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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2021, Vol. 08 ›› Issue (02) : 61 -67. doi: 10.3877/cma.j.issn.2095-7157.2021.02.004

所属专题： 文献；

论著

进展期结直肠腺瘤及高危腺瘤的危险因素分析
雷甜甜1, 刘家欢2, 黄虹玉2, 杨锦林2, 马洪升1,†()   
  1. 1. 610041　成都，四川大学华西医院日间手术中心
    2. 610041　成都，四川大学华西医院消化内科，四川大学-牛津大学华西消化道肿瘤联合研究中心
  • 收稿日期:2020-09-25 出版日期:2021-05-15
  • 通信作者: 马洪升
  • 基金资助:
    四川省科技计划资助(2019JDRC0021); 四川省科技计划资助(2020YFS0237)

Analysis of risk factors for advanced colorectal adenoma and high-risk adenoma

Tiantian Lei1, Jiahuan Liu2, Hongyu Huang2, Jinlin Yang2, Hongsheng Ma1,†()   

  1. 1. Department of Day Surgery Centre, West China Hospital, Sichuan University, Chengdu 610041 China
    2. Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu 610041, China
  • Received:2020-09-25 Published:2021-05-15
  • Corresponding author: Hongsheng Ma
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引用本文：

雷甜甜, 刘家欢, 黄虹玉, 杨锦林, 马洪升. 进展期结直肠腺瘤及高危腺瘤的危险因素分析[J]. 中华胃肠内镜电子杂志, 2021, 08(02): 61-67.

Tiantian Lei, Jiahuan Liu, Hongyu Huang, Jinlin Yang, Hongsheng Ma. Analysis of risk factors for advanced colorectal adenoma and high-risk adenoma[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2021, 08(02): 61-67.

目的

探讨进展期结直肠腺瘤(ACA)及高危腺瘤的危险因素。

方法

纳入2014年1月至2019年12月四川大学华西医院日间手术中心经内镜下治疗的结直肠腺瘤患者4 573例(10 653枚腺瘤)，根据腺瘤直径大小、是否有绒毛结构形成或伴高级别上皮内瘤变，分为进展期腺瘤组(1 205例患者，1 619枚腺瘤)、非进展期腺瘤组(3 368例患者，9 034枚腺瘤)。以结直肠腺瘤患者为研究对象，分为进展期腺瘤患者组和非进展期腺瘤患者组，比较年龄、性别、体质指数(BMI)、腺瘤分布位置、大体形态、是否合并结肠黑变病、一级亲属结直肠癌家族史的差异有无统计学意义；根据腺瘤个数及病理特征，将研究对象分为高危腺瘤组2 141例、非高危腺瘤组2 432例，比较年龄、性别、BMI、是否合并结肠黑变病、一级亲属结直肠癌家族史在两组间的差异，运用单因素分析和多因素Logistic回归模型，分别分析ACA和结直肠高危腺瘤的危险因素。

结果

ACA占所有结直肠腺瘤的15.2%。腺瘤分布位置(远端结肠)、腺瘤大体形态(有蒂腺瘤、无蒂腺瘤)在两组间的差异有统计学意义(P<0.05)，是ACA的独立危险因素。位于远端结肠发生进展期腺瘤的几率是近端结肠发生进展期腺瘤的1.244倍；与扁平腺瘤相比，有蒂腺瘤和无蒂腺瘤发生进展期腺瘤的风险明显升高，分别是扁平腺瘤的23.948倍和3.426倍。以患者为研究对象，年龄(41～60岁、>60岁)、性别(男性)、合并结肠黑变病、有一级亲属结肠癌家族史在两组间的差异有统计学意义(P<0.05)，是高危腺瘤患者的独立危险因素。年龄段为41～60岁和>60岁的高危腺瘤发生率分别是≤40岁年龄段的1.733倍和2.489倍；男性发生高危腺瘤的风险是女性的1.294倍；合并结肠黑变病、有一级亲属结肠癌家族史的结直肠腺瘤患者发生高危腺瘤的风险分别升高至1.972倍和1.765倍。BMI在两组间的差异没有统计学意义(P>0.05)，不是高危腺瘤的独立危险因素。

