结直肠腺瘤性息肉发病的危险因素分析

doi:10.3760/cma.j.cn101202-20210104-00003

摘要
图/表
参考文献(24)
相关文章 (6)

全文: PDF (861 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨结直肠腺瘤性息肉发病的危险因素。方法回顾性病例对照研究。纳入2018年1月—2019年12月皖西卫生职业学院附属医院消化内科内镜中心行肠镜检查及摘除结直肠息肉的患者780例,其中男492例(63.1%)、女288例(36.9%),年龄9～93(56.86±12.65)岁。根据息肉的病理诊断结果分为腺瘤组540例和非腺瘤组240例。比较两组患者的临床特征(年龄、性别、腹部临床表现)、内镜特征以及病理表现(结直肠息肉的数目、大小、位置、息肉蒂情况、分叶情况及息肉上皮内瘤变情况),将有统计学差异的指标进一步纳入多因素logistic回归分析。结果腺瘤组患者的平均发病年龄、便血和腹痛的发生率均高于非腺瘤组,差异均有统计学意义(P值均＜0.05);腺瘤组中存在息肉直径≥1 cm、息肉数目≥3枚、息肉带蒂、息肉分叶、高低级别上皮内瘤变及上皮癌变等的患者占比均高于非腺瘤组,差异均有统计学意义(P值均＜0.05)。进一步多因素logistic回归分析显示,年龄≥70岁[比值比(OR)=1.772, 95%置信区间(CI)=1.333~2.770, P＜0.05]、便血(OR=1.290, 95% CI 1.015~1.637, P＜0.05)、腹痛(OR=1.732, 95% CI 1.207~2.483, P＜0.05)、息肉数目≥3枚(OR=0.390, 95% CI 0.202~0.753, P＜0.05)、息肉直径≥1cm(OR=0.604, 95 CI 0.383~0.952, P＜0.05)、息肉有蒂(带蒂和亚蒂)(OR=2.779, 95% CI 1.511~5.112, P＜0.05)和息肉存在高、低级别上皮内瘤变或癌变(OR=0.599, 95% CI 0.373~0.960, P＜0.05)是结直肠腺瘤性息肉发病的危险因素。结论腺瘤性息肉易发生上皮内瘤变及癌变,高龄 (≥70岁)、便血、腹痛,结直肠息肉数目≥3枚、直径≥1cm以及息肉有蒂的患者患结直肠腺瘤可能性较大。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	朱贞祥
	程桐花
	刘术松
	沈瑞雪
	苏磊
	朱运超

关键词 ：腺瘤性息肉, 肠息肉, 内镜检查术, 危险因素, logistic模型

Abstract：Objective To investigate the risk factors of colorectal adenomatous polyps.Methods A retrospective case-control study was performed on 780 patients with colorectal polyps who underwent colonoscopic resection from January 2018 to December 2019 at the Department of Gastroenterology of the Affiliated Hospital of West Anhui Health Vocational College. The patients comprised 492 males (63.1%) and 288 females (36.9%) aged 9-93 (56.86±12.65) years old. According to the pathological diagnosis of polyps, the patients were divided into adenomatous polyps group (n=540) and non-adenomatous polyps group (n=240). First, the clinical and endoscopic characteristics(age, sex, abdominal clinical manifestations, number, size and location of colorectal polyps, pedicle and lobulation of polyps and intraepithelial neoplasia)of the two groups were compared. Then, the indicators with statistical differences were included in multivariate logistic regression analysis.Results The average age, incidence of hematochezia, and incidence of stomachache of patients with adenomatous polyps were higher than those of patients with non-adenomatous polyps (all P values＜0.05). In addition, patients with adenomatous polyps had polyp diameter ≥1 cm, ≥3 polyps, obvious polyp pedicle, lobulation and canceration, and significantly higher change rates to low- and high-level intraepithelial neoplasia than patients with non-adenomatous polyps (all P values＜0.05). Logistic regression analysis showed that age ≥70 years old (odds ratio [OR]=1.772, 95% confidence interval(CI) 1.133-2.770, P＜0.05), hematochezia (OR=1.290, 95% CI 1.015-1.637, P＜0.05), stomachache (OR=1.732, 95% CI 1.207-2.483, P＜0.05), ≥3 polyps (OR=0.390, 95% CI 0.202-0.753, P＜0.05), polyp diameter ≥ 1 cm (OR=0.604, 95% CI 0.383-0.952, P＜0.05), obvious polyp pedicle (OR=2.779, 95% CI 1.511-5.112, P＜0.05), and the incidence of canceration and low- and high-level intraepithelial neoplasia were risk factors of colorectal polyps (OR=0.599, 95% CI 0.373-0.960, P＜0.05).Conclusions Adenomatous polyps are prone to develop into intraepithelial neoplasia and cancer. Patients with old age (age ≥ 70 years old), hematochezia, stomachache, ≥3 polyps, polyp diameter ≥ l cm, and obvious polyp pedicle can easily develop colorectal adenoma.

