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目的本研究拟设计一个能够有效筛检胆囊息肉病变(PLG)的简单工具,为PLG的有效管理及防治提供参考。方法采用横断面病例-对照研究设计方法,整群抽取2014年1月—8月在陕西省西安市第四军医大学第一附属医院西京医院体检中心进行健康体检且其体检信息满足本次研究要求的12 888名体检者进行问卷调查、体格检查、腹部超声检查和实验室检测。结果 12 888名体检人群中,219例被超声诊断患有PLG,患病率为1.70%;多因素条件logistic回归分析结果表明,在校正了变量间的交互作用及多重共线性后,年龄较大、甘油三酯(TG)较高和间接胆红素较高是PLG的危险因素;将这些变量纳入构建PLG的预测模型中,最终构建的预测指数为:PLG指数=13×年龄(年龄≥50,取值为1;年龄<50,取值为0)+间接胆红素+TG;PLG指数在训练数据集中的受试者工作特征曲线(ROC曲线)下面积为0.622(95%CI=0.571~0.673),在验证数据集中的ROC曲线下面积为0.615(95%CI=0.562~0.660);PLG指数P75的PLG的阳性率分别为1.0%、1.7%、2.0%,随着PLG指数的增加,PLG的阳性率随之增加(P<0.001)。结论 PLG指数在增加筛检成本效益方面具有重要意义,也可为PLG的有效防治和进一步的生活方式治疗提供帮助。
Objective This study designed to be a simple tool for effective screening of polypoid lesions of gallbladder (PLG), to provide a reference for the effective management and prevention of PLG. METHODS: A cross-sectional case-control study was conducted to collect the data from January 2014 to August 2008 in Xijing Hospital, First Affiliated Hospital of the Fourth Military Medical University, Xi’an, Shaanxi Province. The physical examination information meets the requirements of this study 12 888 physical examiners conducted questionnaires, physical examination, abdominal ultrasound examination and laboratory tests. Results Among 12 888 medical examinations, 219 cases were diagnosed with PLG by ultrasound and the prevalence was 1.70%. Multivariate conditional logistic regression analysis showed that after adjusting for the interaction between variables and multicollinearity, the older , Higher triglycerides (TG) and higher indirect bilirubin were risk factors for PLG. These variables were included in the prediction model for constructing PLG. The final prediction index was: PLG index = 13 × age (age≥50 , With a value of 1; age <50, with a value of 0) + indirect bilirubin + TG. The area under the receiver operating characteristic curve (ROC curve) for the PLG index in the training dataset was 0.622 (95% CI 0.571 ~ 0.673). The area under the ROC curve of validation data set was 0.615 (95% CI = 0.562 ~ 0.660). The positive rates of PLG with PLG index P75 were 1.0%, 1.7%, 2.0 %, With the PLG index increased, the positive rate of PLG increased (P <0.001). Conclusion The PLG index is of great significance in increasing the cost-effectiveness of screening. It can also help to effectively prevent and treat PLG and further treatment of lifestyle.