女性胆石症相关危险因素的研究与分析

发布时间：2018-06-02 11:44

本文选题：胆石症 + 女性　；参考：《山东大学》2017年硕士论文

【摘要】：第一部分:女性胆石症发病的危险因素分析背景:胆石症是一种历史悠久、分布广泛的疾病。20世纪60年代以来,随着我国经济快速发展,人民生活水平提高,饮食习惯改变,胆石症的发病率逐年上升。胆石的形成主要是由于胆汁内各种成分比例改变及胆道运动功能异常等因素长期互相作用所造成的。按照其成分的不同,可以分成胆固醇为主型、胆色素为主型和混合性结石;根据其存在部位小同,又分为肝内胆管结石、肝外胆管结石以及胆囊结石等。胆石阻塞胆道可以引起胆道梗阻、急性胆源性胰腺炎,甚至穿孔,引起胆汁性腹膜炎,其长期反复刺激更可更可能会产生癌变。另一方面,大量研究表明女性人群与男性相比,胆石症的发病率明显升高,其对女性有着史大的危害性。因此,胆石症具有分布广泛、严重影响国民身体健康的特点,加上其病因较为复杂,医务工作者应该对胆石症发病的危险因素进行全方位分析评价,以采取综合全面的预防措施,维护大众健康。本文通过分析就诊于山东大学齐鲁医院的部分女性胆石症患者和非胆石症患者的病例资料,总结女性人群胆石症发病的相关危险因素,以更好的制定预防策略,以及指导临床工作。方法:总结2013年1月至2016年12月期间于山东大学齐鲁医院肝胆外科行胆囊切除术并术后病理确诊为胆石症的100名女性患者和100名非胆石症女性患者(同期来自齐鲁医院)的病例资料,并进行回顾性分析。收集的资料包括患者的一般情况,家族史,个人史,既往史,体质指数,血液学检查等信息。对各个变量进行规格化和数量化后行单因素分析,计算OR值和95%可信区间。对具有统计学意义的影响因素进一步行Logistic回归分析,了解其相关性。P0.05认为具有统计学意义。结果:胆石症患者组平均年龄50.14± 11.42岁;对照组平均年龄51.26± 12.04岁。分析结果显示雌激素使用史是胆石症发病的独立危险因素OR值为9.77(95%C1=4.08-23.39),包括口服避孕药和雌激素替代治疗;BMI是胆石症发病的独立危险因素,OR值为12.99(95%CI =5.98-28.20);此外多次生育和家族史都是胆石症发病的危险因素,而其余因素包括胃肠手术史,糖尿病病史,肝炎病史,吸烟,饮酒,血清甘油三酯,血清胆固醇,ALT,AST,AKP,GGT与胆石症发病之间的关系无明显的统计学意义。结论:本研究结果表明外源性雌激素摄入、BMI、多次生育和家族史都与胆石症的发生发展有着重要的联系,其中外源性雌激素摄入和BMI为胆石症发病的独立危险因素,因此应倡导均衡饮食、积极锻炼和谨慎使用外源性雌激素来预防胆囊结石;而其它因素与胆石症之间的联系没有明显的统计学意义,需要进行进一步的大样本分析,以对胆石症的预防和控制提出更为合理的意见。第二部分:外源性雌激素与胆石症关系的研究背景:胆石症是国人的常见病,多发病,是一种由于胆汁成分改变、胆道功能异常等多种因素相互长期影响而引起的疾病。胆石症发病的相关危险因素很多,包括性别、年龄、肥胖、雌激素等。其中对于外源性雌激素的摄入,主要为口服避孕药和雌激素替代治疗两种,与胆石症发病的关系已有大量的研究报道,但其结果还存在着较多的争议。为了更好地分析外源性雌激素摄入与胆石症发病之间的关系,指导临床治疗及用药,本研究综合了国内外已发表的文献资料进行了 Meta分析,同时结合病例对照研究进一步论证。方法:通过对PUBMED、EMBASE和Cochrane library数据库内的文献进行搜索,筛选出19篇关于讨论外源性雌激素与胆石症之间关系的文献进行定量综合分析,包含计算相对风险率(RR)或相对危险性值(OR)及其95%的可信区间,应用固定效应模型或随机效应模型评估,亚组分析,异质性检验等,并且结合部分就诊于山东大学齐鲁医院患者的病历资料进行病例对照研究。结果:筛选出的19篇文献中约有556620位参与者。外源性雌激素摄入的合并RR值为1.59(95%CI:1.44-1.75),提示其是胆石症发生的危险因素。口服避孕药合并RR值为1.19(95%C1:0.97-1.45),而雌激素替代治疗合并RR值为1.79(95%CI:1.61-2.00)。病例对照研究显示口服避孕药的OR值为1.23(95%C1:0.93-1.62),雌激素替代治疗的 OR 值为 1.84(95%%CI:1.39-2.43)。结论:外源性雌激素摄入与胆石症发病之间有着明显的相关性,其中,雌激素替代治疗与胆石症发病间存在显著的正相关性,而口服避孕药则没有。提示雌激素替代治疗是胆石症发病的重要危险因素,对于接受雌激素替代治疗的女性,除了定期检查其乳腺、卵巢和子宫外,还需要特别关注其胆囊的健康状况,及时调整用药策略,预防胆石症的发生。
[Abstract]:The first part: analysis of the risk factors of the incidence of cholelithiasis in women: cholelithiasis is a long history and widely distributed disease in the.20 century since 60s. With the rapid development of China's economy, the people's living standard has been improved, the dietary habits have changed, the incidence of cholelithiasis has increased year by year. The formation of cholelithiasis is mainly due to various ingredients in the bile. It can be divided into cholesterol - based, choledocholithiasis and mixed stones according to their different components. According to their existence, they are divided into intrahepatic bile duct stones, extrahepatic bile duct stones and gallstones. Choledocholithiasis can be caused by biliary tract. Bile duct obstruction, acute biliary pancreatitis, even perforation, causing bile peritonitis, and its long-term repeated stimulation may be more likely to produce cancer. On the other hand, a large number of studies have shown that the incidence of cholelithiasis is significantly higher in women than in men, and it has a great history of harm to women. Therefore, cholelithiasis is widely distributed and serious. The medical workers should carry out a comprehensive analysis and evaluation of the risk factors of cholelithiasis, in order to adopt comprehensive and comprehensive preventive measures to maintain public health. This paper analyzes some cases of female cholelithiasis and non cholelithiasis in Qilu Hospital of Shandong University. To sum up the related risk factors of gallstone disease in women, to make a better prevention strategy and to guide clinical work. Methods: To summarize 100 women and 100 non patients who were diagnosed as cholelithiasis in the Department of hepatobiliary surgery, Qilu Hospital, Shandong University from January 2013 to December 2016. The data of cases of gallstone women (from Qilu Hospital during the same period) were analyzed retrospectively. The data included general information, family history, personal history, past history, body mass index, hematological examination and so on. The OR value and 95% confidence interval were calculated. The statistically significant factors were further analyzed by Logistic regression analysis, and the correlation.P0.05 was found to be statistically significant. Results: the average age of the patients with cholelithiasis was 50.14 + 11.42 years; the average age of the control group was 51.26 + 12.04 years. The analysis showed that the history of estrogen use was an independent risk factor of cholelithiasis (9.77 (9) (9). 