Key words： Adenomatous polyps Intestinal polyps Endoscopy Risk factor Logistic models

收稿日期: 2021-01-04

基金资助:安徽省高校自然科学重点研究项目(KJ2018A0960)

通讯作者: 朱贞祥,Email: 245439060@qq.com

引用本文:

朱贞祥, 程桐花, 刘术松, 沈瑞雪, 苏磊, 朱运超. 结直肠腺瘤性息肉发病的危险因素分析[J]. 中华解剖与临床杂志, 2021, 26(4): 470-474.
Zhu Zhenxiang, Cheng Tonghua, Liu Shusong, Shen Ruixue, Su Lei, Zhu Yunchao. Risk factors for colorectal adenomatous polyps. Chinese Journal of Anatomy and Clinics, 2021, 26(4): 470-474.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210104-00003 或 http://www.cjac.com.cn/CN/Y2021/V26/I4/470

[1]	Dubé C, Yakubu M, McCurdy BR, et al. Risk of advanced adenoma, colorectal cancer, and colorectal cancer mortality in people with low-risk adenomas at baseline colonoscopy: a systematic review and meta-analysis[J]. Am J Gastroenterol, 2017, 112(12): 1790-1801. DOI:10.1038/ajg.2017.360.
[2]	Wolf A, Fontham E, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society[J]. CA Cancer J Clin, 2018, 68(4): 250-281. DOI:10.3322/caac.21457.
[3]	Derry MM, Raina K, Balaiya V, et al. Grape seed extract efficacy against azoxymethane-induced colon tumorigenesis in A/J mice: interlinking miRNA with cytokine signaling and inflammation[J]. Cancer Prev Res (Phila), 2013, 6(7): 625-633. DOI:10.1158/1940-6207.CAPR-13-0053.
[4]	Hawkins NJ, Bariol C, Ward RL. The serrated neoplasia pathway[J]. Pathology, 2002, 34(6): 548-555.
[5]	刘彤华. 刘彤华诊断病理学[M]. 4版. 北京: 人民卫生出版社, 2018: 77-78.
	Liu TH. Liu Tonghua diagnostic pathology[M]. 4th ed. Beijing: People's Health Publishing House,2018:77-78.
[6]	Dano H, Baldin P, Demetter P, et al. Guidelines for an optimal management of a malignant colorectal polyp. What is essential in a pathology report ?[J]. Acta Gastroenterol Belg, 2020, 83(1): 53-59.
[7]	Sakamoto T, Matsuda T, Nakajima T, et al. Clinicopathological features of colorectal polyps: evaluation of the ‘predict, resect and discard’ strategies[J]. Colorectal Dis, 2013, 15(6): e295-e300. DOI:10.1111/codi.12210.
[8]	Niikura R, Hirata Y, Suzuki N, et al. Colonoscopy reduces colorectal cancer mortality: a multicenter, long-term, colonoscopy-based cohort study[J]. PLoS One, 2017, 12(9): e0185294. DOI:10.1371/journal.pone.0185294.
[9]	Kahi CJ, Pohl H, Myers LJ, et al. Colonoscopy and colorectal cancer mortality in the veterans affairs health care system: a case-control study[J]. Ann Intern Med, 2018, 168(7): 481-488. DOI:10.7326/M17-0723.
[10]	Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline[J]. Endoscopy, 2017, 49(3): 270-297. DOI:10.1055/s-0043-102569.
[11]	代珍, 郑荣寿, 邹小农, 等. 中国结直肠癌发病趋势分析和预测[J]. 中华预防医学杂志, 2012, 46 (7): 598-603. DOI:10.3760/cma.j.issn.0253-9624.2012.07.005.
	Dai Z, Zheng RS, Zou XN, et al. Trend analysis and prediction of colorectal cancer in China[J]. Chin J Prevent Med, 2012, 46(7): 598-603. DOI:10.3760/cma.j.issn.0253-9624.2012.07.005.
