Analysis on the associated factors of adult urolithiasis in China based on two-level Logistic regression model
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摘要:
目的 探讨我国成人尿石症患病的影响因素。 方法 于2013年5月-2014年7月，采用多阶段分层整群随机抽样，在全国随机抽7个省/直辖市，14个区/县的11个社区和19个自然村进行面对面问卷调查，包括泌尿系超声检查、血常规、尿常规和血液生化检查等。 结果 有效问卷9 310例中，尿石症患者1 447例，患病率为15.5%(1 447/9 310)；在14个地区之间的患病率有差异(χ2=711.523，P < 0.001)，最低为山西农村(0.76%)，最高为广东农村(35.99%)。零模型结果显示各地区尿石症患病有统计学聚集性(t=2.48，P=0.027)，且组内相关系数ICC=48.74%。随机效应模型结果显示男性(OR=1.235，95%CI：1.082~1.411，P=0.005)、年龄增长(OR=1.101，95%CI：1.047~1.158，P=0.001)、糖尿病史(OR=1.411，95%CI：1.192~1.670，P=0.001)、结石家族史(OR=1.867，95%CI：1.500~2.323，P < 0.001)、低密度脂蛋白(low density lipoprotein，LDL)(OR=1.150，95%CI：1.050~1.260，P=0.006)、饮咖啡(OR=1.352，95%CI：1.065~1.716，P=0.017)、饮碳酸饮料(OR=1.547，95%CI：1.203~1.990，P=0.002)等为尿石症发生的危险因素，食醋酸(OR=0.567，95%CI：0.498~0.645，P < 0.001)和适量食用豆类(OR=0.726，95%CI：0.628~0.839，P < 0.001)等为尿石症发生的保护因素。 结论 尿石症患病具有地方聚集性，生活环境和饮食习惯影响尿石症的形成。 -
关键词:
- Logistic回归分析模型 /
- 尿石症 /
- 影响因素
Abstract:Objective To investigate the risk factors of adult urolithiasis in China. Methods 14 areas including 11 communities and 19 villages were randomly selected from 7 provinces of China by multi-stage stratified cluster sampling method during the period of May 2013 to July 2014. Individuals were investigated by a face-to-face questionnaire and a physical examination including urinary tract ultrasonographic examinations, routine blood and urine tests and blood biochemical examination ect. Results In total, 1 447 participants were found with the urolithiasis among 9 310 individuals and the overall prevalence was 15.5% (1 447/9 310). The prevalence of urolithiasis was significantly different among 14 areas (χ2=711.523, P < 0.001), the lowest was the village in Shanxi (0.76%) and the highest was the village in Guangdong(35.99%). The intercept-only model further indicated the reginal aggregation for the individuals of urolithiasis (t=2.48, P=0.027) and the ICC was 48.74%. The two-level Logistic regression model showed that the gender (OR=1.235, 95% CI: 1.082-1.411, P=0.005), age (OR=1.101, 95% CI: 1.047-1.158, P=0.001), diabetes mellitus (OR=1.411, 95%CI: 1.192-1.670, P=0.001), family history of urinary calculi (OR=1.867, 95% CI: 1.500-2.323, P < 0.001), LDL (OR=1.150, 95% CI: 1.050-1.260, P=0.006), drinking coffee (OR=1.352, 95% CI: 1.065-1.716, P=0.017) and drinking sodas (OR=1.547, 95% CI: 1.203-1.990, P=0.002) were the risk factors for urolithiasis. By contrast, consumed more fermented vinegar (OR=0.567, 95% CI: 0.498-0.645, P < 0.001) and had a amount of legume (OR=0.726, 95% CI: 0.628-0.839, P < 0.001) were protective factors of urolithiasis. Conclusion The prevalence of urolithiasis among adults reveal an aggregation in area-level, influenced by life environment and dietary habits of individual. -
Key words:
- Logistic regression analysis model /
- Urolithiasis /
- Risk factors
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表 1 我国成年人尿石症的地区分布
Table 1. Prevalence of adult urolithiasis among different regions in China
地区 总人数(人) 患病人数(人) 患病率(%) 广东农村 842 303 35.99 广东城市 759 147 19.37 湖南农村 708 153 21.61 湖南城市 722 158 21.88 山西农村 661 5 0.76 山西城市 687 8 1.16 重庆农村 851 111 13.04 重庆城市 522 49 9.39 上海农村 685 148 21.61 上海城市 571 80 14.01 黑龙江农村 507 95 18.74 黑龙江城市 548 127 23.18 甘肃农村 620 21 3.39 甘肃城市 627 42 6.70 
