The Influence Of Hyperlipidemia And Insulin Resistance On The Biliary Tract Stone Formation

Objective To investigate the influence of all kinds of risk factors to hyperlipidemiaand insulin resistance on the biliary tract stone formation.Methods From January2012to August2013, a total of66consecutive hospitalizedpatients diagnosed to the biliary tract stone in general surgery department were beencollected to research group with taking retrospective analysis (36males and30females, mean age51.2±7.4years). The42hospitalized patients receiving biliary tractoperation but without biliary tract stone formation were been collected to controlgroup (24males and18females, mean age54.9±8.5years).1. The comparison of the clinical characteristic between two groups. The clinicalbasic characteristics, such as age, gender, weight, body mass index (BMI), abdominalcircumference, hip circumference, waist-hip ratio (WHR) etc, were comparedbetween two groups.2. The comparison of the levels of serum biochemical indexes between twogroups. The indexes of serum total triglyceride (TG), total cholesterol (CHOL), highdensity lipoprotein (HDL), lower density lipoprotein (LDL), creatinine (CREA), uricacid (UA), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL)were detected by biochemistry analyzer and were compared between two groups.3. The comparison of the levels of serum insulin and glycemic indexes betweentwo groups. The indexes of serum fasting insulin (FINS),2hour postprandial insulin(PINS), fasting plasma glucose (FPG),2hour postprandial plasma glucose (PPG),glycosylated hemoglobin (HbA1C), homeostasis model assessment insulin resistance(HOMA-IR), insulin sensitivity index (ISI) were detected by enzyme-linkedimmunosorbent assay (ELISA) and were compared between two groups.4. The comparison of the relative indexes of bile between two groups. The freshbile of two groups’ patients were collected and the bile indexes of cholesterol (CHOL),total bile acids (TBA) and phosphholipid (PL) were detected by ELISA methods. Andthe cholesterol saturation indexes (CSI) of two groups’ patients were calculated.Above indexes were compared between two groups. 5. The correlation analysis of the CSI and relative clinical factors. Thecorrelations of serum total triglyceride (TG), total cholesterol (CHOL), high densitylipoprotein (HDL), lower density lipoprotein (LDL), creatinine (CREA), uric acid(UA), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) andserum fasting insulin (FINS),2hour postprandial insulin (PINS), fasting plasmaglucose (FPG),2hour postprandial plasma glucose (PPG), glycosylated hemoglobin(HbA1C), homeostasis model assessment insulin resistance (HOMA-IR), insulinsensitivity index (ISI) and bile cholesterol (CHOL), total bile acids (TBA),phosphholipid (PL) and CSI were confirmed by Pearson linear regression analysis.6. The correlation analysis of the prevalence rate of bile stone and relativeclinical factors. The correlations of serum total triglyceride (TG), total cholesterol(CHOL), high density lipoprotein (HDL), lower density lipoprotein (LDL), creatinine(CREA), uric acid (UA), total bilirubin (TBIL), direct bilirubin (DBIL) and indirectbilirubin (IBIL) and serum fasting insulin (FINS),2hour postprandial insulin (PINS),fasting plasma glucose (FPG),2hour postprandial plasma glucose (PPG),glycosylated hemoglobin (HbA1C), homeostasis model assessment insulin resistance(HOMA-IR), insulin sensitivity index (ISI) and bile cholesterol (CHOL), total bileacids (TBA), phosphholipid (PL) and CSI and the prevalence rate of bile stone wereconfirmed by multivariate Logistic regression analyses.Results1. The comparison of the clinical characteristic between two groups. Compared tocontrol group, the clinical features of BMI, abdominal circumference, WHR inresearch group were higher (P<0.05), the clinical features of age, gender, weight, hipcircumference, smoking history and alcohol consumption history in research groupwere no different (P>0.05). The patients in research groups were divided into five agebrackets based on partition by10years, which