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高血压与胆石症风险的关联性研究

于文倩 谢林君 李诗懿 娄彦梅 江果恒 李鸿钰 颜子彤 白轩 罗菁 张弛 李光灿 单雪峰 王新

引用本文:
Citation:

高血压与胆石症风险的关联性研究

DOI: 10.12449/JCH240623
基金项目: 

国家自然科学基金 (81903398);

中央高校基本科研基金 (YJ2021112);

四川省医学会医学科研青年创新课题 (Q21016);

四川天府峨眉计划青年人才项目 (Sichuan Emei 1841);

四川省科学技术厅杰出青年科学基金 (2023NSFSC1927)

伦理学声明: 本研究方案于2021年8月20日经由四川大学华西公共卫生学院/华西第四医院伦理委员会批准,批号:Gwll2021055。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:王新、于文倩、谢林君、李诗懿、娄彦梅负责调查、拟定写作思路,论文起草与撰写修订;江果恒、李鸿钰、白轩、罗菁负责软件、成像分析和修订;张弛、李光灿为方法论、写作和数据管理做出了贡献;单雪峰负责验证、数据管理、项目管理。所有作者阅读并批准了最终手稿。
详细信息
    通信作者:

    王新, wangxinmarine@126.com (ORCID: 0000-0001-9325-3194)

Association between hypertension and the risk of gallstone disease

Research funding: 

National Natural Science Foundation of China (81903398);

Fundamental Research Funds for the Central Universities (YJ2021112);

Young Innovative Subjects for Medical Research of Sichuan Medical Association (Q21016);

Young Talent Project of Sichuan Tianfu Emei Program (Sichuan Emei 1841);

Outstanding Young Science Foundation of Sichuan Provincial Science and Technology Department (2023NSFSC1927)

More Information
  • 摘要:   目的  通过开展一项全国多中心研究及一项系统综述和Meta分析,全面研究高血压与胆石症(GSD)患病风险的关联性。  方法  研究分为3个阶段:第1阶段,于2015—2020年在成都、天津、北京和重庆地区共4个中心招募参与健康检查的研究对象。使用多因素Logistic回归分析研究不同中心高血压与GSD患病风险的相关性;第2阶段,系统检索Embase、PubMed、万方、维普和中国知网数据库中2021年5月之前发表的相关研究文献,并通过Meta分析以进一步验证这种关联性;第3阶段,采用随机效应模型对多中心横断面研究结果与既往文献结果进行合并分析。  结果  横断面研究共招募633 948例受试者,GSD的患病率为7.844%。多因素Logistic回归分析显示,高血压与GSD患病风险呈正相关(P<0.05)。亚组分析结果显示高血压与GSD的关联在性别、年龄和胆结石亚型中无明显差异。系统综述和Meta分析最终纳入了80篇文献,结果表明每升高10 mmHg的舒张压和收缩压,GSD风险分别增加1.022倍和1.014倍。  结论  高血压显著增加GSD的患病风险,本研究结果将为探讨GSD的病因学和识别高危人群提供基础。

     

  • 图  1  横断面研究中血压与胆结石疾病风险之间关联性的森林图

    Figure  1.  Forest plot of association between blood pressure and gallstone disease in the cross-section study

