非酒精性脂肪肝与结直肠腺瘤的相关性研究

发布时间：2018-04-14 14:29

本文选题：结直肠腺瘤性息肉 + 非酒精性脂肪肝　；参考：《安徽医科大学》2014年硕士论文

【摘要】：背景代谢综合征和胰岛素抵抗与结直肠腺瘤性息肉的发病密切相关，非酒精性脂肪肝（NAFLD）被认为是代谢综合征在肝脏的表现，我们推测非酒精性脂肪肝是结直肠腺瘤性息肉发病的重要影响因素之一。目的分析结直肠腺瘤性息肉发病的危险因素，并探讨NAFLD与结直肠腺瘤性息肉的相关性。方法选择我院2007年10月--2013年5月住院完善肠镜检查和相关辅助检查资料完整的患者2165例,划分为结直肠腺瘤组(n=413)及对照组(1752)。记录分析患者的一般资料（姓名、性别、年龄、血压值，既往有无高血压病、2型糖尿病、吸烟、饮酒情况）；血生化检查结果（空腹血糖、总胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、血尿酸）；已完善的上腹部B超或CT检查了解有无NAFLD。根据肠镜检查及病理学检查结果分为结直肠腺瘤组和对照组，对两组各项指标先行t或X2检验，比较两组间的NAFLD发病率有无差异；应用非条件Logistic回归分析进行单因素及多因素分析NAFLD是否为结直肠腺瘤性息肉的危险因素，并对NAFLD与结直肠腺瘤性息肉的位置、数目、大小、病理类型进行非条件Logistic回归分析。结果（1）与对照组相比，结直肠腺瘤性息肉组的年龄平均值、男性发病率、舒张压平均值均高于对照组，且差异存在统计学意义（P＜0.05）；结直肠腺瘤组的收缩压平均值虽高于对照组，但差异无统计学意义（P＞0.05）。（2）比较两组间的血生化指标发现结直肠腺瘤组的谷丙转氨酶、谷草转氨酶、尿酸、空腹血糖、甘油三脂的平均值高于对照组，高密度脂蛋白低于对照组，差异存在统计学意义（P＜0.05）；而低密度脂蛋白、γ-谷氨酰转肽酶、总胆固醇的值虽高于对照组，但差异无统计学意义(P＞0.05)。（3）结直肠腺瘤组与对照组高血压病的发病率分别为18.4%、12.9%；2型糖尿病发病率分别为10.5%、6.1%；吸烟率分别为20.3%、14.4%，NAFLD的发病率分别为30.7%、23.1%；两组间差异均有统计学意义（P＜0.05）。（4）采用Logistic回归法对数据分析后显示,年龄、性别、吸烟病史、NAFLD是结直肠腺瘤性息肉的危险因素,其OR值及95%CI分别为（2.1395%CI1.70-2.65、1.8895%CI1.45-2.47、1.5495%CI1.18-2.04、1.1695%CI1.04-1.58）(P＜0.05);而高血压病、2型糖尿病与结直肠腺瘤性息肉的发生无明显相关性,其OR值及95%CI分别为（1.050.82-1.45、1.330.86-2.25）（P＞0.05）。（5）采用Logistic回归对数据分析腺瘤性息肉位置、大小、数目、高危腺瘤与NAFLD的相关性：仅结直肠腺瘤性息肉的数目与NAFLD有相关性(OR,1.82,95%CI,1.06-3.15)，而息肉大小、位置、是否为高危腺瘤与NAFLD无先关性，，其OR值及95%CI分别为（1.360.68~2.23；0.780.62~1.15；0.820.62~1.83）。（校正年龄、性别、吸烟病史的混杂因素影响）结论男性、高龄、代谢综合征部分因素及NAFLD和结直肠腺瘤性息肉相关，多因素回归分析显示年龄、性别、吸烟、NAFLD是结直肠腺瘤性息肉发生的独立危险因素，NAFLD患者更易发生结直肠多发的腺瘤性息肉。
[Abstract]:The background of the metabolic syndrome and insulin resistance syndrome patients with colorectal adenomatous polyps are closely related, nonalcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of the metabolic syndrome, we hypothesized that nonalcoholic fatty liver is an important effect of colorectal adenomatous polyps factor.
Objective to analyze the risk factors of colorectal adenomatous polyps and to explore the correlation between NAFLD and colorectal adenomatous polyps.
Methods in our hospital in October 2007 --2013 year in May 2165 cases of hospitalized complete colonoscopy and related auxiliary examination with complete data, divided into colorectal adenoma group (n=413) and control group (1752). Analysis of records of patients with general information (name, gender, age, blood pressure, history of hypertension, type 2 diabetes mellitus. Smoking, alcohol); blood biochemical tests (fasting blood glucose, total cholesterol, glycerin three fat, high density lipoprotein, low density lipoprotein, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transpeptidase, uric acid); have perfect abdominal ultrasound or CT examination to understand whether NAFLD. according to the colonoscopy and pathological examination were divided into colorectal adenoma group and control group, two groups of indicators of the first t or X2 test, compared the incidence of NAFLD between the two groups was no difference; the application of non conditional Logistic regression analysis of single factor and multiple factors To analyze whether NAFLD is a risk factor for colorectal adenomatous polyps, and to make an unconditional Logistic regression analysis of the location, number, size and pathological types of NAFLD and colorectal adenomatous polyps.
