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摘要: 目的 探讨结直肠管状绒毛状腺瘤发生的相关危险因素。方法 将2022年4月—2023年4月于江苏省中医院消化内镜中心住院接受结肠镜下息肉治疗，并经内镜下手术所取标本病理确诊的228例患者纳为研究对象，其中管状腺瘤患者131例，管状绒毛状腺瘤患者97例，通过单因素分析比较两组间年龄、性别、吸烟史、饮酒史、肠癌家族史、BMI、高血压、糖尿病、高脂血症、病变部位、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、尿素、肌酐、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白方面的差异，并通过二分类logistic回归分析明确结直肠管状绒毛状腺瘤发生的危险因素。结果 在单因素分析中，两组的年龄、性别、吸烟史、饮酒史、BMI、高血压、糖尿病、高脂血症、血清学指标比较均差异无统计学意义(均P>0.05)；两组在是否有肠癌家族史、病变部位是否在肝曲、横结肠和降结肠比较中差异有统计学意义(P<0.05)；年龄作为危险因素差异有统计学意义，通过二分类logistic分析显示，肠癌家族史(OR=7.838，95%CI：2.205~27.859，P=0.001)、年龄(OR=1.032，95%CI：1.003~1.062，P=0.031)、病变部位在横结肠(OR=0.277，95%CI：0.092~0.836，P=0.023)与结直肠管状绒毛状腺瘤的发生有关。结论 患者的年龄、有无肠癌家族史和病变部位为横结肠是结直肠管状绒毛状腺瘤发生的相关危险因素，应对病理类型为结直肠管状绒毛状腺瘤患者的降结肠、肝曲在行肠镜检查过程中加强关注。Abstract: Objective To explore the relevant risk factors for the occurrence of colonic villous adenoma.Methods Two hundred and twenty-eight patients who underwent colonoscopic polyp treatment at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Traditional Chinese Medicine from April 2022 to April 2023 and were pathologically confirmed through endoscopic surgery were included in this study. Among them, 131 patients with tubular adenoma and 97 patients with tubular villous adenoma were compared between the two groups in terms of age, gender, smoking history, drinking history, family history of bowel cancer, BMI, hypertension, diabetes, hyperlipidemia, lesion site, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol Differences in glycosylated hemoglobin were identified through binary logistic regression analysis to identify risk factors for the development of colorectal villous adenoma.Results In the univariate analysis, there was no significant difference between the two groups in age, sex, smoking history, drinking history, BMI, hypertension, diabetes, hyperlipidemia, and serological indicators(P>0.05); there was a statistically significant difference(P<0.05) between the two groups in whether they had a family history of colon cancer and whether the lesion was located in the liver curvature, transverse colon, and descending colon; there is a statistically significant difference in age as a risk factor. Through binary logistic analysis, it was found that a family history of colorectal cancer(OR=7.838, 95%CI: 2.205-27.859, P=0.001), age(OR=1.032, 95%CI: 1.003-1.062, P=0.031), and lesion location in the transverse colon(OR=0.277, 95%CI: 0.092-0.836, P=0.023) are associated with the occurrence of colorectal tubular villous adenoma.Conclusion The age of the patient, family history of colorectal cancer, and the location of the lesion in the transverse colon are related risk factors for the occurrence of colorectal tubular villous adenoma; Moreover, it is necessary to strengthen attention during the colonoscopy examination of patients with colorectal villous adenoma and liver curvature.
