| Objective: Retrospective investigation from January 2017 to December 2018 in qinghai province people’s hospital of the hospitalize patients with gallbladder stone disease of basic information and all kinds of preoperative complications,hospitalization expenses,such as clinical data,analysis of the patient’s general situation and hospitalization cost composition and influence factors,for the disease in clinical single diseases after further provide a scientific basis for control of hospitalization expenses and to reduce the length of time;Collected from qinghai province people’s hospital of general surgery Tibetan,han Chinese gall bladder calculi patients and the hospital physical examination center venous blood,Tibetan,han no gall bladder calculi normal by gene sequencing analysis between Tibetan and han people gall bladder calculi disease relation with ABCG5/8 gene single nucleotide polymorphisms,explore the gallbladder calculus disease with genetic differences between ethnic groups.Method:The first part is to collect medical information of patients admitted to the gallbladder stone disease from January 2017 to December 2018 by the Qinghai Provincial Pople’s Hospital HIS(Hospital Management Information System)system and establish an Excel database.The second part is to collect venous blood of Tibetan and Han nationality patients with gallbladder stone from 2018 to 2019 in general surgery department of Qinghai Province People’s Hospital.At the same time,we also collect venous blood of Tibetan and Han nationality populations of the physical examination center without gallstones.To extract whole blood genomic DNA,PCR-RFLP or Taqman MGB probe method is applied to detect ABCG5(Q604E)and ABCG8(T400K Y54 C D19H)four common DNA single polymorphism loci,compare the genotype distribution differences between ethnic groups.All qualified database and test records data were imported into SPSS19.0 software for correlation analysis.All kinds of effective operation factors(age,hospitalization days,whether surgery,etc.)did regression analysis by the non-parameter rank and sum test for single factor analysis,Chi-square test was used to count the data,and P < 0.05 was considered statistically significant.Result: 1.Basic information Qinghai Provincial People’s Hospital received 1903 cases of gallstones from January 2017 to December 2018.After screening,there were 1,644 cases of medical records that met the research requirements of this project.The geographical distribution of patients was mainly in Xining and Haidong city,respectively accounting for 41.79%(687/1644)and 27.92%(459/1644),followed by Hainan and Haibei prefecture,accounting for 7.18%(118/1644)and 6.45%(106/1644)respectively.The patients were mainly aged 41 ~ 60,accounting for 47.12%,the youngest was 13 years old,the oldest was 90 years old and the average age was 52.71±14.83 years old.The majority of ethnic groups are han,hui and Tibetan,accounting for 53.53%(880/1644),22.14%(364/1644)and17.15%(282/1644)respectively.The occupation distribution is mainly farmers,accounting for 35.95%(591/1644).The sex ratio of male to female was 41.00%(674/1644)and 59.00%(970/1644)respectively,the number of females was greater than males.Surgical patients accounted for 71.96%(1,183 cases)and non-surgical patients accounted for 28.04%(461 cases).During the same period,venous blood was collected from Tibetan and Han patients with cholecystolithiasis diagnosed by the department of general surgery of Qinghai Provincial People’s Hospital,and 77 cases were included in the cholelithiasis group.A total of 84 venous blood samples from the normal Tibetan han population without gallbladder stone disease were diagnosed by the physical examination center as the control group.2.Univariate analysis of hospitalization costs The median cost of hospitalization for 1644 patients with gallstone disease was 12,943.25 yuan.There was a statistically significant difference in hospitalization expenses between males and females(Z=-1.972,P=0.049).The highest median hospitalization expenses were 13475.10 yuan for patients aged 61-70 years,and the differences were statistically significant(χ2=43.005,P=0.00 < 0.05).There was no significant difference in hospitalization cost among different ethnic groups,and there was no statistical significance(χ2=6.498,P=0.370).There were significant differences in hospitalization costs between different occupations,with statistical significance(χ2=17.135,P=0.029 < 0.05).There were significant differences among groups on different hospitalization days,with statistical