發(fā)布時(shí)間：2018-06-02 11:44

  本文選題：膽石癥 + 女性��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：第一部分:女性膽石癥發(fā)病的危險(xiǎn)因素分析背景:膽石癥是一種歷史悠久、分布廣泛的疾病。20世紀(jì)60年代以來,隨著我國(guó)經(jīng)濟(jì)快速發(fā)展,人民生活水平提高,飲食習(xí)慣改變,膽石癥的發(fā)病率逐年上升。膽石的形成主要是由于膽汁內(nèi)各種成分比例改變及膽道運(yùn)動(dòng)功能異常等因素長(zhǎng)期互相作用所造成的。按照其成分的不同,可以分成膽固醇為主型、膽色素為主型和混合性結(jié)石;根據(jù)其存在部位小同,又分為肝內(nèi)膽管結(jié)石、肝外膽管結(jié)石以及膽囊結(jié)石等。膽石阻塞膽道可以引起膽道梗阻、急性膽源性胰腺炎,甚至穿孔,引起膽汁性腹膜炎,其長(zhǎng)期反復(fù)刺激更可更可能會(huì)產(chǎn)生癌變。另一方面,大量研究表明女性人群與男性相比,膽石癥的發(fā)病率明顯升高,其對(duì)女性有著史大的危害性。因此,膽石癥具有分布廣泛、嚴(yán)重影響國(guó)民身體健康的特點(diǎn),加上其病因較為復(fù)雜,醫(yī)務(wù)工作者應(yīng)該對(duì)膽石癥發(fā)病的危險(xiǎn)因素進(jìn)行全方位分析評(píng)價(jià),以采取綜合全面的預(yù)防措施,維護(hù)大眾健康。本文通過分析就診于山東大學(xué)齊魯醫(yī)院的部分女性膽石癥患者和非膽石癥患者的病例資料,總結(jié)女性人群膽石癥發(fā)病的相關(guān)危險(xiǎn)因素,以更好的制定預(yù)防策略,以及指導(dǎo)臨床工作。方法:總結(jié)2013年1月至2016年12月期間于山東大學(xué)齊魯醫(yī)院肝膽外科行膽囊切除術(shù)并術(shù)后病理確診為膽石癥的100名女性患者和100名非膽石癥女性患者(同期來自齊魯醫(yī)院)的病例資料,并進(jìn)行回顧性分析。收集的資料包括患者的一般情況,家族史,個(gè)人史,既往史,體質(zhì)指數(shù),血液學(xué)檢查等信息。對(duì)各個(gè)變量進(jìn)行規(guī)格化和數(shù)量化后行單因素分析,計(jì)算OR值和95%可信區(qū)間。對(duì)具有統(tǒng)計(jì)學(xué)意義的影響因素進(jìn)一步行Logistic回歸分析,了解其相關(guān)性。P0.05認(rèn)為具有統(tǒng)計(jì)學(xué)意義。結(jié)果:膽石癥患者組平均年齡50.14± 11.42歲;對(duì)照組平均年齡51.26± 12.04歲。分析結(jié)果顯示雌激素使用史是膽石癥發(fā)病的獨(dú)立危險(xiǎn)因素OR值為9.77(95%C1=4.08-23.39),包括口服避孕藥和雌激素替代治療;BMI是膽石癥發(fā)病的獨(dú)立危險(xiǎn)因素,OR值為12.99(95%CI =5.98-28.20);此外多次生育和家族史都是膽石癥發(fā)病的危險(xiǎn)因素,而其余因素包括胃腸手術(shù)史,糖尿病病史,肝炎病史,吸煙,飲酒,血清甘油三酯,血清膽固醇,ALT,AST,AKP,GGT與膽石癥發(fā)病之間的關(guān)系無明顯的統(tǒng)計(jì)學(xué)意義。結(jié)論:本研究結(jié)果表明外源性雌激素?cái)z入、BMI、多次生育和家族史都與膽石癥的發(fā)生發(fā)展有著重要的聯(lián)系,其中外源性雌激素?cái)z入和BMI為膽石癥發(fā)病的獨(dú)立危險(xiǎn)因素,因此應(yīng)倡導(dǎo)均衡飲食、積極鍛煉和謹(jǐn)慎使用外源性雌激素來預(yù)防膽囊結(jié)石;而其它因素與膽石癥之間的聯(lián)系沒有明顯的統(tǒng)計(jì)學(xué)意義,需要進(jìn)行進(jìn)一步的大樣本分析,以對(duì)膽石癥的預(yù)防和控制提出更為合理的意見。第二部分:外源性雌激素與膽石癥關(guān)系的研究背景:膽石癥是國(guó)人的常見病,多發(fā)病,是一種由于膽汁成分改變、膽道功能異常等多種因素相互長(zhǎng)期影響而引起的疾病。膽石癥發(fā)病的相關(guān)危險(xiǎn)因素很多,包括性別、年齡、肥胖、雌激素等。其中對(duì)于外源性雌激素的攝入,主要為口服避孕藥和雌激素替代治療兩種,與膽石癥發(fā)病的關(guān)系已有大量的研究報(bào)道,但其結(jié)果還存在著較多的爭(zhēng)議。為了更好地分析外源性雌激素?cái)z入與膽石癥發(fā)病之間的關(guān)系,指導(dǎo)臨床治療及用藥,本研究綜合了國(guó)內(nèi)外已發(fā)表的文獻(xiàn)資料進(jìn)行了 Meta分析,同時(shí)結(jié)合病例對(duì)照研究進(jìn)一步論證。方法:通過對(duì)PUBMED、EMBASE和Cochrane library數(shù)據(jù)庫(kù)內(nèi)的文獻(xiàn)進(jìn)行搜索,篩選出19篇關(guān)于討論外源性雌激素與膽石癥之間關(guān)系的文獻(xiàn)進(jìn)行定量綜合分析,包含計(jì)算相對(duì)風(fēng)險(xiǎn)率(RR)或相對(duì)危險(xiǎn)性值(OR)及其95%的可信區(qū)間,應(yīng)用固定效應(yīng)模型或隨機(jī)效應(yīng)模型評(píng)估,亞組分析,異質(zhì)性檢驗(yàn)等,并且結(jié)合部分就診于山東大學(xué)齊魯醫(yī)院患者的病歷資料進(jìn)行病例對(duì)照研究。結(jié)果:篩選出的19篇文獻(xiàn)中約有556620位參與者。外源性雌激素?cái)z入的合并RR值為1.59(95%CI:1.44-1.75),提示其是膽石癥發(fā)生的危險(xiǎn)因素�？诜�避孕藥合并RR值為1.19(95%C1:0.97-1.45),而雌激素替代治療合并RR值為1.79(95%CI:1.61-2.00)。病例對(duì)照研究顯示口服避孕藥的OR值為1.23(95%C1:0.93-1.62),雌激素替代治療的 OR 值為 1.84(95%%CI:1.39-2.43)。結(jié)論:外源性雌激素?cái)z入與膽石癥發(fā)病之間有著明顯的相關(guān)性,其中,雌激素替代治療與膽石癥發(fā)病間存在顯著的正相關(guān)性,而口服避孕藥則沒有。提示雌激素替代治療是膽石癥發(fā)病的重要危險(xiǎn)因素,對(duì)于接受雌激素替代治療的女性,除了定期檢查其乳腺、卵巢和子宮外,還需要特別關(guān)注其膽囊的健康狀況,及時(shí)調(diào)整用藥策略,預(yù)防膽石癥的發(fā)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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.62

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