Takahashi Yu, Yamamichi Nobutake, Shimamoto Takeshi, Mochizuki Satoshi, Fujishiro Mitsuhiro, Takeuchi Chihiro, Sakaguchi Yoshiki, Niimi Keiko, Ono Satoshi, Kodashima Shinya, Mitsushima Toru, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
J Gastroenterol. 2014 May;49(5):882-9. doi: 10.1007/s00535-013-0832-z. Epub 2013 Jun 5.
Our aim is to elucidate causative factors for gallstones, especially focusing on Helicobacter pylori (HP) infection.
We analyzed 15,551 Japanese adults who had no history of gastrectomy, cholecystectomy, HP eradication, and didn't use proton pump inhibitors, anti-diabetic drugs, or anti-cholesterol drugs. 1,057 subjects who previously had HP eradication were analyzed separately.
Gallstones were detected in 409 of 8,625 men (4.74%) and 285 of 6,926 women (4.11%) by ultrasonography. Among the 25 factors univariately analyzed, age, HP infection, alcohol intake, weight, body mass index (BMI), and 14 blood test values (AST, ALT, ALP, γ-GTP, T-Chol, HDL-Chol, LDL-Chol, TG, TP, Hb, HbA1c, pepsinogen I, pepsinogen II, and pepsinogen I/II ratio) displayed significant association with gallstones (p < 0.05), whereas gender, smoking, height, and three blood test values (Alb, T-Bil, MCV) did not. Multivariate analysis showed that age, gender, alcohol intake, BMI, γ-GTP, LDL-Chol, TP, and HP infection had significant association (p < 0.05). Successive multiple logistic regression analysis calculating odds ratio (OR) and standardized coefficients (β) showed that age (OR/β = 1.57/0.450), BMI (OR/β = 1.30/0.264), HP infection (OR/β = 1.51/0.206), lower alcohol intake (OR/β = 1.33/0.144), γ-GTP (OR/β = 1.15/0.139), and pepsinogen I/II ratio (OR/β = 1.08/0.038) have significant positive association with gallstones, whereas gender does not. The gallstone prevalence among HP-negative, HP-eradicated, and HP-positive subjects was 3.81, 4.73 and 6.08%, respectively. The matched analysis controlling age, BMI, γ-GTP, alcohol intake, pepsinogen I/II ratio and gender also demonstrated that gallstone prevalence among HP-eradicated subjects was significantly lower compared with HP-positive subjects (p < 0.05).
HP infection is positively associated with gallstones. HP eradication may lead to prevention of gallstones.
我们的目的是阐明胆结石的致病因素，尤其关注幽门螺杆菌（HP）感染。
我们分析了15551名无胃切除术、胆囊切除术、HP根除史且未使用质子泵抑制剂、抗糖尿病药物或抗胆固醇药物的日本成年人。对1057名既往有HP根除史的受试者进行了单独分析。
通过超声检查，8625名男性中有409名（4.74%）检出胆结石，6926名女性中有285名（4.11%）检出胆结石。在单因素分析的25个因素中，年龄、HP感染、饮酒量、体重、体重指数（BMI）以及14项血液检测值（谷草转氨酶、谷丙转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、总蛋白、血红蛋白、糖化血红蛋白、胃蛋白酶原I、胃蛋白酶原II和胃蛋白酶原I/II比值）与胆结石有显著关联（p<0.05），而性别、吸烟、身高以及3项血液检测值（白蛋白、总胆红素、平均红细胞体积）则无关联。多因素分析显示，年龄、性别、饮酒量、BMI、γ-谷氨酰转肽酶、低密度脂蛋白胆固醇、总蛋白和HP感染有显著关联（p<0.05）。计算比值比（OR）和标准化系数（β）的连续多因素逻辑回归分析显示，年龄（OR/β=1.57/0.450）、BMI（OR/β=1.30/0.264）、HP感染（OR/β=1.51/0.206）、较低饮酒量（OR/β=1.33/0.144）、γ-谷氨酰转肽酶（OR/β=1.15/0.139）和胃蛋白酶原I/II比值（OR/β=1.08/0.038）与胆结石呈显著正相关，而性别则无。HP阴性、HP根除和HP阳性受试者的胆结石患病率分别为3.81%、4.73%和6.08%。控制年龄、BMI、γ-谷氨酰转肽酶、饮酒量、胃蛋白酶原I/II比值和性别的匹配分析也表明，HP根除受试者的胆结石患病率显著低于HP阳性受试者（p<0.05）。
HP感染与胆结石呈正相关。根除HP可能有助于预防胆结石。