were20year-29year,30year-39year,40year-49year,50year-59year and60year-70year. The prevalence rate of bile stoneof five age brackets were15.15%(10/66),25.76%(17/66),33.33%(22/66),19.70%(13/66) and6.06%(4/66) respectively. The prevalence rates of bile stone werestatistical different among five age brackets (P<0.05). And the prevalence rates of bile stone in40year-49year was highest, but the prevalence rates of bile stone in60year-70year was lowest.2. The comparison of the levels of serum biochemical indexes between twogroups. Compared to control group, the indexes of total cholesterol (CHOL), lowerdensity lipoprotein (LDL) in research group’s patients were higher (P<0.05), and theindex of high density lipoprotein (HDL) in research group’s patients were lower(P<0.05). But the indexes of serum total triglyceride (TG), creatinine (CREA), uricacid (UA), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL)were no different between two groups (P>0.05).3. The comparison of the levels of serum insulin and glycemic indexes betweentwo groups. Compared to control group, the indexes of serum fasting insulin (FINS),2hour postprandial insulin (PINS) and homeostasis model assessment insulinresistance (HOMA-IR) in research group’s patients were higher (P<0.05), and theindex of insulin sensitivity index (ISI) in research group’s patients were lower(P<0.05). But the indexes of fasting plasma glucose (FPG),2hour postprandialplasma glucose (PPG), glycosylated hemoglobin (HbA1C) were no different betweentwo groups (P>0.05).4. The comparison of the relative indexes of bile between two groups. Comparedto control group, the indexes of the bile cholesterol (CHOL), phosphholipid (PL) andthe cholesterol saturation indexes (CSI) in research group’s patients were higher(P<0.05), and the index of total bile acids (TBA) in research group’s patients werelower (P<0.05).5. The correlation analysis of the CSI and relative clinical factors. The positivecorrelations of total cholesterol (CHOL), lower density lipoprotein (LDL), serumfasting insulin (FINS),2hour postprandial insulin (PINS), homeostasis modelassessment insulin resistance (HOMA-IR) and bile cholesterol (bCHOL) to the CSIwere confirmed by Pearson linear regression analysis. The negative correlations ofhigh density lipoprotein (HDL), insulin sensitivity index (ISI) and total bile acids(TBA) to the CSI were confirmed. But the correlations of serum total triglyceride(TG), creatinine (CREA), uric acid (UA), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL) and fasting plasma glucose (FPG),2hourpostprandial plasma glucose (PPG), glycosylated hemoglobin (HbA1C) andphosphholipid (PL) to the CSI were no confirmed by Pearson linear regressionanalysis.6. The correlation analysis of the prevalence rate of bile stone and relativeclinical factors. The risk factors of total cholesterol (CHOL), lower densitylipoprotein (LDL), homeostasis model assessment insulin resistance (HOMA-IR) andthe CSI to the prevalence rate of bile stone were confirmed by multivariate Logisticregression analyses. The protective factors of high density lipoprotein (HDL) andinsulin sensitivity index (ISI) to the prevalence rate of bile stone were confirmed. Butthe factors of serum total triglyceride (TG), creatinine (CREA), uric acid (UA), totalbilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL), serum fastinginsulin (FINS),2hour postprandial insulin (PINS), fasting plasma glucose (FPG),2hour postprandial plasma glucose (PPG), glycosylated hemoglobin (HbA1C), and bilecholesterol (bCHOL), total bile acids (TBA), phosphholipid (PL) were no risk factorsto the prevalence rate by multivariate Logistic regression analyses.Conclusion1. The patients with the biliary tract cholesterol stone formation were obviouslyhypercholesterolemia, high LDL hyperlipidemia and low HDL hyperlipidemia.2. The patients with biliary tract cholesterol stone formation were obviously insulinresistance.3. The hypercholesterolemia, high LDL hyperlipidemia, low HDL hyperlipidemia andinsulin resistance were independent risk factors to the biliary tract cholesterol stoneformation.