    图  2  Meta分析文献筛选流程图

    Figure  2.  Flowchart of study selection process

    图  3  血压与GSD风险相关性的Meta分析

    Figure  3.  Meta-analysis of the association between blood pressure and GSD risk

    表  1  横断面研究对象的基线特征

    Table  1.   Baseline characteristics of subjects in the cross-section study

    指标 重庆医科大学附属第一医院金山医院 (n=170 038) 开州区人民医院 (n =372 289)
    GSD组 (n=12 518) 非GSD组 (n=157 520) 统计值 P GSD组 (n=32 367) 非GSD组 (n=339 922) 统计值 P
    年龄(岁) 52.00 (42.00~61.00) 39.00 (31.00~39.00) Z=-82.17 <0.001 51.00 (44.00~58.00) 34.00 (43.00~52.00) Z=-113.30 <0.001
    女性[例(%)] 6 121(48.90) 70 846(44.98) χ 2=71.99 <0.001 18 143(56.05) 155 377(45.71) χ 2=1 270.80 <0.001
    胆囊切除术[例(%)] 6 345(50.69) 17 769(54.90)
    BMI(kg/m2 22.35 (22.36~26.53) 20.94 (20.94~25.38) Z=-41.18 <0.001 25.10 (23.10~27.30) 23.90 (21.70~26.20) Z=-66.91 <0.001
    DBP(mmHg) 77.00 (70.00~86.00) 73.00 (66.00~82.00) Z=-32.55 <0.001 79.00 (71.00~88.00) 77.00 (69.00~85.00) Z=-33.81 <0.001
    SBP(mmHg) 128.00 (133.00~141.00) 121.00 (111.00~133.00) Z=-38.80 <0.001 127.00 (115.00~140.00) 121.00 (111.00~134.00) Z=-51.70 <0.001
    FBG(mmol/L) 5.40 (5.00~6.00) 5.20 (4.90~5.60) Z=-41.17 <0.001 5.53 (5.14~6.10) 5.32 (5.00~5.72) Z=-65.44 <0.001
    TBil(μmol/L) 12.85 (10.30~16.30) 12.70 (10.10~16.10) Z=-4.25 <0.001 14.10 (11.30~17.80) 13.90 (11.10~17.70) Z=-3.23 0.001
    UA(μmol/L) 341.00 (281.00~408.00) 339.00 (275.00~409.00) Z=-3.70 <0.001 340.34 (282.95~404.50) 342.30 (280.80~407.80) Z=-1.33 0.184
    TC(mmol/L) 4.97 (4.35~5.60) 4.81 (4.24~5.44) Z=-16.64 <0.001 5.03 (4.43~5.71) 4.94 (4.34~5.60) Z=-21.79 <0.001
    TG(mmol/L) 1.49 (1.04~2.17) 1.23 (0.86~1.85) Z=-35.08 <0.001 1.56 (1.09~2.32) 1.33 (0.93~2.11) Z=-49.35 <0.001
    LDL-C(mmol/L) 3.01 (2.49~3.57) 2.87 (2.36~3.42) Z=-17.22 <0.001 2.63 (2.22~3.08) 2.56 (2.16~3.01) Z=-20.73 <0.001
    HDL-C(mmol/L) 1.32 (1.12~1.56) 1.37 (1.16~1.61) Z=-14.65 <0.001 1.30 (1.12~1.53) 1.34 (1.14~1.57) Z=-20.06 <0.001
    脂肪肝[例(%)] 5 162(41.24) 37 795(24.00) χ 2=1 826.04 <0.001 13 261(40.97) 87 569(25.76) χ 2=3 457.16 <0.001
    肾结石[例(%)] 679(5.42) 6279(3.99) χ 2=61.10 <0.001 1 197(3.70) 10 475(3.08) χ 2=36.87 <0.001
    高血压[例(%)] 4 169(33.30) 27 439(17.42) χ 2=1 906.37 <0.001 9 226(28.50) 62 264(18.32) χ 2=2 130.90 <0.001
