结直肠息肉不同病理类型的危险因素分析
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摘要
目的探讨结直肠息肉不同病理类型的危险因素。方法收集入院体检(包含结肠镜检查)发现结直肠息肉的患者342例,其中腺瘤型息肉172例(腺瘤型息肉组),增生型息肉81例(增生型息肉组)、炎症型息肉89例(炎症型息肉组);同期肠镜检查未见明显异常者628例为对照组。收集性别、年龄、是否吸烟、饮酒、血压、BMI、13C呼气试验结果等资料;检测血清中血糖、血脂、肝功能等代谢相关指标。比较结直肠息肉不同病理类型者与对照组的上述各指标差异。采用多因素logistic回归分析结直肠息肉不同病理类型的危险因素。结果腺瘤型息肉组与对照组性别、吸烟史、饮酒史、年龄、BMI、收缩压、舒张压、ALT、AST、ALP、γ-GT、TG、血糖等比较差异均有统计学意义(均P<0.05);增生型息肉组与对照组性别、吸烟史、饮酒史、BMI、收缩压、舒张压、γ-GT、TG等比较差异均有统计学意义(均P<0.05);炎症型息肉组与对照组吸烟、年龄、BMI、收缩压等比较差异均有统计学意义(均P<0.05)。男性、饮酒是腺瘤型息肉发生的危险因素(P<0.05或0.01),年龄<50岁人群腺瘤型息肉检出率明显低于年龄>50岁的人群(P<0.05);吸烟是增生型和炎症型息肉发生的独立危险因素(均P<0.01)。结论年龄>50岁,有吸烟、饮酒的男性是结直肠息肉(特别是腺瘤型息肉)发病的高危人群。
Objective To explore the risk factors may associated with different pathological types of colorectal polyps. Methods A total of 342 patients with colorectal polys who were admitted for physical examination(contain colonoscopy) were collected, including 172 adenomatous(adenomatous poly group), 81 hyperplastic polyps(hyperplastic polyp group) and 89 inflammations polys( inflammatory polyp group); the Control group involved 628 cases with no abnormality in colonoscopy during the same period. Collect personal data about gender,age, whether smoked or drank, blood pressure, body mass index(BMI) and 13 C Urea Breath Test. The level of blood sugar, lipids, liver function were also tested. Compare the distribution about the above index among controls and different pathological types of colorectal polyps. Using Multivariate logistic regression to analyse the risk of different pathological types of colorectal polyps. Results The gender, age, the prevalence of smoking, drinking, BMI, hypertension, ALT, AST, alkaline phosphatase, γ-GT, triglyceride(TG), blood glucose were all significantly different between the adenomatous poly group and the control group(P<0.05); The gender, the prevalence of smoking, drinking,BMI, hypertension, γ-GT, TG had significantly difference between the hyperplastic polyp group and the control group(P<0.05); The prevalence of smoking, age, BMI, systolic pressure were significantly different between the inflammation group and the control group(P<0.05).Male and drinking were independently risk factors of colorectal adenoma(P<0.05). While the Morbidity for age<50 y is lower than older population(P<0.05); Smoking was the independent risk factor for hyperplastic and inflammatory polyps. Conclusion For male aged 50 or more, had history of smoking or/and drinking was high-risk population of colorectal polyps(especially adenomatous polyp).
Objective To explore the risk factors may associated with different pathological types of colorectal polyps. Methods A total of 342 patients with colorectal polys who were admitted for physical examination(contain colonoscopy) were collected, including 172 adenomatous(adenomatous poly group), 81 hyperplastic polyps(hyperplastic polyp group) and 89 inflammations polys( inflammatory polyp group); the Control group involved 628 cases with no abnormality in colonoscopy during the same period. Collect personal data about gender,age, whether smoked or drank, blood pressure, body mass index(BMI) and 13 C Urea Breath Test. The level of blood sugar, lipids, liver function were also tested. Compare the distribution about the above index among controls and different pathological types of colorectal polyps. Using Multivariate logistic regression to analyse the risk of different pathological types of colorectal polyps. Results The gender, age, the prevalence of smoking, drinking, BMI, hypertension, ALT, AST, alkaline phosphatase, γ-GT, triglyceride(TG), blood glucose were all significantly different between the adenomatous poly group and the control group(P<0.05); The gender, the prevalence of smoking, drinking,BMI, hypertension, γ-GT, TG had significantly difference between the hyperplastic polyp group and the control group(P<0.05); The prevalence of smoking, age, BMI, systolic pressure were significantly different between the inflammation group and the control group(P<0.05).Male and drinking were independently risk factors of colorectal adenoma(P<0.05). While the Morbidity for age<50 y is lower than older population(P<0.05); Smoking was the independent risk factor for hyperplastic and inflammatory polyps. Conclusion For male aged 50 or more, had history of smoking or/and drinking was high-risk population of colorectal polyps(especially adenomatous polyp).