[12]	Alatise OI, Ayandipo OO, Adeyeye A, et al. A symptom-based model to predict colorectal cancer in low-resource countries: results from a prospective study of patients at high risk for colorectal cancer[J]. Cancer, 2018,124(13):2766-2773. DOI: 10.1002/cncr.31399.
[13]	刘术松, 胡乃中. 563例结直肠息肉临床内镜病理分析[J]. 安徽医学, 2012, 33(4): 441-443. DOI:10.3969/j.issn.1000-0399.2012.04.022.
	Liu SS, Hu NZ. Clinical analysis of 563 cases colorectal polyps[J]. Anhui Medical Journal, 2012, 33(4): 441-443. DOI:10.3969/j.issn.1000-0399.2012.04.022.
[14]	Long X, Li X, Ma L, et al. Clinical and endoscopic-pathological characteristics of colorectal polyps: an analysis of 1,234 cases[J]. Int J Clin Exp Med, 2015, 8(10): 19367-19373.
[15]	De Rosa M, Pace U, Rega D, et al. Genetics, diagnosis and management of colorectal cancer (Review)[J]. Oncol Rep, 2015, 34(3): 1087-1096. DOI:10.3892/or.2015.4108.
[16]	Han X, Qian W, Liu Y, et al. Effect of age, sex and pathologic type on risk of multiple polyps in a Chinese teaching hospital based study[J]. J Dig Dis, 2020, 21(9): 505-511. DOI:10.1111/1751-2980.12863.
[17]	Jia W, Rajani C, Xu H, et al. Gut microbiota alterations are distinct for primary colorectal cancer and hepatocellular carcinoma[J]. Protein Cell, 2021, 12(5):374-393. DOI:10.1007/s13238-020-00748-0.
[18]	Robrahn L, Jiao L, Cramer T. Barrier integrity and chronic inflammation mediated by HIF-1 impact on intestinal tumorigenesis[J]. Cancer Lett, 2020, 490: 186-192. DOI:10.1016/j.canlet.2020.07.002.
[19]	Provenzale D, Gupta S, Ahnen DJ, et al. NCCN guidelines insights: colorectal cancer screening, version 1.2018[J]. J Natl Compr Canc Netw, 2018, 16(8): 939-949. DOI:10.6004/jnccn.2018.0067.
[20]	Lee K, Kim YH. Colorectal polyp prevalence according to alcohol consumption, smoking and obesity[J]. Int J Environ Res Public Health, 2020, 17(7): 2387. DOI:10.3390/ijerph17072387.
[21]	Segev L, Kalady MF, Plesec T, et al. The location of premalignant colorectal polyps under age 50: a further rationale for screening sigmoidoscopy[J]. Int J Colorectal Dis, 2020, 35(3): 529-535. DOI:10.1007/s00384-020-03504-2.
[22]	Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society[J]. CA Cancer J Clin, 2006, 56(3): 143-159. DOI:10.3322/canjclin.56.3.143.
[23]	Levine JS, Ahnen DJ. Clinical practice. Adenomatous polyps of the colon[J]. N Engl J Med, 2006, 355(24): 2551-2557. DOI:10.1056/NEJMcp063038.
[24]	陈宏达, 卢明, 代敏. 我国结直肠癌人群筛查参与率现状及影响因素探讨[J]. 华西医学, 2018, 33(12): 1455-1459. DOI:10.7507/1002-0179.201812094.
	Chen HD, Lu M, Dai M. Current status of participation rate in population-based colorectal cancer screening programs in China and its associated factors[J]. West China Medicine, 2018, 33(12): 1455-1459. DOI:10.7507/1002-0179.201812094.