结论

远端结肠腺瘤、有蒂或无蒂腺瘤是发生ACA的独立危险因素，年龄>40岁、男性、合并结肠黑变病、有一级亲属结肠癌家族史是高危腺瘤的独立危险因素。本研究对结直肠腺瘤癌变风险分层有重要临床意义，以期进一步推动我国结直肠肿瘤癌前病变的早诊早治和结直肠癌的防治工作。

关键词: 进展期结直肠腺瘤, 高危腺瘤, 危险因素
Objective

To investigate the risk factors of advanced colorectal adenoma(ACA)and high-risk adenoma.

Methods

A retrospective analysis was conducted on the data of 4 573 patients with 10 653 adenomas, who received endoscopic polypectomy at the Day Surgery Center of West China Hospital of Sichuan University from January 2014 to December 2019. Patients were divided into advanced adenoma group (1 205 patients with 1619 adenomas) and non-advanced adenoma group (3 368 patients with 9 034 adenomas) according to the diameter, the villous component or high-grade dysplasia of the adenoma. Age, gender, body mass index of patients, distribution, morphological classification of the colorectal adenoma polyps, melanosis coli and family history of colorectal cancer(CRC) in first-degree relatives(FDRs) were compared between two groups at the perspective of polyps and patients, separately. Besides, we divided the subjects into high-risk adenoma group(2 141 patients) and non-high-risk adenoma group(2 432 patients) based on the number of adenoma and pathological characteristics. The differences in age, gender, body mass index, melanosis coli and family history of CRC in FDRs were compared between the two groups. Risk factors of ACA and colorectal high-risk adenoma were analyzed by multivariate Logistic regression model.

Results

Advanced colorectal adenomas accounted for 15.2% of all colorectal adenomas in this study. For a single adenoma, the distribution (distal colon)and the morphological classification (pedunculated and sessile adenomas) were significantly different between two groups(P<0.05), which were confirmed to be the independent risk factors of ACA. ACA counted 1.244 times in the distal colon than which in the proximal colon. Compared with flat adenomas, the risks of ACA for pedunculated and sessile adenoma were significantly higher, which were 23.948 times and 3.426 times than which for flat adenomas. For a single patient, there were statistically significant differences between the two groups in age (41-60 years old, >60 years old), gender (male), melanosis coli and family history of CRC in FDRs(P<0.05), which were independent risk factors for patients with high-risk adenomas. The risks of high-risk adenoma in patients aged 41-60 and over 60 were 1.733 times and 2.489 times than who under 40. The risk of high-risk adenoma in men was 1.294 times than that in women. Colorectal adenoma patients with melanosis coli and with family history of CRC in FDRs had increased risk of high-risk adenomas to 1.972 times and 1.765 times, respectively. There were no statistically difference in BMI between two groups(P>0.05)and it was not an independent risk factor for high-risk adenoma.

Conclusions

Distal colonic adenoma, pedunculated and sessile adenoma were independent risk factors of ACA. Ages beyond 40, males, melanosis coli, family history of family history of CRC in FDRs were independent risk factors for high-risk adenoma. This study has great clinical significance for the risk stratification of colorectal adenomas cancerization and it aims to further promote the early diagnosis and treatment of precancerous lesions for colorectal tumors as well as the prevention and treatment of colorectal cancer.

