Chinese population[J]. HPB (Oxford),2012,14(6):373-381.
[9] 叶忻, 王保钢, 项晓宇, 等. 上海江湾地区成年人胆囊结石发病情况调查[J]. 肝胆胰外科杂志,2003,15(1):28-30.
[10] Shaffer EA.Gallstone disease: Epidemiology of gallbladder stone disease[J]. Best Pract Res Clin Gastroenterol,2006,20(6):981-996.
[11] Cirillo DJ, Wallace RB, Rodabough RJ, et al.Effect of estrogen therapy on gallbladder disease[J]. JAMA,2005, 293(3):330-339.
[12] Sanders G, Kingsnorth AN.Gallstones[J]. BMJ,2007,335(7614):295-299.
[13] Einarsson K, Nilsell K, Leijd B, et al.Influence of age on secretion of cholesterol and synthesis of bile acids by the liver[J]. N Engl J Med,1985,313(5):277-282.
[14] Shaffer EA.Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?[J]. Curr Gastroenterol Rep,2005,7(2):132-140.
[15] Kaechele V, Wabitsch M, Thiere D, et al.Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development[J]. J Pediatr Gastroenterol Nutr,2006,42(1):66-70.
[16] Stinton LM, Myers RP, Shaffer EA.Epidemiology of gallstones[J]. Gastroenterol Clin North Am,2010,39(2):157-169.
[17] 费健, 韩天权, 蒋兆彦, 等. 胆囊结石病家系遗传特征的初步研究[J]. 肝胆胰外科杂志,2002,14(1):4-6.
[18] Katsika D, Grjibovski A, Einarsson C, et al.Genetic and environmental influences on symptomatic gallstone di-sease: a Swedish study of 43 141 twin pairs[J]. Hepatology,2005,41(5):1138-1143.
[19] von Kampen O, Buch S, Nothnagel M, et al. Genetic and functional identification of the likely causative variant for cholesterol gallstone disease at the ABCG5/8 lithogenic locus[J]. Hepatology,2013,57(6):2407-2417.
[20] Maclure KM, Hayes KC, Colditz GA, et al.Weight, diet, and the risk of symptomatic gallstones in middle-aged women[J]. N Engl J Med,1989,321(9):563-569.
[21] Marschall HU, Einarsson C.Gallstone disease[J]. J Intern Med,2007,261(6):529-542.
[22] Fornari F, Imberti D, Squillante MM, et al.Incidence of gallstones in a population of patients with cirrhosis[J]. J Hepatol,1994,20(6):797-801.
[23] Younossi ZM, Blissett D, Blissett R, et al.The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe[J]. Hepatology,2016,64(5):1577-1586.
[24] Jaruvongvanich V, Sanguankeo A, Upala S.Significant association between gallstone disease and nonalcoholic fatty liver disease: a systematic review and Meta-analysis[J]. Dig Dis Sci,2016,61(8):2389-2396.
[25] Utzschneider KM, Kahn SE.Review: The role of insulin resistance in nonalcoholic fatty liver disease[J]. J Clin Endocr Metab,2006,91(12):4753-4761.
[26] Tsai CJ, Leitzmann MF, Willett WC, et al.Macronutrients and insulin resistance in cholesterol gallstone disease[J]. Am J Gastroenterol,2008,103(11):2932-2939.
[27] Lambou-Gianoukos S, Heller SJ.Lithogenesis and bile metabolism[J]. Surg Clin North Am,2008,88(6):1175-1194.
[28] Zamani F, Sohrabi M, Alipour A, et al.Prevalence and risk factors of cholelithiasis in Amol city, northern Iran: a population based study[J]. Arch Iran Med,2014,17(11):750-754.
[29] Chen LY, Qiao QH, Zhang SC, et al.Metabolic syndrome and gallstone disease[J]. World J Gastroenterol,2012,18(31):4215-4220.
[30] Froutan Y, Alizadeh A, Mansour-Ghanaei F, et al.Gallstone disease founded by ultrasonography in functional dyspepsia: prevalence and associated factors[J]. Int J Clin Exp Med,2015,8(7):11283-11288.