老年胆结石患者内脂面积及其与合并糖尿病的相关性分析

Analysis of the Internal Lipid Area and Its Correlation with Diabetes in Elderly Patients with Gallstones

摘要: 目的：了解老年胆结石患者内脂面积分布情况，并分析老年胆结石患者内脂肥厚与合并糖尿病的相关性，为开展以患者为中心的个性化性护理提供相关依据。方法：选取2023年1月至2024年7月在吴起县人民医院内分泌科或普外科住院的患者，采用方便随机抽样法选取老年胆结石患者。收集患者一般资料与疾病相关资料，及采用生物电阻抗法(欧姆龙DUALSCANHDS‐2000)测量患者内脏脂肪面积(VFA)与皮下脂肪面积(SFA)进行数据收集。计数资料使用频数、百分比(n, %)描述，组间比较使用c²检验；呈正态分布的计量资料以均数 ± 标准差($\overline{\text{x}}\pm \text{s}$)描述，组间比较采用t检验；使用风险比值比(OR)分析老年胆结石患者内脏脂肪面积肥厚风险倍数，采用Spearman相关分析老年胆结石患者内脂面积与是否合并糖尿病的相关性；以P < 0.05差异具有统计学意义。结果：本研究共纳入104例老年胆结石患者，BMI平均为(23.23 ± 2.57) kg/m²，内脏脂肪面积平均为(111.13 ± 41.35) cm²，皮下脂肪面积平均为(163.53 ± 43.18) cm²，合并糖尿病组的老年胆结石患者内脂面积肥厚，平均为133.08 ± 43.95 cm²，而无糖尿病组的老年胆结石患者内脂面积正常，平均为91.56 ± 26.77 cm²。老年胆结石合并糖尿病患者内脏脂肪面积肥厚风险是无糖尿病合并症患者的5倍。采用Spearman相关分析，结果显示老年胆结石患者内脏脂肪面积肥厚与合并糖尿病的相关系数为0.487，呈中等正相关，且在0.01级别相关性显著。结论：老年胆结石患者内脂面积肥厚，老年内脂肥厚合并糖尿病的患者较内脂面积正常的患者更易得胆结石，老年患者胆结石、内脂肥厚和糖尿病之间存在正相关关系，其间是相互影响的，并非单向因果关系，即内脂肥厚、糖尿病可以增加患胆结石的风险，而同时胆结石的存在也可能加重糖尿病的进展。临床上指导老年胆结石患者保持良好的血糖控制、合理饮食、药物治疗和必要的手术干预都是处理这种关联的重要方式。

Abstract: Objective: To investigate the distribution of internal lipid area in elderly patients with gallstones, and to analyze the correlation between internal lipid hypertrophy and diabetes in elderly patients with gallstones, so as to provide a relevant basis for patient-centered personalized nursing. Methods: The patients hospitalized in the Department of Endocrinology or General Surgery of Wuqi County People’s Hospital from January 2023 to July 2024 were selected by convenient random sampling method. General and disease-related data were collected, and visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by bioresistive method (Omron DualscanHDS- 2000). Usage frequency and percentage (n, %) of counting data were described. Comparison between groups was conducted using 2 test; The measurement data with normal distribution were described as mean ± standard $\overline{\text{x}}\pm \text{s}$ deviation, and T-test was used for inter-group comparison. Risk odds ratio (OR) was used to analyze the risk multiple of visceral fat area hyperplasia in elderly patients with gallstones, and Spearman correlation was used to analyze the correlation between internal fat area and diabetes mellitus. The difference was statistically significant with P < 0.05. Results: A total of 104 elderly patients with gallstones were included in this study. The average BMI was (23.23 ± 2.57) kg/m², the average visceral fat area was (111.13 ± 41.35) cm², and the average subcutaneous fat area was (163.53 ± 43.18) cm². The internal fat area of elderly patients with gallstones combined with diabetes mellitus was hyperplasia. The mean lipid area was 133.08 ± 43.95cm², and the mean lipid area was 91.56 ± 26.77 cm² in the elderly patients without diabetes. The risk of visceral fat area hypertrophy in elderly patients with gallstones and diabetes is 5 times that of patients without diabetes complications. Spearman correlation analysis showed that the correlation coefficient between visceral fat area hypertrophy and diabetes mellitus in elderly patients with gallstones was 0.487, showing a moderate positive correlation, and the correlation was significant at 0.01 level. Conclusions: Elderly patients with cholelithiasis have internal lipid area hypertrophy, and elderly patients with internal lipid hypertrophy combined with diabetes are more likely to develop gallstones than those with normal internal lipid area. There is a positive correlation between gallstones, internal lipid hypertrophy and diabetes in elderly patients, and they are mutually influenced, not one-way causality, that is, internal lipid hypertrophy and diabetes can increase the risk of gallstones. At the same time, the presence of gallstones may also aggravate the progression of diabetes. Clinical guidance to elderly patients with gallstones to maintain good blood glucose control, rational diet, medication and necessary surgical intervention is an important way to manage this association.