东营市成年居民胆囊息肉样病变特征及影响因素分析

doi:10.12183/j.scjpm.2023.1224

摘要/Abstract

摘要： 目的探讨东营市成年居民胆囊息肉样病变（polypoid lesions of gallbladder,PLG）特征及影响因素分析。方法采用多阶段分层整群抽样方法抽取东营市成年居民进行问卷调查、体检检查、腹部超声检查和血生化指标检测,对该人群PLG情况及病变特征进行描述性分析,并采用单、多因素分析方法对PLG影响因素进行分析。结果共体检10 865人,其中男5 562人（51.19%）,女5 303人（48.81%）;年龄为28~74岁。PLG检出896例,检出率为8.25%。PLG患者的息肉直径1.9~35.0 mm,其中<5 mm占56.92%,5~<10 mm占39.96%,≥10 mm占3.13%。胆囊壁厚度0.2~2.1 cm,平均（0.31±0.07）cm;息肉单发 564例（62.95%）,多发332例（37.05%）。合并慢性胆囊炎者269例（30.02%）,合并结石者178例（19.87%）。息肉内血流信号占比43.19%。367例（40.96%）接受手术治疗,手术病理结果证实非肿瘤性息肉324例（88.28%）,其中290例胆固醇性息肉;肿瘤性息肉43例（11.72%）,均为胆囊腺瘤。多因素logistic回归分析结果显示男性（OR=1.745）、年龄≥ 40岁（OR=2.442）、HBsAg阳性（OR=1.519）、高脂血症（OR=1.429）、高尿酸血症（OR=1.896）人群的PLG检出风险较高。结论东营市人群PLG患病率处于较高水平,年龄、性别、乙肝表面抗原、高脂血症、高尿酸血症为PLG的影响因素。

关键词: 体检人群, 胆囊息肉样病变, 病变特征, 影响因素

Abstract: Objective To explore the characteristics and influencing factors of polypoid lesion of gallbladder （PLG） in adult residents of Dongying City. Methods A multi-stage stratified cluster sampling method was used to select adult residents in Dongying City for questionnaire survey, physical examination, abdominal ultrasound examination, and blood biochemical index testing. Descriptive analysis was conducted on the condition and characteristics of PLG in this population, and univariate and multivariate analysis methods were used to analyze the influencing factors of PLG. Results A total of 10 865 people underwent physical examinations, including 5 562 males （51.19%） and 5 303 females （48.81%）, aged 28-74 years. A total of 896 cases of PLG were identified, with a detection rate of 8.25%. The diameter of polyps in PLG patients was 1.9-35.0 mm, with <5 mm （56.92%）, 5-10 mm （39.96%）, and ≥ 10 mm （3.13%）. The thickness of the gallbladder wall was 0.2-2.1 cm, with an average of （0.31±0.07） cm. There were 564 cases （62.95%） of single polyps and 332 cases （37.05%） of multiple polyps. Chronic cholecystitis was present in 269 cases （30.02 %）, while 178 cases （19.87%） had calculi. The proportion of blood flow signals in polyps was 43.19%. Among them, 367 cases （40.96%） received surgical treatment, and the pathological results confirmed that 324 cases （88.28%） were non tumor polyps, including 290 cases of cholesterol polyps; there were 43 cases （11.72%） of tumor polyps, all of which were gallbladder adenomas. The results of multivariate logistic regression analysis showed that the risk of PLG was higher in individuals with male （OR=1.745）, age≥40 years （OR=2.442）, HBsAg positive （OR=1.519）, hyperlipidemia （OR=1.429）, and hyperuricemia （OR=1.896）. Conclusions The prevalence of PLG in Dongying population is at a high level. Age, gender, hepatitis B surface antigen, hyperlipidemia, hyperuricemia are the influencing factors for PLG.

Key words: Physical examination population, Polypoid lesion of gallbladder, Pathological characteristics, Influencing factor

中图分类号:

R195

许艳, 王学霞, 韩春玲. 东营市成年居民胆囊息肉样病变特征及影响因素分析[J]. 华南预防医学, 2023, 49(10): 1224-1228.

XU Yan, WANG Xuexia, HAN Chunling. Characteristics and influencing factors of polypoid lesion of gallbladder in adult residents of Dongying City[J]. South China Journal of Preventive Medicine, 2023, 49(10): 1224-1228.