    Ⅰ级 2 308(18.44) 17 633(11.19) χ 2=1 333.05 <0.001 6 212(19.19) 43 914(12.92) χ 2=2 192.15 <0.001
    Ⅱ级 621(4.96) 3 970(2.52) 2 310(7.14) 13 773(4.05)
    Ⅲ级 488(3.90) 2 383(1.51) 704(2.18) 4 578(1.35)
    指标 北京小汤山医院 (n=80 681) 天津医科大学肿瘤医院 (n=10 940)
    GSD组 (n=4 333) 非GSD组 (n=76 348) 统计值 P GSD组 (n=507) 非GSD组 (n=10 433) 统计值 P
    年龄(岁) 54.00 (45.00~67.00) 42.00 (33.00~51.00) Z=-53.24 <0.001 56.00 (47.00~65.00) 39.00 (33.00~52.00) Z=-19.40 <0.001
    女性[例(%)] 1 805(41.66) 31 177(40.84) χ 2=1.15 0.285 265(52.27) 5861(56.2) χ 2=3.00 0.083
    胆囊切除术[例(%)] 1 213(28.00) 146(28.80)
    BMI(kg/m2 26.02 (23.86~28.22) 25.00 (22.52~27.44) Z=-18.08 <0.001
    DBP(mmHg) 76.00 (70.00~82.00) 74.00 (67.00~80.00) Z=-11.03 <0.001 81.00 (72.00~88.00) 76.00 (68.00~84.00) Z=-7.75 <0.001
    SBP(mmHg) 125.00 (115.00~137.00) 119.00(110.00~130.00) Z=-23.32 <0.001 139.00 (123.00~153.00) 124.00 (114.00~138.00) Z=-12.80 <0.001
    FBG(mmol/L) 5.47 (5.07~6.06) 5.21 (4.89~5.64) Z=-24.58 <0.001 5.78 (5.34~6.75) 5.40 (5.09~5.79) Z=-12.32 <0.001
    Tbil(μmol/L) 16.50 (13.20~20.00) 17.10 (13.50~20.00) Z=-1.11 0.268
    指标 北京小汤山医院 (n=80 681) 天津医科大学肿瘤医院 (n=10 940)
    GSD组 (n=4 333) 非GSD组 (n=76 348) 统计值 P GSD组 (n=507) 非GSD组 (n=10 433) 统计值 P
    UA(μmol/L) 337.80 (281.60~397.15) 326.00 (267.00~389.00) Z=-8.77 <0.001 302.00 (253.25~367.00) 292.00 (242.00~353.00) Z=-3.09 0.002
    TC(mmol/L) 4.88 (4.26~5.56) 4.74 (4.16~5.39) Z=-8.53 <0.001 5.55 (4.90~6.14) 5.25 (4.63~5.93) Z=-5.51 <0.001
    TG(mmol/L) 1.38 (0.98~2.01) 1.24 (0.84~1.90) Z=-12.00 <0.001 1.36 (0.99~1.86) 1.11 (0.82~1.56) Z=-8.34 <0.001
    LDL-C(mmol/L) 3.04 (2.50~3.56) 2.93 (2.43~3.46) Z=-8.06 <0.001
    HDL-C(mmol/L) 1.28 (1.10~1.50) 1.31 (1.12~1.54) Z=-5.64 <0.001
    脂肪肝[例(%)] 2 051(47.33) 27 364(35.84) χ 2=229.27 <0.001 274(54.04) 3 180(30.48) χ 2=124.26 <0.001
    肾结石[例(%)] 306(7.06) 2 443(3.20) χ 2=185.85 <0.001 22(4.34) 233(2.23) χ 2=9.42 0.002
    高血压[例(%)] 1 973(45.53) 19 221(25.18) χ 2=874.65 <0.001 246(48.52) 2 592(24.84) χ 2=139.70 <0.001
    Ⅰ级 869(20.06) 9 867(12.92) χ 2=227.71 <0.001 153(30.18) 1 780(17.06) χ 2=147.45 <0.001
    Ⅱ级 198(4.57) 2 334(3.06) 73(14.40) 632(6.06)
    Ⅲ级 33(0.76) 409(0.54) 20(3.94) 180(1.73)
    下载: 导出CSV

