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非酒精性脂肪性肝病与结直肠腺瘤性息肉的相关性分析
Association between nonalcoholic fatty liver disease and colorectal adenomatous polyps
文章发布日期:2020年06月01日  来源:  作者:钏莉雪,常江,赵锦涵,等  点击次数:173次  下载次数:36次

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【摘要】:目的 探讨非酒精性脂肪性肝病(NAFLD)与结 直肠腺瘤性息肉的相关性及NAFLD严重程度与结直肠腺瘤性息肉发生风险的关系。方法选取2019年3月-2019年8月在昆明医科大学第二附属医院消化内科住院的结直肠腺瘤性息肉患者67例为腺瘤组,另选取同期就诊的结肠镜检查正常或病理学检查为炎性、增生性息肉者45例为对照组。比较2组基线资料及肝受控衰减参数(CAP)的差异。根据FibroTouch检测结果将所有研究对象分为无脂肪肝组及轻度、中度、重度NAFLD组,分析NAFLD严重程度与结直肠腺瘤性息肉发病风险的关系。正态分布的计量资料两组间比较采用t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。非正态分布的计量资料两组间比较采用 Mann-Whitney U检验;多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Nemenyi法。计数资料组间比较采用χ2检验。采用logistic回归分析结直肠腺瘤的危险因素。结果 腺瘤组中男性(51.11% vs 73.13%,χ2=5.687,P=0.017)、年龄[(56.24±12.44)岁vs(50.84±11.49)岁,t=-2.319,P=0.022]、BMI[(24.69±3.36)kg/m2 vs(22.54±3.31)kg/m2,t=-3.346,P=0.001]、腰围[(89.45±10.51)cm vs(83.44±10.30)cm,t=-2.753,P=0.007]、收缩压[(128.78±16.92)mm Hg vs(117.00±15.91)mm Hg,t=-3.698,P<0.001]、ALT[24.00(18.00~40.00)U/L vs 22.00(16.00~29.00)U/L,Z=-1.957,P=0.022]、TC[(4.73±0.96)mmol/L vs(4.27±0.90)mmol/L,t=-2.537,P=0.013]、LDL[(2.92±0.78)mmol/L vs(2.59±0.68)mmol/L,t=-2.295,P=0.024]、CAP[(257.51±34.22)dB/m vs(238.67±33.44)dB/m,t=-2.789,P=0.006]均高于对照组。logistic回归分析结果显示,年龄[比值比(OR)=1.054,95%可信区间(95%CI):1.009~1.102,P=0.019]、BMI(OR=1.191,95%CI:1.026~1.382,P=0.021)、LDL(OR=2.058,95%CI:1.034~4.097,P=0.040)、ALT(OR=1.038,95%CI:1.008~1.070,P=0.013)、CAP(OR=1.320,95%CI:1.163~1.481,P=0.001)为结直肠腺瘤性息肉的独立危险因素。NAFLD组结直肠腺瘤性息肉[重度组19例(73.08%)、中度组19例(73.08%)、轻度组14例(53.85%)vs 11例(40.74%),χ2=8.088,P=0.040]高于无脂肪肝组。logistic回归分析结果显示,在模型1、2中,中度NAFLD(OR值分别为1.044、1.011,95%CI分别为1.007~1.083、1.001~1.022,P值分别为0.019、0.033)、重度NAFLD(OR值分别为1.183、1.129,95%CI分别为1.034~1.354、1.030~1.236,P值分别为0.015、0.009)是结直肠腺瘤性息肉危险因素;在模型3中,校正年龄、性别、BMI、吸烟史、高血压、糖尿病、尿酸、TG、LDL、ALT后,重度NAFLD(OR=1.078,95%CI:1.023~1.136,P=0.005)仍是结直肠腺瘤性息肉发病的危险因素。结论 NAFLD是结直肠腺瘤性息肉发生的独立危险因素,NAFLD严重程度越高,结直肠腺瘤性息肉发生风险越高。因此,建议NAFLD患者,特别是重度NAFLD患者定期行结肠镜检查,以早期发现、早期治疗结直肠腺瘤性息肉,最终降低我国结直肠肿瘤发病率及死亡率。
【Abstract】:Objective To investigate the association between nonalcoholic fatty liver disease (NAFLD) and colorectal adenomatous polyps and the correlation of NAFLD severity with the risk of colorectal adenomatous polyps. Methods A total of 67 patients with colorectal adenomatous polyps who were hospitalized in Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, from March to August 2019 were enrolled as adenoma group, and 45 patients who attended our hospital during the same period of time and had normal results of colonoscopy or were diagnosed with inflammatory and proliferative polyps based on pathology were enrolled as control group. The two groups were compared in terms of baseline data and controlled attenuation parameter (CAP) of the liver. All subjects were divided into non-fatty liver group and mild, moderate, and severe NAFLD groups according to FibroTouch, and the correlation of the severity of NAFLD with the risk of colorectal adenomatous polyps was analyzed. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. For non-normally distributed continuous data, the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Nemenyi method was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the risk factors for colorectal adenoma. ResultsCompared with the control group, the adenoma group had significantly higher proportion of male patients [49 (73.13%) vs 23 (51.11%), χ2=5.687, P=0.017], age (56.24±12.44 years vs 50.84±11.49 years, t=-2.319, P=0.022), body mass index (BMI) (24.69±3.36 kg/m2 vs 22.54±3.31 kg/m2, t=-3.346, P=0.001), waist circumference (89.45±10.51 cm vs 83.44±10.30 cm, t=-2.753, P=0.007), systolic pressure (128.78±16.92 mmHg vs 117.00±15.91 mmHg, t=-3.698, P<0.001), alanine aminotransferase (ALT) [24.00 (18.00~40.00) U/L vs 22.00 (16.00~29.00) U/L, Z=-1.957, P=0.022], total cholesterol (TC) (4.73±0.96 mmol/L vs 4.27±0.90 mmol/L, t=-2.537, P=0.013), low-density lipoprotein (LDL) (2.92±0.78 mmol/L vs 2.59±0.68 mmol/L, t=-2.295, P=0.024), and CAP (257.51±34.22 dB/m vs 238.67±33.44 dB/m, t=-2.789, P=0.006). The logistic regression analysis showed that age (odds ratio [OR]=1.054, 95% confidence interval [CI]: 1.009-1.102, P=0.019), BMI (OR=1.191, 95% CI: 1.026-1.382, P=0.021), LDL (OR=2.058, 95% CI: 1.034-4.097, P=0.040), ALT (OR=1.038, 95% CI: 1.008-1.070, P=0.013), and CAP (OR=1.320, 95% CI: 1.163-1.481, P=0.001) were independent risk factors for colorectal adenomatous polyps. The severe, moderate, and mild NAFLD groups had a significantly higher proportion of patients with colorectal adenomatous polyps than the non-fatty liver group [73.08% (19 patients)/73.08% (19 patients)/53.85% (14 patients) vs 40.74% (11 patients), χ2=8.088, P=0.040]. The logistic regression analysis showed that in the models 1 and 2, moderate NAFLD (model 1: OR=1.044, 95%CI: 1.007-1.083, P=0.019; model 2: OR=1.011, 95%CI: 1.001-1.022, P=0.033) and severe NAFLD (model 1: OR=1.183, 95%CI: 1.034-1.354, P=0.015; model 2: OR=1.129, 95%CI: 1.030-1.236, P=0.009) were risk factors for colorectal adenomatous polyps. In model 3, after adjustment for age, sex, BMI, smoking history, hypertension, diabetes mellitus, uric acid, triglyceride, LDL, and ALT, severe NAFLD (OR=1.078, 95%CI: 1.023-1.136, P=0.005) was still a risk factor for colorectal adenomatous polyps. Conclusion NAFLD is an independent risk factor for colorectal adenomatous polyps, and patients with higher severity of NAFLD tend to have a higher risk of colorectal adenomatous polyps. Therefore, NAFLD patients, especially those with severe NAFLD, should undergo regular colonoscopy for early identification and treatment of colorectal adenomatous polyps, so as to eventually reduce the incidence rate and mortality rate of colorectal tumor in China.
【关键字】:非酒精性脂肪性肝病; 结肠腺瘤息肉病; 危险性评估
【Key words】:non-alcoholic fatty liver disease; adenomatous polyposis coli; risk assessment
【引证本文】:CHUAN LX, CHANG J, ZHAO JH, et al. Association between nonalcoholic fatty liver disease and colorectal adenomatous polyps[J]. J Clin Hepatol, 2020, 36(6): 1299-1303. (in Chinese)
钏莉雪, 常江, 赵锦涵, 等. 非酒精性脂肪性肝病与结直肠腺瘤性息肉的相关性分析[J]. 临床肝胆病杂志, 2020, 36(6): 1299-1303.

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