参考文献

[1] Valibouze C, El Amrani M, Truant S, et al.The management of gallbladder polyps[J]. J Visc Surg, 2020, 157(5):410-417.
[2] Zhang X, Guan L, Tian H, et al.Prevalence and risk factors of gallbladder stones and polyps in Liaoning, China[J]. Front Med (Lausanne), 2022, 9:865458.
[3] Yamin Z, Xuesong B, Zhen Z, et al.Correlation of dyslipidemias and gallbladder polyps-A large retrospective study among Chinese population[J]. Asian J Surg, 2020, 43(1):181-185.
[4] Riddell ZC, Corallo C, Albazaz R, et al.Gallbladder polyps and adenomyomatosis[J]. Br J Radiol, 2023, 96(1142):20220115.
[5] Konstantinoff KS, Feister KF, Mellnick VM.Radio Graphics Update: New follow-up and management recommendations for polypoid lesions of the gallbladder[J]. Radiographics, 2023, 43(3):e220189.
[6] 王海蛟, 王石. 胆囊息肉样病变相关危险因素的研究现状[J]. 内蒙古医学杂志, 2021, 53(8):936-938.
[7] 何权瀛, 高莹慧. 关于吸烟问题若干名词定义[J]. 中华结核和呼吸杂志, 2009, 32(1):56.
[8] World Health Organization.Global status report on alcohol and health 2014[M]. Geneva: World Health Organization, 2014:4.
[9] 陈春明. 中国成人超重和肥胖症预防控制指南[M]. 北京:人民卫生出版社, 2006:3.
[10] 中国高血压防治指南修订委员会,高血压联盟(中国),中华医学会心血管病学分会, 中国医师协会高血压专业委员会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1):24-56.
[11] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[12] 中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016, 31(10):937-950.
[13] 中国医师协会肾脏内科医师分会.中国肾脏疾病高尿酸血症诊治的实践指南(2017版)[J].中华医学杂志, 2017, 97(25):1927-1936.
[14] Foley KG, Lahaye MJ, Thoeni RF, et al.Management and follow-up of gallbladder polyps: Updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE[J]. Eur Radiol, 2022, 32(5):3358-3368.
[15] Fei X, Lu WP, Luo YK, et al.Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: A prospective case-control study[J]. Abdom Imaging, 2015, 40(7):2355-2363.
[16] Zhang J, Wu Y, Feng Y, et al.The value of CT findings combined with inflammatory indicators for preoperative differentiation of benign and malignant gallbladder polypoid lesions[J]. World J Surg Oncol, 2023, 21(1):51.
[17] Pickering O, Pucher PH, Toale C, et al.Prevalence and sonographic detection of gallbladder polyps in a Western European Population[J]. J Surg Res, 2020, 250:226-231.
[18] Hwang BW, Kim YL, Kim KH, et al.Prevalence and risk factors of gallbladder polyp, and association between gallbladder polyp and metabolic syndrome in health examinees[J]. Korean J Fam Pract, 2017, 7(1):131-136.
[19] Zhang X, Tang S, Huang L, et al.Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid lesions of gallbladder ≥1 cm[J]. BMC Gastroenterol, 2022, 22(1):354.
[20] Mao W, Deng F, Wang D, et al.Treatment of advanced gallbladder cancer: A SEER-based study[J]. Cancer Med, 2020, 9(1):141-150.
[21] Liu XS, Chen T, Gu LH, et al.Ultrasound-based scoring system for differential diagnosis of polypoid lesions of the gallbladder[J]. J Gastroenterol Hepatol, 2018, 33(6):1295-1299.
[22] 陈善鹏, 王智翔, 张小弟, 等. 胆囊息肉样病变的流行病学及危险因素[J]. 临床肝胆病杂志, 2019, 35(2):441-443.
[23] 党学娟, 张春芳, 唐萍, 等. 甘肃省企事业单位人群胆囊息肉样病变分布特点及易感因素分析[J]. 中国公共卫生管理, 2021, 37(6):828-830.
[24] 刘力玮, 姚贵宾, 白雪松, 等. 胆囊息肉形成相关风险因素的研究进展[J]. 医学研究杂志, 2020, 49(2):13-15,19.
[25] Wang H, Men P, Xiao Y, et al.Hepatitis B infection in the general population of China:A systematic review and meta-analysis[J]. BMC Infect Dis, 2019, 19(1):811.
[26] 王刚刚, 沈晓伟, 张鑫, 等. 胆囊息肉样病变相关危险因素分析[J]. 沈阳医学院学报, 2022, 24(5):470-473.