胆囊癌发生相关危险因素的探讨
Risk factors of gallbladder carcinoma
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摘要: 目的 探索胆囊癌发生的相关危险因素,为防治胆囊癌提供理论依据。方法 回顾性分析 2000年1月至2010年12月北京协和医院收治的153例胆囊癌患者(胆囊癌组)的临床病理资料,并抽取 同期收治的300例胆囊结石患者(胆囊结石组)和 300例非胆道疾病的成年患者(对照组)作为对照进行 1∶2病例对照研究。计数资料采用 χ 2 检验,对相关危险因素先进行单因素分析,采用 χ 2 检验,筛选出有统 计学意义的可疑危险因素,再用多因素 Logistic回归方程进行分析。结果 胆囊癌组与对照组患者比较, 年龄、胆囊结石病史、绝经年龄、累积行经时间、生育与否及生育次数是胆囊癌的危险因素,差异有统计学 意义(χ 2 =58.22,180.14,9.59,24.30,18.66,15.17,P<0.05);年龄、胆囊结石病史、累积行经时间及生育 次数是胆囊癌的独立危险因素(χ 2 =55.76,180.95,24.30,8.54,P<0.05);进一步分析发现,有胆囊结石 的患者罹患胆囊癌的危险性是无相关病史患者的34倍(OR=34.22)。绝经年龄越晚(51~55岁)、累积行 经时间越长(≥30年)、生育次数较多(3次)的女性患胆囊癌的可能性越大(OR=3.96,9.68,3.51)。胆囊 癌组胆囊结石患者与胆囊结石组患者比较,年龄、胆囊结石病程、累积行经时间及生育次数是胆囊癌的危 险因素(χ 2 =70.66,16.66,11.59,4.69,P<0.05);年龄、胆囊结石病程及累积行经时间是患胆囊癌的独立 危险因素(χ 2 =64.29,8.82,5.58,P<0.05);进一步分析发现,罹患胆囊癌危险性随着年龄升高而增大,胆 囊癌发生的危险性随着结石病程延长而升高。对于女性患者,累积行经时间≥30年也会增加罹患胆囊癌 的危险因素。结论 年龄、胆囊结石病史、胆囊结石病程、累积行经时间及生育次数可能是胆囊癌发病的 危险因素。对于年龄≥60岁、胆囊结石病程≥3年的患者应切除胆囊,以降低胆囊癌的发病率;女性患者 有以上表现者应高度重视,及时诊断和治疗。Abstract:
Objective To investigate the risk factors of gallbladder carcinoma, so as to provide theoretical base for the prevention of gallbladder carcinoma. Methods The clinical data of 153 patients with gallbladder carcinoma (gallbladder carcinoma group) who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed. A total of 300 patients with cholecystolithiasis (cholecystolithiasis group) and 300 patients without gallbladder carcinoma or cholecystolithiasis (control group) were collected and matched at the ratio of 1:2 to conduct the controlled study. Data were statistically analyzed by the Chisquare test and conditional Logistric regression. Results Univariate analysis showed significant difference in age, history of cholecystolithiasis, postmenopausal age, accumulated menstrual period, giving birth or not and number of birth between gallbladder carcinoma group and control group (χ 2 =58.22, 180.14, 9.59, 24.30, 18.66, 15.17, P <0.05). Age, history of cholecystolithiasis, accumulated menstrual period and number of birth were the independent risk factors of gallbladder carcinoma (χ 2=55.76, 180.95, 24.30, 8.54, P <0.05). The risk of having gallbladder carcinoma in patients who had a history of cholecystolithiasis was 34 times higher than those who did not have the history of cholecystolithiasis ( OR =34.22). Late postmenopausal age (51-55 years old), longer accumulated menstrual period (≥30 years), and the number of birth (3 times) were associated with higher risk of gallbladder carcinoma ( OR= 3.96, 9.68, 3.51). Age, course of cholecystolithiasis and accumulated menstrual period and number of birth were the risk factors of gallbladder carcinoma when comparing patients who have history of cholecystolithiasis in the gallbladder carcinoma group with those in the cholecystolithiasis group (χ 2 = 70.66, 16.66, 11.59, 4.69, P <0.05). Age, course of cholecystolithiasis and accumulated menstrual period were the independent risk factors of gallbladder carcinoma (χ 2=64.29, 8.82, 5.58, P <0.05). The risk of gallbladder carcinoma increased as the increase of age and course of cholecystolithiasis. The accumulated menstrual period≥30 years was also a risk factor of gallbladder carcinoma. Conclusions Age, history of cholecystolithiasis, course of cholecystolithiasis, accumulated menstrual period and number of birth may be the risk factors of gallbladder carcinoma. For patients with age above 60 years and course of cholecystolithiasis above 3 years, cholecystectomy should be conducted to reduce the incidence of gallbladder carcinoma, and great importance should be attached to female patients with indications mentioned above.