引文
[1]陈万青,郑荣寿.2012年中国恶性肿瘤发病及死亡分析[J].中国肿瘤2016,25(1):2-5.DOI:10.11735/j.issn.1004-0242.2016.01.A004.
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[9]Carmela Di Gregorio,Luca Reggiani Bonetti.Clinical outcome of low-and high-risk malignant colorectal polyps:results of a population-based study and meta-analysis of the available literature[J].Intern Emerg Med,2014,9:151-160.DOI:10.1007/s11739-012-0772-2-Epub 2012 Mar 27.
[10]Hsin-En Huang,Yi-ching Yang,Jin-Shang Wu,et al.The relationship between different glycemic and colon polyps in a Taiwanese population[J].J Gastroenterol,2014,49:1145-1151.DOI:10.1007/s00535-013-0863-5.Epub 2014 Jan 16.
[11]Dagfinn Aune,Doris S.M.Chan.Red and processed meat intake and risk of colorectal adenomas:a systematic review and meta-anaylsis of epidemiological studies[J].Cancer Causes Control,2013,26:611-627.DOI:10.1007/s10552-012-0.19-z.Epub 2013 Feb 5.
[12]Naoko Honma,Ken Yamamoto.Estrogen receptor-βgene polymorphism and colorectal cancer risk:effect modified by body mass index and isoflavone intake[J].Int J Cancer,2013,132(4):951-958 DOI:10.1002/ijc.27688.Epub 2012 Jul 3.
[13]Nam JH,Hong CW,Kim BC,et al.Helicobater pylori infection is an independent risk factor colonic adenomatous neoplasms[J].Cancer Cause Control,2017,28(2):107-115.DOI:10.1007/s10552-016-0839-x.Epub 2016 Dec 27.
[2]汪雯,李辉章,朱陈,等.浙江省2014-2015年度居民癌症风险评估及筛查结果分析[J].浙江医学,2016,38(22):1795-1798.
[3]房静远.关注结直肠腺瘤的诊治研究[J].中华消化杂志,2010,30(7):433-435.DOI:10.3760/cma.j.issn.0254-1432.2010.07.001.
[4]林斌,邢周雄,余璐,等.高脂血症与结直肠息肉相关性的临床分析[J].中华消化杂志,2014,34(1):37-40.DOI:10.3760/cma.j.issn.0254-1432.2014.01.013.
[5]David A.Lieberman,Shiela Prindiville.Risk factors for Advanced Colonic Neoplasia and Hyperplastic polyps in asymptomatic individuals[J].JAMA,2003,290:2959.DOI:10.1001/jama.290.22.2959.
[6]Kim NH,Suh JY,Park JH,et al,Parameter of Glucose and Lipid Metabolism Affect the Occurrence of Colorectal Adenomas Detected by Surveillance Colonscopies[J].YonseiMed J,2017,58(2):347-354.DOI:10.3349/ymj.2017.58.2.347.
[7]Lin CC,Huang KW,Luo JC,et al.Hypertension is an important predictor of recurreent colorectal adenoma after screening colonoscopy with adenoma polypectoy[J].J Chin Med Assoc,2014,77(10):508-512.DOI:10.1016/jcma.2012.03.007.Epub 2014Aug 19.
[8]Nelson F Sanchez,Bryan Stierman,Said Saab,et al.Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population[J].BMC Research Notes,2012,5:312.DOI:10.1186/1756-0500-5-312.
[9]Carmela Di Gregorio,Luca Reggiani Bonetti.Clinical outcome of low-and high-risk malignant colorectal polyps:results of a population-based study and meta-analysis of the available literature[J].Intern Emerg Med,2014,9:151-160.DOI:10.1007/s11739-012-0772-2-Epub 2012 Mar 27.
[10]Hsin-En Huang,Yi-ching Yang,Jin-Shang Wu,et al.The relationship between different glycemic and colon polyps in a Taiwanese population[J].J Gastroenterol,2014,49:1145-1151.DOI:10.1007/s00535-013-0863-5.Epub 2014 Jan 16.
[11]Dagfinn Aune,Doris S.M.Chan.Red and processed meat intake and risk of colorectal adenomas:a systematic review and meta-anaylsis of epidemiological studies[J].Cancer Causes Control,2013,26:611-627.DOI:10.1007/s10552-012-0.19-z.Epub 2013 Feb 5.
[12]Naoko Honma,Ken Yamamoto.Estrogen receptor-βgene polymorphism and colorectal cancer risk:effect modified by body mass index and isoflavone intake[J].Int J Cancer,2013,132(4):951-958 DOI:10.1002/ijc.27688.Epub 2012 Jul 3.
[13]Nam JH,Hong CW,Kim BC,et al.Helicobater pylori infection is an independent risk factor colonic adenomatous neoplasms[J].Cancer Cause Control,2017,28(2):107-115.DOI:10.1007/s10552-016-0839-x.Epub 2016 Dec 27.