南疆地区胆囊结石与代谢综合征的关联性分析
DOI: 10.3969/j.issn.1001-5256.2022.08.026
-
摘要:
目的 通过研究南疆地区胆囊结石(GS)与代谢综合征(MS)的相关性,为南疆地区代谢性疾病的预防与控制提供经验。 方法 通过整群抽样收集2015年3月—2019年3月于新疆生产建设兵团第一师医院、第二师库尔勒医院、新疆生产建设兵团第三师医院就诊的GS患者作为病例组。通过整群抽样收集同期于第三师五十一团医院体检人群为对照组。通过纳入排除标准及按年龄、性别进行一比一配对,最终病例组、对照组均纳入1140例。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验;采用logistic回归探讨GS的影响因素。通过logistic回归纳入哑变量的方法评价MS组分间的相乘交互作用;借用logistic回归模型的参数估计值和协方差矩阵(相关系数矩阵)及交互作用计算表,计算和评价MS组分之间的相加交互作用。 结果 MS患者GS的患病风险是非MS患者的2.33倍(OR=2.33,95%CI:1.86~2.92)。且MS的各组分:血糖(OR=2.94,95%CI:2.36~3.68)、血压(OR=1.50,95%CI:1.26~1.80)、血脂(OR=1.48,95%CI:1.25~1.75)、BMI(OR=1.44,95%CI:1.21~1.70)也增加了GS的患病风险。经多因素调整后,随着代谢异常数目:一项异常(OR=1.55,95%CI:1.22~1.99)、两项异常(OR=2.13,95%CI:1.66~2.72)、三项异常(OR=3.48,95%CI:2.59~4.69)、四项异常(OR=4.65,95%CI:2.79~7.84)的增加,GS的患病风险逐渐增加。MS各组分之间未发现存在相加、相乘交互作用。 结论 南疆地区GS与MS密切相关,且随着MS组分的增加,GS的发病风险逐渐增高,GS与MS各组分之间无相加交互及相乘交互作用。 Abstract:Objective To investigate the association between gallstones (GS) and metabolic syndrome (MS) in southern Xinjiang, China, and to provide experience for the prevention and control of metabolic diseases in southern Xinjiang. Methods The patients with GS who visited First Division Hospital, Second Division Korla Hospital, and Third Division Hospital of Xinjiang Production and Construction Corps from March 2015 to March 2019 were enrolled as case group, and cluster sampling was used to select the individuals who underwent physical examination in Third Division 51st Regiment Hospital during the same period of time were enrolled as control group. According to inclusion and exclusion criteria, 1140 cases were enrolled in each group after 1∶ 1 matching based on age and sex. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a logistic regression analysis was used to investigate the influencing factors for GS. Dummy variables were included by logistic regression to evaluate multiplicative interaction between MS components, and the parameter estimate and covariance matrix of the logistic regression model and interaction calculation table were used to calculate and evaluate additive interaction between MS components. Results The risk of GS in MS patients was 2.33 times that in non-MS patients (odds ratio [OR]=2.33, 95% confidence interval [CI]: 1.86-2.92). In addition, the components of MS also increased the risk of GS, including blood glucose (OR=2.94, 95%CI: 2.36-3.68), blood pressure (OR=1.50, 95%CI: 1.26-1.80), blood lipids (OR=1.48, 95%CI: 1.25-1.75), and body mass index (OR=1.44, 95%CI: 1.21-1.70). After adjustment for multiple factors, the risk of GS gradually increased with the increase in the number of metabolic abnormalities, i.e., one abnormality (OR=1.55, 95%CI: 1.22-1.99), two abnormalities (OR=2.13, 95%CI: 1.66-2.72), three abnormalities (OR=3.48, 95%CI: 2.59-4.69), and four abnormalities (OR=4.65, 95%CI: 2.79-7.84). No additive or multiplicative interaction was found between MS components. Conclusion GS is closely associated with MS in southern Xinjiang, and the risk of GS gradually increases with the increase in MS components. No additive or multiplicative interaction is found between GS and MS components. -