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Key words:
- colorectal polyps /
- tubular adenoma /
- tubular villous adenoma /
- metabolic syndrome /
- risk factors
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表 1 两组患者的年龄分布情况
例(%) 年龄/岁 管状腺瘤组
(n=131)管状绒毛状腺瘤组
(n=97)合计 21~30 2(0.88) 1(0.44) 3(1.32) >30~40 6(2.63) 4(1.75) 10(4.39) >40~50 17(7.46) 8(3.51) 25(10.96) >50~60 52(22.81) 34(14.91) 86(37.72) >60~70 44(19.30) 34(14.91) 78(34.21) >70 10(4.39) 16(7.02) 26(11.40) 
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表 2 不同类型结直肠腺瘤患者的危险因素单因素分析
X±S，例(%)，M(P25，P75) 危险因素 管状腺瘤组(n=131) 管状绒毛状腺瘤组(n=97) t/χ2 P 年龄/岁 57.73±10.25 60.77±10.98 -2.210 0.394 性别 男 85(64.89) 60(61.86) 0.221 0.638 女 46(35.11) 37(38.14) 高血压 0.185 0.667 有 49(37.40) 39(40.21) 无 82(62.60) 58(59.79) 糖尿病 0.041 0.840 有 16(12.21) 11(11.34) 无 115(87.79) 86(88.66) 高脂血症 0.074 0.785 有 15(11.45) 10(10.31) 无 116(88.55) 87(89.69) 吸烟史 -0.001 0.999 有 27(20.61) 20(20.62) 无 104(79.39) 77(79.38) 饮酒史 -0.855 0.392 有 20(15.27) 19(19.59) 无 111(84.73) 78(80.41) 肠癌家族史 8.233 0.004 有 5(3.82) 14(14.43) 无 126(96.18) 83(85.57) BMI 25.57±3.16 24.23±3.02 0.632 0.616 AST/(U/L) 19.00(14.00，26.00) 19.00(15.00，24.00) -0.102 0.919 ALT/(U/L) 19.00(15.00，24.00) 17.00(12.50，24.50) -1.695 0.090 Ure/(mmol/L) 5.11(4.37，6.25) 5.30(4.48，6.12) -0.339 0.734 Cr/(μmmol/L) 69.35(61.00，80.02) 67.40(60.00，81.85) -0.308 0.758 TC/(mmol/L) 4.50±8.99 4.65±1.02 -0.577 0.595 TG/(mmol/L) 1.50(1.01，2.10) 1.29(0.93，1.99) -1.453 0.146 HDL-C/(mmol/L) 1.19(1.01，1.42) 1.27(1.05，1.47) -1.765 0.078 LDL-C/(mmol/L) 2.57±0.77 2.68±0.81 -0.819 0.211 HbA1c/% 5.80(5.50，6.10) 5.70(5.40，6.00) -0.707 0.480
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表 3 不同类型结直肠腺瘤病变部位分析
处(%) 病变部位 管状腺瘤组(234处) 管状绒毛状腺瘤组(105处) Z P 肝曲 26(11.11) 2(1.90) -4.037 < 0.01 横结肠 46(19.66) 8(7.62) -4.707 < 0.01 回盲部 14(5.98) 6(5.71) -1.185 0.236 降结肠 27(11.54) 3(2.86) -3.860 < 0.01 降乙交界 0 1(0.95) -1.162 0.245 盲肠 1(0.43) 1(0.95) -0.214 0.831 脾曲 2(0.85) 3(2.86) -0.797 0.426 升结肠 32(13.68) 16(15.24) -1.449 0.147 乙状结肠 63(26.92) 36(34.29) -1.650 0.099 直肠 20(8.55) 23(21.90) -1.608 0.108 直乙交界 3(1.28) 6(5.71) -1.490 0.136
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表 4 危险因素二分类logistic回归分析
影响因素 β SE Wald χ2 P OR 95%CI 年龄 0.032 0.015 4.627 0.031 1.032 1.003~1.062 肠癌家族史 2.059 0.647 10.128 0.001 7.838 2.205~27.859 病变部位在肝曲 -2.787 1.626 2.936 0.087 0.062 0.003~1.493 病变部位在横结肠 -1.283 0.563 5.189 0.023 0.277 0.092~0.836 病变部位在降结肠 1.132 1.526 0.550 0.458 3.102 0.156~61.743 常量 -1.975 0.898 4.840 0.028 0.139
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