5%C1=4.08-23.39) including oral contraceptives and estrogen replacement therapy; BMI is an independent risk factor for cholelithiasis, OR is 12.99 (95%CI =5.98-28.20); moreover, multiple and family history are risk factors for cholelithiasis, while the other factors include the history of gastrointestinal surgery, diabetes, hepatitis, smoking, drinking, and serum glycerin. The relationship between three esters, serum cholesterol, ALT, AST, AKP, GGT and cholelithiasis has no significant statistical significance. Conclusion: the results of this study suggest that exogenous estrogen intake, BMI, multiple birth and family history have an important relationship with the development of cholelithiasis, and its endogenous estrogen intake and BMI are independent risk of cholelithiasis. Risk factors, therefore, should advocate a balanced diet, active exercise and cautious use of exogenous estrogen to prevent gallstone, and other factors and cholelithiasis have no significant statistical significance. Further large sample analysis should be carried out to put forward more reasonable opinions on the prevention and control of cholelithiasis. The second part: exogenous The study background of the relationship between sexual estrogens and cholelithiasis: cholelithiasis is a common disease of the country. It is a disease caused by a variety of factors such as the change of bile composition and the abnormal function of biliary tract. There are many risk factors related to cholelithiasis, including sex, age, obesity, estrogen and so on. The intake of hormone, mainly two kinds of oral contraceptives and estrogen replacement therapy, has been widely reported in the relationship with the incidence of cholelithiasis, but there are many disputes. In order to better analyze the relationship between exogenous estrogen intake and cholelithiasis, guide clinical treatment and drug use, this study integrated the domestic study. The published literature was analyzed by Meta and combined with case control study. Methods: through searching the literature in the database of PUBMED, EMBASE and Cochrane library, 19 literatures on the relationship between exogenous estrogen and cholelithiasis were selected and analyzed quantitatively, including the calculation of relative wind. The risk rate (RR) or relative risk value (OR) and its 95% confidence interval were used to use fixed effect model or random effect model assessment, subgroup analysis, heterogeneity test and so on. In addition, a case control study was carried out on the medical records of patients in Qilu Hospital of Shandong University. Results: there were about 556620 participants in the 19 selected articles. The combined RR value of exogenous estrogen intake was 1.59 (95%CI:1.44-1.75), suggesting that it was a risk factor for cholelithiasis. The oral contraceptive combined with RR was 1.19 (95%C1:0.97-1.45), while estrogen replacement therapy combined RR was 1.79 (95%CI:1.61-2.00). The case control study showed that the OR value of oral contraceptives was 1.23 (95%C1:0.93-1.62) and estrogen. The OR value of alternative therapy was 1.84 (95%%CI:1.39-2.43). Conclusion: there is a significant correlation between exogenous estrogen intake and cholelithiasis. There is a significant positive correlation between estrogen replacement therapy and cholelithiasis, while oral contraceptives are not. It suggests that estrogen replacement therapy is an important risk factor for cholelithiasis. In addition, in addition to regular examination of the breast, ovary and uterus of women who receive estrogen replacement therapy, it is necessary to pay special attention to the health of the gallbladder, adjust the strategy of drug use in time, and prevent the occurrence of cholelithiasis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.62

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