Key words:
- Cholecystolithiasis /
- Metabolic Syndrome X /
- Southern Xinjiang
-
表 1 研究人群的基线特征
Table 1. Baseline characteristics of the study population
项目 病例组(n=1140) 对照组(n=1140) 统计值 P值 MS[例(%)] 283(24.82) 144(12.63) χ2=55.675 <0.001 男性[例(%)] 366(32.11) 365(32.02) χ2=0.002 0.964 年龄(岁) 59.30±13.90 58.36±14.63 t=-1.582 0.114 TG(mmol/L) 1.57±1.02 1.62±0.89 t=1.163 0.245 FPG(mmol/L) 5.92±2.23 5.01±1.61 t=-10.932 <0.001 收缩压(mmHg) 130.67±21.11 129.70±18.60 t=-1.166 0.244 舒张压(mmHg) 79.41±12.51 75.05±12.07 t=-8.480 <0.001 HDL-C(mmol/L) 1.09±0.29 1.53±0.60 t=22.300 <0.001 LDL-C(mmol/L) 2.62±0.83 2.58±0.83 t=-1.259 0.208 TC(mmol/L) 4.42±0.98 4.65±1.18 t=5.145 <0.001 BMI(kg/m2) 25.75±4.09 25.03±5.27 t=-3.639 <0.001 注:FPG,空腹血糖。 表 2 各代谢异常组分与GS的关联性分析
Table 2. Correlation analysis of metabolic abnormal components and GS
变量 模型1[OR(95%CI)] 模型2[OR(95%CI)] 高血糖 2.91(2.33~3.62) 2.94(2.36~3.68) 超重和/或肥胖 1.41(1.20~1.66) 1.44(1.21~1.70) 高血压 1.47(1.24~1.75) 1.50(1.26~1.80) 血脂紊乱 1.47(1.25~1.74) 1.47(1.25~1.74) 注: 模型1,不调整;模型2,调整年龄、性别、TC、LDL-C。 表 3 代谢异常聚集数目与GS的关联性分析
Table 3. Correlation analysis of metabolic abnormal aggregation number and GS
代谢异常聚集数目 模型1 [OR(95%CI)] 模型2 [OR(95%CI)] 0 1.0(ref) 1.0(ref) 1 1.56(1.22~1.99) 1.55(1.22~1.99) 2 2.10(1.65~2.68) 2.13(1.66~2.72) 3 3.41(2.55~4.58) 3.48(2.59~4.69) 4 4.40(2.64~7.35) 4.65(2.79~7.84) 注: 模型1,不调整;模型2,调整年龄、性别、TC、LDL-C。 表 4 MS各组分间的相乘交互作用
Table 4. Multiplicative interactions between MS components
变量1 变量2 模型1 模型2 OR(95%CI) P值 OR(95%CI) P值 FPG BMI - - 1.0(ref) 1.0(ref) + - 3.09(2.21~4.32) <0.001 3.11(2.21~4.36) <0.001 - + 1.36(1.13~1.64) 0.001 1.37(1.14~1.66) 0.001 + + 3.58(2.67~4.80) <0.001 3.66(2.72~4.93) <0.001 SI相乘 0.85(0.55~1.33) 0.479 0.86(0.55~1.35) 0.509 FPG 血压 - - 1.0(ref) 1.0(ref) + - 2.98(2.22~3.99) <0.001 3.02(2.25~4.06) <0.001 - + 1.38(1.14~1.69) 0.001 1.41(1.15~1.73) 0.001 + + 3.55(2.58~4.88) <0.001 3.64(2.63~5.03) <0.001 SI相乘 0.86(0.55~1.35) 0.512 0.85(0.54~1.34) 0.494 FPG 血脂 - - 1.0(ref) 1.0(ref) + - 3.74(2.72~5.16) <0.001 3.71(2.68~5.12) <0.001 - + 1.55(1.29~1.87) <0.001 1.55(1.28~1.87) <0.001 + + 3.37(2.50~4.55) <0.001 3.47(2.56~4.70) <0.001 SI相乘 0.58(0.37~0.90) 0.016 0.61(0.39~0.95) 0.028 BMI 血压 - - 1.0(ref) 1.0(ref) + - 1.35(1.10~1.66) 0.004 1.39(1.13~1.72) 0.002 - + 1.41(1.09~1.83) 0.008 1.47(1.13~1.91) 0.004 + + 1.92(1.53~2.42) <0.001 1.97(1.56~2.50) <0.001 SI相乘 1.01(0.71~1.43) 0.979 0.96(0.67~1.37) 0.825 BMI 血脂 - - 1.0(ref) 1.0(ref) + - 