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表 2 一般人口特征尿石症患病率比较
Table 2. Comparisons of prevalence of urolithiasis by demographic characteristics
项目 调查人数(人) 患病人数(人) 患病率(%) χ2值 P值 城乡 20.195 ＜0.001 城市 4 847 836 13.77 农村 4 436 611 17.15 南北方 248.972 ＜0.001 南方 5 660 1 149 20.30 北方 3 650 298 8.16 性别 15.966 ＜0.001 男性 3 792 658 17.35 女性 5 518 789 14.30 年龄(岁) 24.775 ＜0.001 18~ 720 73 10.14 31~ 1 228 174 14.17 41~ 2 162 333 15.40 51~ 2 389 389 16.28 61~ 1 874 308 16.44 >70 937 170 18.14
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表 3 零模型参数估计结果
Table 3. The estimation of two-level null Logistic regression model
固定效应 估计值 标准误 t值 P值 固定部分(截距) -2.105 0.319 -6.59 < 0.001 随机部分 水平2 1.395 0.562 2.48 0.027 水平1 1.467 0.608
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表 4 纳入水平2解释变量的模型结果
Table 4. The estimation of model including explanatory variable in the second-level
项目 估计值 s t值 P值 固定部分 常数项 -1.448 0.416 -3.48 0.004 水平2解释变量 城乡 -0.065 0.506 -0.13 0.900 南北方 -1.458 0.514 -2.84 0.014 随机部分 水平2 0.866 0.352 2.46 0.029 水平1 1.096 0.494
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表 5 随机效应模型结果
Table 5. Two-level Logistic regression model of urolithiasis
项目 β sx t值 P值 OR(95 % CI)值 固定部分 常数项 -2.276 0.276 -8.240 < 0.001 0.103(0.057~0.187) 性别 0.211 0.062 3.430 0.005 1.235(1.082~1.411) 年龄 0.096 0.023 4.110 0.001 1.101(1.047~1.158) 饮咖啡 0.301 0.110 2.730 0.017 1.352(1.065~1.716) 饮碳酸饮料(适量) 0.437 0.117 3.750 0.002 1.547(1.203~1.990) 饮碳酸饮料(大量) 0.082 0.181 0.450 0.658 1.086(0.734~1.606) 食醋酸 -0.567 0.060 -9.490 < 0.001 0.567(0.498~0.645) 食豆类(适量) -0.321 0.067 -4.790 < 0.001 0.726(0.628~0.839) 食豆类(大量) -0.135 0.125 -1.070 0.303 0.874(0.667~1.146) 糖尿病史 0.345 0.078 4.420 0.001 1.411(1.192~1.670) 结石家族史 0.624 0.101 6.170 < 0.001 1.867(1.500~2.323) LDL值 0.140 0.042 3.300 0.006 1.150(1.050~1.260) 随机部分 σμ02 0.739 0.315 2.350 0.036 σe0 0.781 0.341
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表 6 变量赋值说明
Table 6. Variable assignment description
指标名称 定义及赋值 解释变量 性别 男=1，女=0 年龄(岁) 18~=0，31~=1, 41~=2，51~=3, 61~=4， > 70=5 饮咖啡 3次/月及以下=1，1~4次/周=2，5次/周及以上=3 饮碳酸饮料 3次/月及以下=1，1~4次/周=2，5次/周及以上=3，以3次/月及以下为参照设置哑变量 食醋酸 3次/月及以下=1，1~4次/周=2，5次/周及以上=3 食豆类 3次/月及以下=1，1~7次/周=2，每天及以上=3，以3次/月及以下为参照设置哑变量 糖尿病史 无=0，有=1 结石家族史 无=0，有=1 LDL值 连续性变量 因变量 无结石=0，有结石=1 地区 水平2单位 个体 水平1单位
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[1] Alelign T, Petros B. Kidney stone disease: an update on current concepts[J]. Adv Urol, 2018: 3068365. DOI: 10.1155/2018/3068365. [2] Sorokin I, Mamoulakis C, Miyazawa K, et al. Epidemiology of stone disease across the world[J]. World J Urol, 2017, 35(9): 1301-1320. DOI: 10.1007/s00345-017-2008-6. [3] El-Zoghby ZM, Lieske JC, Foley RN, et al. Urolithiasis and the risk of ESRD[J]. Clin J Am Soc Nephro, 2012, 7(9): 1409-1415. DOI: 10.2215/CJN.03210312. [4] Mao S, Jiang H, Wu Z, et al. Urolithiasis: The most risk for nephrectomy in nonrenal tumor patients[J]. J Endourol, 2012, 26(10): 1356-1360. DOI: 10.1089/end.2012.0080. [5] 张立峰, 方志辉, 靳勇, 等. 影响泌尿系结石的多因素研究[J]. 黑龙江医药, 2015, 28(1): 170-172. DOI: 10.14035/j.cnki.hljyy.2015.01.076.Zhang LF, Fang ZH, Jin Y, et al. Multivariate study of urinary calculi[J]. Heilongjiang Medicine Journal, 2015, 28(1): 170-172. DOI: 10.14035/j.cnki.hljyy.2015.01.076. [6] 刘祥, 扶雪莲, 刘本燕, 等. 