Results (1) compared with the control group, colorectal adenomatous polyp group average age, male incidence rate, average blood pressure values were higher than the control group, and the difference wasstatistically significant (P < 0.05); colorectal adenoma group mean systolic pressure was higher than the control group, but the difference was not statistically significant (P > 0.05).
(2) the comparison between two groups of blood biochemical indexes of colorectal adenoma group, alanine aminotransferase, aspartate transaminase, uric acid, fasting blood glucose, average value of glycerin three greases was higher than the control group, the high density lipoprotein is lower than the control group, the difference was statistically significant (P < 0.05); low density lipoprotein, gamma glutamyl transpeptidase, total cholesterol values are higher than the control group, but the difference was not statistically significant (P > 0.05).
(3) the incidence of hypertension in colorectal adenoma group and control group was 18.4% and 12.9% respectively; the incidence of type 2 diabetes was 10.5% and 6.1%, smoking rates were 20.3% and 14.4%, respectively, and the incidence of NAFLD was 30.7% and 23.1%, respectively, and the difference between two groups was statistically significant (P < two).
(4) using Logistic regression method for data analysis showed that age, gender, smoking history, NAFLD is a risk factor for colorectal adenomatous polyps, the values of OR and 95%CI respectively (2.1395%CI1.70-2.65,1.8895%CI1.45-2.47,1.5495%CI1.18-2.04,1.1695%CI1.04-1.58) (P < 0.05); and hypertension, there is no significant association between type 2 diabetes and colorectal adenomatous polyps. The values of OR and 95%CI respectively (1.050.82-1.45,1.330.86-2.25) (P > 0.05).
(5) using Logistic regression adenomatous polyp location, size of data analysis, the number of correlation between high-risk adenomas and NAFLD: correlation of only colorectal adenomatous polyp number and NAFLD (OR, 1.82,95%CI, 1.06-3.15), and the polyp size, location, whether high-risk adenoma and NAFLD without first off, the value of OR and 95%CI respectively (1.360.68~2.23; 0.780.62~1.15; 0.820.62~1.83). (adjusted for age, sex, smoking history confounding effects)
Conclusion male, age, metabolic syndrome factors and NAFLD and colorectal adenomatous polyps, multi factor regression analysis showed that age, gender, smoking, NAFLD is an independent risk factor for colorectal adenomatous polyps, NAFLD patients are more susceptible to multiple colorectal polyps gland tumor.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.5;R735.34

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