1.59(1.27~2.00) <0.001 1.59(1.26~2.01) <0.001 - + 1.71(1.34~2.17) <0.001 1.68(1.32~2.15) <0.001 + + 1.86(1.50~2.32) <0.001 1.89(1.52~2.36) <0.001 SI相乘 0.69(0.49~0.96) 0.027 0.71(0.50~1.00) 0.047 血压 血脂 - - 1.0(ref) 1.0(ref) + - 1.33(1.05~1.69) 0.019 1.34(1.05~1.71) 0.019 - + 1.36(1.11~1.67) 0.003 1.35(1.10~1.67) 0.005 + + 2.16(1.69~2.76) <0.001 2.23(1.74~2.86) <0.001 SI相乘 1.19(0.84~1.69) 0.325 1.23(0.86~1.75) 0.252 注:模型1,不调整;模型2,调整年龄、性别、TC、LDL-C。 表 5 MS各组分间的相加交互作用
Table 5. Additive interactions between MS components
变量1 变量2 RERI[OR(95%CI)] AP[OR(95%CI)] SI[OR(95%CI)] 模型1 模型2 模型1 模型2 模型1 模型2 FPG BMI 0.13(-1.23~1.49) 0.18(-1.21~1.58) 0.04(-0.34~0.41) 0.05(-0.32~0.42) 1.05(0.61~1.81) 1.07(0.62~1.85) FPG 血压 0.19(-1.16~1.54) 0.21(-1.19~1.60) 0.05(-0.32~0.42) 0.06(-0.32~0.43) 1.08(0.63~1.87) 1.09(0.63~1.88) FPG 血脂 -0.92(-2.40~0.55) -0.79(-2.28~0.71) -0.27(-0.76~0.21) -0.23(-0.70~0.24) 0.72(0.43~1.21) 0.76(0.45~1.28) BMI 血压 0.16(-0.37~0.68) 0.11(-0.45~0.66) 0.08(-0.19~0.35) 0.05(-0.22~0.33) 1.20(0.63~2.31) 1.12(0.61~2.07) BMI 血脂 -0.44(-0.99~0.12) -0.38(-0.95~0.19) -0.24(-0.54~0.07) -0.20(-0.51~0.11) 0.66(0.42~1.06) 0.70(0.43~1.14) 血压 血脂 0.47(-0.09~1.03) 0.54(-0.03~1.11) 0.22(-0.02~0.45) 0.24(0.02~0.47) 1.68(0.85~3.30) 1.78(0.91~3.48) 注:模型1,不调整;模型2,调整年龄、性别、TC、LDL-C。 -
[1] LAMMERT F, GURUSAMY K, KO CW, et al. Gallstones[J]. Nat Rev Dis Primers, 2016, 2: 16024. DOI: 10.1038/nrdp.2016.24. [2] ZHU Q, SUN X, JI X, et al. The association between gallstones and metabolic syndrome in urban Han Chinese: a longitudinal cohort study[J]. Sci Rep, 2016, 6: 29937. DOI: 10.1038/srep29937. [3] ECKEL RH, GRUNDY SM, ZIMMET PZ. The metabolic syndrome[J]. Lancet, 2005, 365(9468): 1415-1428. DOI: 10.1016/S0140-6736(05)66378-7. [4] National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Ⅲ). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel Ⅲ) final report[J]. Circulation, 2002, 106(25): 3143-3421. DOI: 10.1161/circ.106.25.3143 [5] YANG JL, HUANG JJ, CHENG N, et al. Sex-specific and dose-response relationship between the incidence of gallstones and components of the metabolic syndrome in Jinchang Cohort: a prospective study[J]. Biomed Environ Sci, 2020, 33(8): 633-638. DOI: 10.3967/bes2020.084. [6] TSAI CH, WU JS, CHANG YF, et al. The number of metabolic abnormalities associated with the risk of gallstones in a non-diabetic population[J]. PLoS One, 2014, 9(3): e90310. DOI: 10.1371/journal.pone.0090310. [7] YANG LZ, PENG XY, ZHANG HW, et al. A comparative analysis of the blood lipid levels and body mass index in the female patients with simple cholelithiasis of Uyghur and Han nationality[J]. Chin J Mod Med, 2021, 31(16): 59-62. DOI: 10.3969/j.issn.1005-8982.2021.16.011.杨凌志, 彭心宇, 张宏伟, 等. 维吾尔族与汉族女性单纯性胆囊结石患者体重指数及血脂水平的对比分析[J]. 