代谢综合征对新发胆石症的预测价值

刘通; 高海静; 王万超; 王一鸣; 刘四清; 曹立瀛; 刘希宁; 李海涛

doi:10.3760/cma.j.issn.1673-9752.2017.06.015

代谢综合征对新发胆石症的预测价值

Predictive value of metabolic syndrome on new onset cholelithiasis

摘要

摘要: 目的:探讨代谢综合征(MS)对新发胆石症的预测价值。
方法:采用回顾性队列研究方法。收集2006年6月至2015年12月华北理工大学附属开滦总医院、开滦林西医院、开滦赵各庄医院、开滦唐家庄医院、开滦范各庄医院、开滦吕家坨医院、开滦荆各庄医院、开滦林南仓医院、开滦钱家营医院、开滦马家沟医院、开滦医院分院行健康体检的89 553例受试者的体检资料。按照国际糖尿病联盟对MS的诊断标准将受试者分为4组，70 657例无MS受试者为正常人群组，14 075例满足3条MS诊断标准的受试者设为MS3组、4 556例满足4条MS诊断标准的受试者设为MS4组、265例满足5条MS诊断标准的受试者设为MS5组。由固定医师团队在相同地点对受试者进行健康体检。收集流行病学调查内容、人体测量学指标、生化指标。观察指标：(1)4组受试者的临床特征比较。(2)受试者胆石症的发病情况。(3)影响受试者新发胆石症的危险因素分析。正态分布的计量资料以±s表示，多组间比较采用单因素方差分析；两两比较，方差齐采用LSD检验，方差不齐采用Dunnett′s T3检验。偏态分布的计量资料采用M(Q)表示，多组间比较采用非参数KruskalWallis检验。计数资料比较采用x²检验。采用KaplanMeier法计算不同分组间胆石症的发病率，组间胆石症发病率比较采用Logrank检验。采用COX比例风险模型分析MS对新发胆石症的风险比(HR)和95%可信区间。
结果:(1)4组受试者的临床特征比较：正常人群组年龄、性别(男性)、收缩压、舒张压、腰围、TG、TC、高密度脂蛋白胆固醇、空腹血糖、BMI、高血压病、糖尿病、饮酒、吸烟及体育锻炼人数分别为(50±12)岁、52 895例、(127±20)mmHg(1mmHg=0.133kPa)、(81±11)mmHg、 (85±9)cm、1.14 mmol/L(0.83～1.56 mmol/L)、(4.9±1.1)mmol/L、(1.56±0.39)mmol/L、(5.2±1.3)mmol/L、(24.5±3.3)kg/m²、24 016例、7 696例、11 636例、20 689例、10 245例；MS3组分别为(54±11)岁、12 905例、(142±19)mmHg、(90±11)mmHg、(94±8)cm、2.08 mmol/L (1.51～3.04 mmol/L)、(5.1±1.3)mmol/L、(1.50±0.42)mmol/L、(6.3±2.1)mmol/L、(27.1±3.2)kg/m²、10 031例、5 737例、3 090例、4 762例、2 353例；MS4组分别为(54±10)岁、4 556例、(146±19)mmHg、(92±11)mmHg、(97±7)cm、2.57 mmol/L(2.03～ 3.80 mmol/L)、(5.2±1.4)mmol/L、(1.44±0.45)mmol/L、(7.2±2.4)mmol/L、(28.1±3.1)kg/m²、3 696例、2 971例、1 091例、1 699例、867例；MS5组分别为(56±11)岁、265例、(146±17)mmHg、(92±11)mmHg、(98±6)cm、2.60 mmol/L(2.06～3.91 mmol/L)、(4.9±1.1)mmol/L、(0.86±0.14)mmol/L、(7.7±2.9)mmol/L、(28.7±2.9)kg/m²、221例、196例、62例、93例、78例；4组受试者上述指标比较，差异均有统计学意义(F=481.40， x²=3 359.07，F=3 551.06，3 280.16，5 915.20， x²=18 358.71，F=211.30，473.42，4 168.34， 3 909.75， x²=9 829.51，14 449.74，375.78，225.14，145.73，P<0.05)。(2)受试者胆石症的发病情况： 89 553例受试者在(8.0±1.1)年的观察研究中，新发胆石症4 313例，累积发病率为4.8%。正常人群组、MS3组、MS4组、MS5组胆石症的累积发病率分别为4.5%、5.6%、6.3%和13.2%，4组比较，差异有统计学意义(x²=89.96，P<0.05)。正常人群组分别与MS3组、MS4组、MS5组比较，差异均有统计学意义 (x²=28.56，29.25，43.48，P<0.05)；MS3组分别与MS4组和MS5组比较，差异均有统计学意义(x²=17.13，35.75，P<0.05)；MS4组和MS5组比较，差异有统计学意义(x²=16.82，P<0.05)。(3)影响受试者新发胆石症的危险因素分析，COX比例风险模型分析结果显示：校正受试者性别、年龄、超敏C反应蛋白、吸烟、饮酒、体育锻炼因素对新发胆石症的影响后，与正常人群组比较，MS3组、MS4组、MS5组新发胆石症的风险均增加(HR=1.16，1.33，2.68，95%可信区间：1.07～1.26，1.17～1.51，1.92～3.74，P<0.05)。
结论:MS是新发胆石症的独立危险因素，且随着受试者满足MS的诊断标准数量增加，其胆石症的发病风险也增加。