Key words: Advanced colorectal adenoma, High-risk adenoma, Risk factors
表1 结直肠进展期腺瘤一般资料[n(%)]
变量 进展期腺瘤(n＝1 619) 非进展期腺瘤(n＝9 028) P值
年龄(岁)      
  ≤40 81(5.0) 472(5.2) 0.530
  41～60 820(50.6) 4 687(51.9)  
  ≥61 718(44.3) 3 869(42.9)  
性别 0.469
  男 1 052(65.0) 5 950(65.9)  
  女 567(35.0) 3 078(34.1)  
BMI (kg/m2) 0.087
  <28 1 569(96.9) 8 814(97.6)  
  ≥28 50(3.1) 214(2.4)  
结肠黑变病 0.245
  有 21(1.3) 153(1.7)  
  无 1 598(98.7) 8 875(98.3)  
结肠癌家族史 0.465
  有 108(6.7) 648(7.2)  
  无 1 511(93.3) 8 380(92.8)  
腺瘤部位a     <0.01
近端结肠 557 (34.4) 3 695 (40.9)  
远端结肠 1 062 (65.6) 5 333 (59.1)  
大体形态a     <0.01
  有蒂 1 023(63.2) 1 308(14.5)  
  无蒂 486(30.0) 4 343(48.1)  
  扁平 110(6.8) 3 377(37.4)  
表2 高危腺瘤患者的一般资料[n(%)]
变量 高危腺瘤患者(n＝2 141) 非高危腺瘤患者(n＝2 432) P值
年龄a(岁) <0.01
  ≤40 110(5.1) 233(9.6)  
  41～60 1 110(51.8) 1 389(57.1)  
  ≥61 921(43.0) 810(33.3)  
性别a <0.01
  男 1 383(64.6) 1 437(59.1)  
  女 758(35.4) 995(40.9)  
BMI (kg/m2)   0.097
  <28 2 087(97.5) 2 388(98.2)  
  ≥28 54(2.5) 44(1.8)  
结肠黑变病a <0.01
  有 36(1.7) 19(0.8)  
  无 2 105(98.3) 2 413(99.2)  
结肠癌家族史a <0.01
  有 155(7.2) 110(4.5)  
  无 1 986(92.8) 2 322(95.5)  
表3 进展期腺瘤单因素和多因素Logistic回归分析
变量 单因素分析 多因素分析
P值 OR (95%CI) β值 P值 OR (95%CI)
年龄(岁)          
  41～60 0.878 1.019(0.796～1.305) 0.106 0.447 1.112(0.846～1.462)
  >60 0.538 1.081(0.843～1.387) 0.201 0.155 1.222(0.927～1.611)
性别          
  男 0.469 1.042(0.932～1.164) 0.082 0.191 1.086(0.960～1.229)
BMI(kg/m2)          
  ≥28 0.088 1.313(0.960～1.794) 0.104 0.560 1.110(0.782～1.576)
结肠黑变病 0.247 1.312(0.829～2.076) 0.454 0.076 1.575(0.954～2.599)
结肠癌家族史 0.465 1.082(0.876～1.336) 0.139 0.244 1.149(0.910～1.452)
部位(远端结肠)a <0.01 1.321(1.182～1.476) 0.218 <0.01 1.244(1.100～1.407)
形态          
  有蒂a <0.01 24.011(19.526～29.526) 3.176 <0.01 23.948(19.469～29.457)
  无蒂a <0.01 3.435(2.780～4.246) 1.231 <0.01 3.426(2.772～4.235)
表4 高危腺瘤单因素和多因素Logistic回归分析
变量 单因素分析 多因素分析
P值 OR (95%CI) β值 P值 OR (95%CI)
年龄a(岁)          
  41～60 <0.01 1.693(1.331～2.152) 0.550 <0.01 1.733(1.361～2.207)
  >60 <0.01 2.408(1.884～3.079) 0.912 <0.01 2.489(1.943～3.188)
性别a(男) <0.01 1.263(1.121～1.424) 0.258 <0.01 1.294(1.146～1.461)
BMIa(kg/m2)          
  ≥28 0.098 1.404(0.939～2.100) 0.329 0.114 1.390(0.924～2.090)
结肠黑变病a有 <0.01 2.172(1.242～3.798) 0.679 0.018 1.972(1.121～3.468)
结肠癌家族史a有 <0.01 1.647(1.281～2.119) 0.568 <0.01 1.765(1.367～2.278)
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