中国现代医学杂志, 2021, 31(16): 59-62. DOI: 10.3969/j.issn.1005-8982.2021.16.011. [8] LI WD. Epidemiological analysis of gallstone in Xinjiang[J]. Contemp Med Forum, 2014, 21: 187-188. https://www.cnki.com.cn/Article/CJFDTOTAL-QYWA201421157.htm李卫东. 对新疆地区胆囊结石的流行病学分析[J]. 当代医药论丛, 2014, 12(21): 187-188. https://www.cnki.com.cn/Article/CJFDTOTAL-QYWA201421157.htm [9] PANG HR, XU SZ, DING YS, et al. Epidemiological characteristics of metabolic syndrome among the Kazak, Uygur and Han people aged 60 years and above in Xinjiang[J]. J Pract Med, 2014, 30(17): 2843-2846. DOI: 10.3969/j.issn.1006-5725.2014.17.053.庞鸿瑞, 徐上知, 丁玉松, 等. 新疆哈萨克族、维吾尔族及汉族60岁及以上老年人群代谢综合征流行特点[J]. 实用医学杂志, 2014, 30(17): 2843-2846. DOI: 10.3969/j.issn.1006-5725.2014.17.053. [10] The Cooperation Group of the Chinese Medical Association Diabetes Branch studying on the Metabolic Syndrome. Suggestion for the metabolic syndrome by the Chinese Medical Association Diabetes Branch[J]. Clin J DIabetes, 2004, 12(3): 5-10. DOI: 10.3321/j.issn:1006-6187.2004.03.002中华医学会糖尿病学分会代谢综合征研究协作组. 中华医学会糖尿病学分会关于代谢综合征的建议[J]. 中华糖尿病杂志, 2004, 12(3): 5-10. DOI: 10.3321/j.issn:1006-6187.2004.03.002 [11] ANDERSSON T, ALFREDSSON L, KÄLLBERG H, et al. Calculating measures of biological interaction[J]. Eur J Epidemiol, 2005, 20(7): 575-579. DOI: 10.1007/s10654-005-7835-x [12] MÉNDEZ-SÁNCHEZ N, CHAVEZ-TAPIA NC, MOTOLA-KUBA D, et al. Metabolic syndrome as a risk factor for gallstone disease[J]. World J Gastroenterol, 2005, 11(11): 1653-1657. DOI: 10.3748/wjg.v11.i11.1653. [13] NERVI F, MIQUEL JF, ALVAREZ M, et al. Gallbladder disease is associated with insulin resistance in a high risk Hispanic population[J]. J Hepatol, 2006, 45(2): 299-305. DOI: 10.1016/j.jhep.2006.01.026. [14] LITTLEFIELD A, LENAHAN C. Cholelithiasis: presentation and management[J]. J Midwifery Womens Health, 2019, 64(3): 289-297. DOI: 10.1111/jmwh.12959. [15] LIOUDAKI E, GANOTAKIS ES, MIKHAILIDIS DP. Lipid lowering drugs and gallstones: a therapeutic option?[J]. Curr Pharm Des, 2011, 17(33): 3622-3631. DOI: 10.2174/138161211798220909. [16] SHEBL FM, ANDREOTTI G, MEYER TE, et al. Metabolic syndrome and insulin resistance in relation to biliary tract cancer and stone risks: a population-based study in Shanghai, China[J]. Br J Cancer, 2011, 105(9): 1424-1429. DOI: 10.1038/bjc.2011.363. [17] NAKEEB A, COMUZZIE AG, Al-Azzawi H, et al. Insulin resistance causes human gallbladder dysmotility[J]. J Gastrointest Surg, 2006, 10(7): 940-948, 948-949. DOI: 10.1016/j.gassur.2006.04.005. [18] LIU CM, HSU CT, LI CY, et al. A population-based cohort study of symptomatic gallstone disease in diabetic patients[J]. World J Gastroenterol, 2012, 18(14): 1652-1659. DOI: 10.3748/wjg.v18.i14.1652. [19] AUNE D, VATTEN LJ. Diabetes mellitus and the risk of gallbladder disease: A systematic review and meta-analysis