significance(χ2=590.447,P<0.001).The median hospitalization expenses in 2017 and 2018 were 13598.88 yuan and 12312.10 yuan respectively.There was a significant difference in hospitalization expenses in the two years(Z=-5.993,P=0.00 < 0.05).The median hospitalization cost of patients without surgery was 7,664.41 yuan,and the hospitalization cost of patients with open cholecystectomy and laparoscopic cholecystectomy was 16,779.52 yuan and 13,417.86 yuan respectively.The influence of different surgical methods on the hospitalization cost was statistically significant(χ2=505.696,P<0.001).However,the combination of preoperative complications had a significant impact on hospitalization costs,and the difference was statistically significant(Z=-7.479,P < 0.001).3.Cost composition In this study,the hospitalization expenses of patients with cholecystolithiasis included drug expenses,surgery expenses,examination expenses,medical consumables expenses and other expenses.Among the average hospitalization expenses in this two-year,the highest was 3,953.45 yuan,examination expenses accounted for 29.66%,drug expenses followed was 2,676.45 yuan accounted for 20.08% and consumables expenses was 2,251.08 yuan accounted for 16.89%.4.Gall bladder calculi patients and healthy control group comparison: the two ABCG8 gene SNP(T400K)and SNP(Y54C)polymorphism in general comparison between the gallstone group and the control group,using four table chi-square Fisher’s Exact Test found that genotype TK(48.1% VS20.2 %,P < 0.05)and the alleles K(25.3% VS12.5 %,χ2= 8.716,P = 0.003)are significantly higher than the control group,with statistical significance.Genotype YC(26.2%VS44.2%,P < 0.05)and allele Y(27.3% VS17.9 %,χ2 = 4.103,P = 0.043)are significantly higher than the control group,with statistical significance.5.The T400 K and Y54 C polymorphisms of ABCG8 gene were further compared by gender and nationality.The genotype TK(75.0%VS14.3%,χ2=11.059,P=0.001)and allele K(37.5%VS7.1%,χ2=7.693,P=0.006)in male gallstone group were significantly higher than that in male control group with statistical significance.Fisher’s Exact Test found that genotype YC(56.3%VS21.4%,P=0.046)and allele Y(46.9%VS17.9%,χ2=5.658,P=0.017)were significantly higher in male gallstone group than control group,with statistically significant differences.In women,there was no statistically significant difference in allele distribution between the two groups.6.On the whole,the T400 K and Y54 C polymorphisms of ABCG8 gene were compared among ethnic groups.The genotype TK(60.0%VS16.7%,χ2=10.370,P=0.001)and allele K(30.0%VS8.3%,χ2=7.718,P=0.005)in the middle gallstone group of the han nationality were significantly higher than those in the control group,showing statistical significance.7.On the whole,the T400 K and Y54 C polymorphisms of ABCG8 gene were compared among ethnic groups.The genotype TK(60.0%VS16.7%,χ2=10.370,P=0.001)and allele K(30.0%VS8.3%,χ2=7.718,P=0.005)in the middle gallstone group of the han nationality were significantly higher than those in the control group,showing statistical significance.Conclusion: 1.The regional distribution of gallstone disease in Qinghai area is mainly Xining and Haidong city.The youngest is 13 years old and the oldest is 90 years old.The average age is 52.71 ± 14.83 years old.The proportion of female patients is higher than that of men,women accounted for 59.00%.Han nationality ranked fist at 53.53%,Tibetans ranked third at 17.15%.Occupational distribution was mainly farmers accounting for 35.95%.2.Among the hospitalization expenses of patients with cholecystolithiasis in qinghai region,the examination expenses account for the highest proportion,and the drug expenses and medical consumables expenses are also the main components.3.ABCG8 T400 K and Y54 C in Qinghai area may be two genetic markers of gallstone disease in Han men.Han male populations carrying these two alleles may have a higher risk of developing gallstone disease.4.There are no differences in the distribution of single nucleotide polymorphisms of ABCG5 gene Q604 E and ABCG8 genes T400 K,Y54C,and D19 H among Tibetan and Han patients with gallbladder stones in Qinghai area,but further increase in sample size and multi-center studies are needed to confirm.5.There were no differences in the distribution of ABCG5(Q604E)and ABCG8(T400K,Y54 C,D19H)in these four common loci among Tibetans in Qinghai area.The mutation site of D19 H of ABCG8 gene may be rare in Tibetan and Han populations in Qinghai region. |
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