    表  2  横断面研究中高血压与GSD风险及亚组多因素Logistic回归分析

    Table  2.   Logistic regression analysis of the risk of hypertension and GSD in cross-sectional studies

    项目 重庆医科大学附属第一医院金山医院 开州区人民医院 北京小汤山医院 天津医科大学肿瘤医院
    OR(95%CI P OR(95%CI P OR(95%CI P OR(95%CI P
    SBP每上升10 mmHg 1.007(0.988~1.026) 0.478 1.015(0.997~1.034) 0.110 1.019(0.991~1.048) 0.185 1.063(0.995~1.135) 0.072
    DBP每上升10 mmHg 1.042(1.012~1.072) 0.005 1.011(0.984~1.039) 0.428 1.004(0.960~1.051) 0.861 1.018(0.917~1.131) 0.732
    高血压 1.153(1.099~1.210) <0.001 1.065(1.014~1.118) 0.012 1.176(1.089~1.270) <0.001 1.304(1.055~1.613) 0.014
    Ⅰ级 1.058(1.001~1.117) 0.046 1.078(1.020~1.138) 0.007 1.032(0.945~1.126) 0.482 1.308(1.038~1.647) 0.023
    Ⅱ级 1.072(0.975~1.179) 0.153 1.048(0.964~1.139) 0.273 0.926(0.785~1.093) 0.365 1.352(0.997~1.834) 0.052
    Ⅲ级 1.177(1.054~1.315) 0.004 0.996(0.865~1.147) 0.956 0.866(0.569~1.318) 0.502 1.105(0.659~1.854) 0.705
    年龄亚组
    <40岁
    SBP每上升10 mmHg 0.962(0.914~1.013) 0.138 0.915(0.861~0.973) 0.005 0.995(0.901~1.098) 0.918 1.001(0.776~1.290) 0.994
    DBP每上升10 mmHg 1.136(1.060~1.217) <0.001 1.106(1.025~1.195) 0.010 1.082(0.940~1.246) 0.273 1.176(0.842~1.643) 0.340
    高血压 1.214(1.053~1.399) 0.007 1.059(0.896~1.252) 0.502 1.156(0.524~2.548) 0.720 1.582(0.824~3.038) 0.168
    40~60岁
    SBP每上升10 mmHg 1.013(0.983~1.043) 0.397 1.010(0.985~1.035) 0.452 1.019(0.975~1.065) 0.406 1.047(0.940~1.167) 0.402
    DBP每上升10 mmHg 1.039(0.994~1.085) 0.088 1.039 (1.002~1.078) 0.040 1.058(0.987~1.134) 0.110 1.027(0.869~1.214) 0.756
    高血压 1.155(1.083~1.233) <0.001 1.068(1.005~1.135) 0.034 1.060(0.872~1.287) 0.560 1.104(0.825~1.476) 0.507
    >60岁
    SBP每上升10 mmHg 1.045(1.016~1.075) 0.002 1.058(1.026~1.091) <0.001 1.013(0.974~1.054) 0.518 1.075(0.981~1.177) 0.121
    DBP每上升10 mmHg 0.962(0.917~1.010) 0.122 0.904(0.859~0.950) <0.001 0.906(0.845~0.971) 0.005 0.970(0.829~1.135) 0.705
    高血压 1.148(1.056~1.248) 0.001 1.056(0.961~1.160) 0.259 0.902(0.736~1.107) 0.324 1.483(1.027~2.140) 0.035
    性别亚组
    男性