of prospective studies[J]. J Diabetes Complications, 2016, 30(2): 368-373. DOI: 10.1016/j.jdiacomp.2015.11.012. [20] ALI AK, ADETUNJI OR. Incidence and prevalence of bile duct and gallbladder disease in patients with diabetes in the U.S. [J]. Diabetes, 2018, 67(Suppl 1): 1559-P. DOI: org/10.2337/db18-1559-P. [21] BIDDINGER SB, HAAS JT, YU BB, et al. Hepatic insulin resistance directly promotes formation of cholesterol gallstones[J]. Nat Med, 2008, 14(7): 778-782. DOI: 10.1038/nm1785. [22] de BOER SY, MASCLEE AA, LAMERS CB. Effect of hyperglycemia on gastrointestinal and gallbladder motility[J]. Scand J Gastroenterol Suppl, 1992, 194: 13-18. DOI: 10.3109/00365529209096020. [23] PORTINCASA P, MOSCHETTA A, PALASCIANO G. Cholesterol gallstone disease[J]. Lancet, 2006, 368(9531): 230-239. DOI: 10.1016/S0140-6736(06)69044-2. [24] LIEW PL, WANG W, LEE YC, et al. Gallbladder disease among obese patients in Taiwan[J]. Obes Surg, 2007, 17(3): 383-390. DOI: 10.1007/s11695-007-9068-4. [25] LIN IC, YANG YW, WU MF, et al. The association of metabolic syndrome and its factors with gallstone disease[J]. BMC Fam Pract, 2014, 15: 138. DOI: 10.1186/1471-2296-15-138. [26] CHEN LY, QIAO QH, ZHANG SC, et al. Metabolic syndrome and gallstone disease[J]. World J Gastroenterol, 2012, 18(31): 4215-4220. DOI: 10.3748/wjg.v18.i31.4215. [27] WANG J, SHEN S, WANG B, et al. Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China[J]. Lipids Health Dis, 2020, 19(1): 50. DOI: 10.1186/s12944-019-1184-3. [28] KIM SS, LEE JG, KIM DW, et al. Insulin resistance as a risk factor for gallbladder stone formation in Korean postmenopausal women[J]. Korean J Intern Med, 2011, 26(3): 285-293. DOI: 10.3904/kjim.2011.26.3.285. [29] AMIGO L, ZANLUNGO S, MENDOZA H, et al. Risk factors and pathogenesis of cholesterol gallstones: state of the art[J]. Eur Rev Med Pharmacol Sci, 1999, 3(6): 241-246. [30] BAI JD, XUE RQ, BAI YL, et al. Association between metabolic syndrome and gallstones[J]. J Clin Hepatol, 2020, 36(3): 701-703. DOI: 10.3969/j.issn.1001-5256.2020.03.052.白济东, 薛荣泉, 白永乐, 等. 代谢综合征与胆囊结石的关系[J]. 临床肝胆病杂志, 2020, 36(3): 701-703. DOI: 10.3969/j.issn.1001-5256.2020.03.052. [31] GUO S. Insulin signaling, resistance, and the metabolic syndrome: insights from mouse models into disease mechanisms[J]. J Endocrinol, 2014, 220(2): T1-T23. DOI: 10.1530/JOE-13-0327. [32] KARHAPÄÄ P, MALKKI M, LAAKSO M. Isolated low HDL cholesterol. An insulin-resistant state[J]. Diabetes, 1994, 43(3): 411-417. DOI: 10.2337/diab.43.3.411. [33] JANZON L, ASPELIN P, ERIKSSON S, et al. Ultrasonographic screening for gallstonedisease in middle-aged women. Detection rate, symptoms, and biochemical features[J]. Scand J Gastroenterol, 1985, 20(6): 706-710.
计量
- 文章访问数: 317
- HTML全文浏览量: 80
- PDF下载量: 21
- 被引次数: 0