Abstract: Objective:To investigate the predictive value of metabolic syndrome (MS) on newonset cholelithiasis.
Methods:The retrospective cohort study was conducted. The data of 89 553 subjects who participated health examination at the Kailuan General Hospital Affiliated to the North China University of Science and Technology, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital, Kailuan Tangjiazhuang Hospital, Kailuan Fan′gezhuang Hospital, Kailuan Lyujiatuo Hospital, Kailuan Jinggezhuang Hospital, Kailuan Linnancang Hospital, Kailuan Qianjiaying Hospital, Kailuan Majiagou Hospital and Kailuan Branch Hospital from June 2006 to December 2015 were collected. According to the diagnostic criteria of MS published by International Diabetes Federation, all the patients were divided into 4 groups, including 70 657 without MS in the normal group, 14 075 corresponded with 3 diagnostic criteria of MS in the MS3 group, 4 556 corresponded with 4 diagnostic criteria of MS in the MS4 group and 265 corresponded with 5 diagnostic criteria of MS in the MS5 group.Health examinations were applied to all subjects by the fixed team of doctors at the same place. Epidemiological investigation, anthropometric parameters and biochemical indicators were collected. Observation indicators: (1) comparisons of clinical characteristics among the 4 groups; (2) incidence of cholelithiasis in the 4 groups; (3) risk factors analysis affecting newonset cholelithiasis. Measurement data with normal distribution were represented as ±s and comparisons among groups were analyzed using the oneway ANOVA. Pairwise comparison and homogeneity of variance were done using the LSD test. Heterogeneity of variance was done using the Dunnett′s T3 test. Measurement data with skewed distribution were described as M (Q) and comparisons among groups were analyzed using the nonparametric KruskalWallis test. Comparisons of count data were analyzed by the chisquare test. The incidence of cholelithiasis in the 4 groups were calculated by the KaplanMeier method and comparisons of incidence were done by the Logrank test. The COX proportional hazards model was used to analyze the hazard ratios (HR) and 95% confidence interval (95%CI) of MS on newonset cholelithiasis.
Results:(1) Comparisons of clinical characteristics among the 4 groups: age, sex (male), systolic blood pressure (SBP), diastolic blood pressure(DBP), waistline, triglyceride(TG), total cholesterol (TC), high density lipoproteincholesterol (HDLC), fasting blood glucose, BMI, cases with hypertension, diabetes, drinking, smoking and physical exercise were (50±12)years, 52 895, (127±20)mmHg (1 mmHg=0.133 kPa), (81±11)mmHg, (85±9)cm, 1.14 mmol/L (range, 0.83-1.56 mmol/L), (4.9±1.1)mmol/L, (1.56±0.39)mmol/L, (5.2±1.3)mmol/L, (24.5±3.3)kg/m², 24 016, 7 696, 11 636, 20 689, 10 245 in the normal group and (54± 11)years, 12 905, (142±19)mmHg, (90±11)mmHg, (94±8)cm, 2.08 mmol/L (range, 1.51-3.04 mmol/L), (5.1±1.3)mmol/L, (1.50±0.42)mmol/L, (6.3±2.1)mmol/L, (27.1±3.2)kg/m², 10 031, 5 737, 3 090, 4 762, 2 353 in the MS3 group and (54±10)years, 4 556, (146±19)mmHg, (92±11)mmHg, (97±7)cm, 2.57 mmol/L (range, 2.03-3.80 mmol/L), (5.2±1.4)mmol/L, (1.44±0.45)mmol/L, (7.2±2.4)mmol/L, (28.1±3.1)kg/m², 3 696, 2 971, 1 091, 1 699, 867 in the MS4 group and (56±11)years, 265, (146± 17)mmHg, (92±11)mmHg, (98±6)cm, 2.60 mmol/L (range, 2.06-3.91 mmol/L), (4.9±1.1)mmol/L, (0.86±0.14)mmol/L, (7.7±2.9)mmol/L, (28.7±2.9)kg/m², 221, 196, 62, 93, 78 in the MS5 group, respectively, with statistically significant differences among the 4 groups (F=481.40, x²=3 359.07, F= 3 551.06, 3 280.16, 5 915.20, x²=18 358.71, F=211.30, 473.42, 4 168.34, 3 909.75, x²=9 829.51, 14 449.74, 375.78, 225.14, 145.73, P<0.05). (2) Incidence of cholelithiasis in the 4 groups: 89 553 subjects were observed for (8.0±1.1)years, and 4 313 had newonset cholelithiasis with a cumulative incidence of 4.8%. The cumulative incidences of cholelithiasis in the normal, MS3, MS4 and MS5 groups were respectively 4.5%, 5.6%, 6.3% and 13.2%, with a statistically significant difference among the 4 groups (x²=89.96, P<0.05). There were statistically significant differences in the cumulative incidences of cholelithiasis among the normal, MS3, MS4 and MS5 groups (x²=28.56, 29.25, 43.48, 17.13, 35.75, 16.82, P<0.05). (3) Risk factors analysis affecting newonset cholelithiasis: results of COX proportional hazards model showed that hazard of the newonset cholelithiasis in the normal group was increased compared with that in the MS3, MS4 and MS5 groups with adjustment for sex, age, highsensitivity Creactive protein, smoking, drinking and physical exercise (HR=1.16, 1.33, 2.68, 95%CI: 1.07-1.26, 1.17-1.51, 1.92-3.74, P<0.05).
Conclusion:MS is an independent risk factor of newonset cholelithiasis, and the increased incidence risk of newonset cholelithiasis is consistent with subjects corresponded with diagnostic criteria of MS.

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