    SBP每上升10 mmHg 0.979(0.952~1.007) 0.134 0.993(0.966~1.020) 0.603 1.017(0.981~1.054) 0.363 1.103(1.002~1.214) 0.044
    DBP每上升10 mmHg 1.076(1.033~1.120) <0.001 1.016(0.978~1.056) 0.416 1.006(0.949~1.066) 0.835 1.012(0.869~1.177) 0.881
    高血压 1.133(1.065~1.205) <0.001 1.011(0.948~1.078) 0.742 1.206(1.097~1.325) <0.001 1.495(1.112~2.010) 0.008
    女性
    SBP每上升10 mmHg 1.047(1.020~1.075) 0.001 1.038(1.012~1.065) 0.004 1.018(0.973~1.065) 0.438 1.026(0.935~1.125) 0.594
    DBP每上升10 mmHg 0.996(0.956~1.039) 0.868 1.007(0.969~1.047) 0.714 1.008(0.937~1.084) 0.838 1.020(0.881~1.182) 0.787
    高血压 1.187(1.09~1.283) <0.001 1.146(1.062~1.237) <0.001 1.117(0.980~1.274) 0.098 1.111(0.814~1.515) 0.508
    胆石症亚型
    胆结石
    SBP每上升10 mmHg 1.030(1.004~1.057) 0.025 1.048(1.021~1.076) <0.001 1.029(0.996~1.063) 0.085 1.091(1.009~1.179) 0.028
    DBP每上升10 mmHg 1.024(0.985~1.065) 0.233 0.982(0.945~1.021) 0.367 1.011(0.959~1.066) 0.679 0.995 (0.880~1.125) 0.934
    高血压 1.141(1.067~1.221) <0.001 1.096(1.022~1.175) 0.011 1.251(1.144~1.367) <0.001 1.370(1.067~1.758) 0.013
    Ⅰ级 1.067(0.988~1.152) 0.098 1.087(1.005~1.176) 0.038 1.101(0.996~1.217) 0.059 1.276 (0.969~1.681) 0.083
    Ⅱ级 1.153(1.013~1.314) 0.031 1.054(0.935~1.189) 0.387 1.007(0.835~1.216) 0.938 1.623(1.147~2.298) 0.006
    Ⅲ级 1.473(1.277~1.698) <0.001 1.307(1.090~1.568) 0.004 0.892(0.549~1.448) 0.643 1.397(0.783~2.491) 0.257
    胆囊切除
    SBP每上升10 mmHg 0.981(0.957~1.006) 0.144 0.984(0.961~1.008) 0.182 0.990(0.942~1.041) 0.708 0.996(0.887~1.119) 0.947
    DBP每上升10 mmHg 1.058(1.017~1.100) 0.005 1.038(1.002~1.076) 0.038 0.989(0.911~1.074) 0.793 1.064(0.883~1.283) 0.512
    高血压 1.138(1.067~1.214) <0.001 1.032(0.968~1.100) 0.336 0.986(0.858~1.134) 0.846 1.122(0.770~1.637) 0.548
    Ⅰ级 1.040(0.967~1.118) 0.295 1.060(0.987~1.138) 0.108 0.871(0.739~1.026) 0.097 1.310(0.881~1.947) 0.182
    Ⅱ级 0.990(0.873~1.124) 0.882 1.037(0.931~1.154) 0.511 0.757(0.550~1.042) 0.088 0.831 (0.466~1.482) 0.531
    Ⅲ级 0.903 (0.774~1.053) 0.193 0.761(0.621~0.932) 0.008 0.821(0.383~1.757) 0.611 0.611(0.214~1.747) 0.358
    下载: 导出CSV

