Characteristics of colorectal polyps in 463 patients with chronic constipation and its correlation with Traditional Chinese Medicine deficiency and excess syndrome
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摘要: 目的 探讨463例慢性便秘患者结直肠息肉的发病特点及其与中医虚实证候的相关性。方法 收集2015年1月-2020年11月期间就诊于首都医科大学附属北京中医医院消化中心，诊断为慢性便秘并行电子结肠镜检查患者的临床资料，回顾性分析结直肠息肉的内镜特点、病理性质以及与中医虚实证候的相关性。结果 ①息肉检出情况：共纳入慢性便秘患者463例，检出息肉者221例(检出息肉371枚)，息肉总检出率为47.73%，单发息肉100例，多发息肉121例；完善病理检查221枚，其中腺瘤性息肉96枚，非腺瘤性息肉125枚，腺瘤性息肉占43.44%。②腺瘤性息肉的发病特点：腺瘤性息肉的检出率男性(47.06%)高于女性(40.34%)，老年(49.67%)高于中年(32.69%)和青年(22.22%)，右半结肠(51.85%)高于左半结肠(38.57%)，多发息肉(49.59%)高于单发息肉(36.00%)，腺瘤性息肉的直径(5.15±3.40) mm大于非腺瘤性息肉(3.80±2.49) mm。③中医虚实证候与结直肠息肉的相关性：463例慢性便秘患者中医辨证为虚证者152例，实证者311例，实证患者比例较高，但虚证便秘患者息肉检出率为53.95%，病理类型为腺瘤性息肉的比例为58.54%，均较实证更高。结论 慢性便秘虚证患者较实证患者肠镜检查发现结直肠息肉和腺瘤性息肉的概率可能更高，且腺瘤性息肉发生与患者性别、年龄、息肉位置、是否为多发和息肉大小存在一定相关性。Abstract: Objective To investigate the characteristics of colorectal polyps in 463 patients with chronic constipation and their correlation with Traditional Chinese Medicine(TCM) patterns of deficiency and excess.Methods Clinical data were collected from patients diagnosed with chronic constipation who underwent colonoscopy at the Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, between January 2015 and November 2020. A retrospective analysis was performed on the endoscopic features of colorectal polyps, pathological nature, and their correlation with TCM patterns of deficiency and excess.Results ① Polyp detection: a total of 463 patients with chronic constipation were included, among whom 221 patients(with 371 polyps) were diagnosed with polyps, resulting in an overall detection rate of 47.73%. There were 100 cases of solitary polyps and 121 cases of multiple polyps. Pathological examination was completed for 221 polyps, including 96 adenomatous polyps and 125 non-adenomatous polyps, with an adenomatous polyp rate of 43.44%. ② Characteristics of adenomatous polyps: the detection rate of adenomatous polyps was higher in males(47.06%) than in females(40.34%), higher in the elderly(49.67%) than in middle-aged(32.69%) and young patients(22.22%), higher in the right colon(51.85%) than in the left colon(38.57%), higher in multiple polyps(49.59%) than in solitary polyps(36.00%), and adenomatous polyps had a larger diameter(5.15±3.40) mm compared to non-adenomatous polyps(3.80±2.49) mm. ③Correlation between TCM deficiency and excess patterns and colorectal polyps: among the 463 patients with chronic constipation, 152 were diagnosed with deficiency pattern according to TCM differentiation, while 311 were diagnosed with excess pattern. The proportion of patients with excess pattern was higher. However, the polyp detection rate in patients with deficiency pattern constipation was 53.95%, and the proportion of adenomatous polyps was 58.54%, both of which were higher than those in patients with excess pattern.Conclusion Patients with deficiency pattern of chronic constipation may have a higher probability of detecting colorectal polyps and adenomatous polyps during colonoscopy compared to patients with excess pattern. The occurrence of adenomatous polyps is correlated with patient's gender, age, polyp location, multiplicity, and size.
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表 1 慢性便秘患者结肠息肉病理性质与人口学特征的关系
例(%) 人口学特征 腺瘤性息肉(n=96) 非腺瘤性息肉(n=125) χ2 P 性别 8.891 0.003 男 48(47.06) 54(52.94) 女 48(40.34) 71(59.66) 年龄/岁 8.127 0.017 青年(＜45) 4(22.22) 14(77.78) 中年(45~59) 17(32.69) 35(67.31) 老年(＞59) 75(49.67) 76(50.33) 
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表 2 慢性便秘患者结肠息肉病理性质与内镜下特点的关系
例(%)，枚(%)，X±S 内镜下特点 腺瘤性息肉(n=96) 非腺瘤性息肉(n=125) χ2/t P 部位/枚 3.683 0.045 左半结肠 54(38.57) 86(61.43) 右半结肠 42(51.85) 39(48.15) 形态/枚 1.385 0.239 无蒂 65(43.62) 84(56.38) 有蒂 11(57.89) 8(42.11) 数量/例 4.114 0.043 单发 36(36.00) 64(64.00) 多发 60(49.59) 61(50.41) 直径/mm 5.15±3.40 3.80±2.49 3.407 ＜0.001
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表 3 慢性便秘患者中医证候与结肠息肉内镜和病理特点的关系
例(%)，枚(%)，X±S 息肉特点 虚证 实证 χ2/t P 息肉检出情况/例 3.504 0.038 检出息肉 82(53.95) 139(44.69) 未检出息肉 70(46.05) 172(55.31) 部位/枚 0.173 0.677 左半结肠 61(61.62) 174(63.97) 右半结肠 38(38.38) 98(36.03) 形态/枚 0.431 0.511 无蒂 42(91.30) 107(87.70) 有蒂 4(8.70) 15(12.30) 数量/例 0.750 0.386 单发 30(50.00) 70(43.48) 多发 30(50.00) 91(56.52) 直径/mm 4.14±2.70 4.51±3.09 1.111 0.268 病理类型/枚 12.095 0.001 腺瘤性 48(58.54) 48(34.53) 非腺瘤性 34(41.46) 91(65.47)
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