多水平视角下探讨老年人自评健康的影响因素[J]. 中华疾病控制杂志, 2018, 22(2): 173-177. DOI: 10.16462/j.cnki.zhjbkz.2018.02.017.Liu X, Fu XL, Liu BY, et al. Analysis on the influencing factors of self-rated health among the elderly by using model[J]. Chin J Dis Control Prev, 2018, 22(2): 173-177. DOI: 10.16462/j.cnki.zhjbkz.2018.02.017. [7] Yang Y, Deng Y, Wang Y. Major geogenic factors controlling geographical clustering of urolithiasis in China[J]. Sci Total Environ, 2016, 571: 1164-1171. DOI: 10.1016/j.scitotenv.2016.07.117. [8] Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis[J]. Investigative and Clinical Urology, 2017, 58(5): 299. DOI: 10.4111/icu.2017.58.5.299. [9] Li YZ, Yan S, Liu J, et al. Risk factors for urinary tract infection in patients with urolithiasis-primary report of a single center cohort[J]. BMC Urol, 2018, 18(1): 45. DOI: 10.1186/s12894-018-0359-y. [10] Chu FY, Chang CC, Huang PH, et al. The association of uric acid calculi with obesity, prediabetes, type 2 diabetes mellitus, and hypertension[J]. Biomed Res Int, 2017: 1-6. DOI: 10.1155/2017/7523960. [11] Zeng G, Mai Z, Xia S, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study[J]. BJU Int, 2017, 120(1): 109-116. DOI: 10.1111/bju.13828. [12] 邓鹏飞, 李文静, 龙耀, 等. 兴国县居民尿石症患病率的调查及危险因素分析[J]. 南昌大学学报(医学版), 2016, 56(1): 1-4. DOI: 10.13764/j.cnki.ncdm.2016.01.001.Deng PF, Li WJ, Long Y, et al. Prevalence and risk factors of urinary calculus in xingguo county, jiangxi province[J]. Journal of Nanchang University(Medical Sciences), 2016, 56(1): 1-4. DOI: 10.13764/j.cnki.ncdm.2016.01.001. [13] Massey LK, Palmer RG, Horner HT. Oxalate content of soybean seeds (Glycine max: Leguminosae), soyfoods, and other edible legumes[J]. J Agric Food Chem, 2001, 49(9): 4262-4266. DOI: 10.1021/jf010484y. [14] 刘旸, 段小鹿, 麦新, 等. 陈醋对大鼠肾脏草酸钙结石形成的影响及作用机制研究[J]. 中华泌尿外科杂志, 2016, 37(4): 304-307. DOI: 10.3760/cma.j.issn.1000-6702.2016.04.018.Liu Y, Duan XL, Mai X, et al. Effect and underlying mechanism of mature vinegar on the renal calcium oxalate stone formation in rats[J]. Chinese Journal of Urology, 2016, 37(4): 304-307. DOI: 10.3760/cma.j.issn.1000-6702.2016.04.018. [15] Setorki M, Asgary S, Eidi A, et al. Acute effects of vinegar intake on some biochemical risk factors of atherosclerosis in hypercholesterolemic rabbits[J]. Lipids Health Dis, 2010, 9: 10. DOI: 10.1186/1476-511X-9-10. [16] Ferraro PM, Taylor EN, Gambaro G, et al. Caffeine intake and the risk of kidney stones[J]. Am J Clin Nutr, 2014, 100(6): 1596-1603. DOI: 10.3945/ajcn.114.089987. [17] Gasinska A, Gajewska D. Tea and coffee as the main sources of oxalate in diets of patients with kidney oxalate stones[J]. Rocz Panstw Zakl Hig, 2007, 58(1): 61-67. [18] Nile SH, Keum YS, Nile AS, et al. Potential cow milk xanthine oxidase inhibitory and antioxidant activity of selected phenolic acid derivatives[J]. J Biochem Mol Toxicol, 2018, 32(1). DOI: 10.1002/jbt.22005. [19] Eisner BH, Asplin JR, Goldfarb DS, et al. Citrate, malate and alkali content in commonly consumed diet sodas: Implications for Nephrolithiasis Treatment[J]. J Urol, 2010, 183(6): 2419-2423. DOI: 10.1016/j.juro.2010.02.2388. -