    表  3  Meta分析中血压与GSD风险相关的亚组分析

    Table  3.   Subgroup analysis of blood pressure associated with GSD risk in meta-analysis

    项目 血压对GSD影响 SBP和DBP血压平均差异对GSD的影响
    数据集 OR(95%CI P I2 P组间 数据集 SMD(95%CI P I2
    SBP每上升1 mmHg 12 1.009(1.000~1.017) 0.043 57.6% 44 0.351(0.291~0.411) <0.001 97.6%
    研究设计 0.340
    横断面研究 7 1.010(1.000~1.020) 0.047 61.1% 31 0.317(0.269~0.366) <0.001 94.4%
    病例对照研究 2 1.068(0.995~1.146) 0.070 1.7% 9 0.549(0.164~0.934) 0.005 99.1%
    队列研究 3 1.001(0.952~1.052) 0.981 26.3% 4 0.183(0.100~0.266) <0.001 80.0%
    地理位置 0.670
    亚洲 9 1.012(1.001~1.022) 0.030 58.1% 34 0.387(0.324~0.450) <0.001 97.8%
    欧洲 3 1.001(0.952~1.052) 0.981 26.3% 6 0.175(-0.011~0.361) 0.916 95.7%
    美洲 3 -0.034(-0.667~0.599) 0.066 93.1%
    非洲 1 0.815(0.450~1.179) <0.001 NA
    性别 0.120
    男性 6 1.000(0.983~1.018) 0.996 45.2% 1 0.115(0.082~0.148) <0.001 NA
    女性 6 1.026(0.998~1.054) 0.071 75.4% 6 0.085(-0.050~0.219) 0.218 48.2%
    GSD分类 <0.001
    胆结石 7 1.032(1.020~1.044) <0.001 12.2% 11 0.360(0.093~0.626) 0.008 98.9%
    胆囊切除 4 0.984(0.968~1.000) 0.045 0.0% 7 0.291(0.143~0.439) <0.001 87.0%
    发表语言 0.061
    英文 5 1.000(0.995~1.004) 0.969 4.7% 26 0.272(0.190~0.354) <0.001 94.6%
    中文 3 1.031(1.000~1.063) 0.053 16.3% 14 0.447(0.235~0.658) <0.001 98.5%
    DBP每上升1 mmHg 11 1.015(1.007~1.023) <0.001 0.0% 44 0.256(0.198~0.313) <0.001 97.3%
    研究设计 0.570
    横断面研究 7 1.015(1.007~1.023) <0.001 0.0% 31 0.192(0.146~0.237) <0.001 93.5%
    病例对照研究 2 1.018(0.942~1.099) 0.654 0.0% 9 0.474(0.048~0.901) 0.029 99.3%
    队列研究 2 0.925(0.765~1.119) 0.424 19.0% 4 0.176(0.132~0.221) <0.001 44.3%
    地理位置 0.290
    亚洲 9 1.015(1.007~1.023) <0.001 0.0% 34 0.293(0.230~0.356) <0.001 97.8%
    欧洲 2 0.925(0.765~1.119) 0.424 19.0% 6 -0.077(-0.365~0.212) 0.602 77.8%
    美洲 3 0.059(-0.004~0.122) 0.066 40.8%
    非洲 1 0.940(0.570~1.309) <0.001 NA
    性别 0.521
    男性 6 1.021(0.991~1.052) 0.168 56.6% 1 0.161(0.128~0.194) <0.001 NA
    女性 6 1.010(0.996~1.024) 0.160 0.0% 6 0.037(-0.144~0.217) 0.69 69.5%
    GSD分类 0.083
    胆结石 7 1.016(1.003~1.028) 0.012 0.0% 11 0.434(0.136~0.732) 0.007 78.4%
    胆囊切除 4 1.042(1.016~1.068) 0.001 0.0% 7 0.106(-0.010~0.221) 0.073 99.1%
    发表语言 0.242
    英文 4 1.009(0.998~1.021) 0.104 0.0% 26 0.179(0.126~0.231) <0.001 85.4%
    中文 3 1.020(1.006~1.035) 0.006 0.0% 14 0.390(0.141~0.640) 0.002 98.9%
    总体 84 1.351(1.284~1.421) <0.001 85.0%
    研究设计 0.011
    横断面研究 53 1.395(1.311~1.485) <0.001 85.7%
    病例对照研究 19 1.403(1.235~1.594) <0.001 86.0%
    队列研究 12 1.184(1.066~1.314) 0.002 56.3%
    地理位置 <0.001
    亚洲 70 1.356(1.285~1.430) <0.001 84.8%
    欧洲 4 1.086(0.779~1.514) 0.626 91.1%
    美洲 8 1.649(1.232~2.209) 0.001 80.0%
    非洲 1 1.618(0.591~4.430) 0.349 NA
    大洋洲 1 0.509(0.223~1.160) 0.108 NA
    性别 0.510
    男性 13 1.214(1.100~1.339) <0.001 79.8%
    女性 15 1.238(1.119~1.370) <0.001 71.6%
    GSD分类 0.260
    胆结石 25 1.246(1.159~1.339) <0.001 76.0%
    胆囊切除 5 1.133(0.977~1.314) 0.099 84.8%
    发表语言 0.160
    英文 39 1.395(1.287~1.513) <0.001 80.1%
    中文 41 1.354(1.255~1.461) <0.001 81.9%
    下载: 导出CSV
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