结肠环境与结肠息肉关系的研究

发布时间：2018-11-18 20:08

【摘要】：目的:探讨结肠环境与结肠息肉之间的关系。方法:回顾性收集南昌大学内腔镜室2015年6月1日至2016年5月31日行电子结肠镜检查的患者2994例并分成病例组和对照组。其中以内镜检查粘膜呈正常结肠的2518例患者为对照组,以活动性结肠炎、炎症性肠病(IBD)、感染性结肠炎、缺血性结肠炎、结肠憩室病、结肠黑变病的476例患者为病例组。其中患有结肠息肉的患者有1019例。使用Student’s t-test、多项Logistic回归比较两组的年龄,使用多项Logistic回归比较两组的性别,使用优势比和95%的置信区间分析两组的息肉患病率,并用多项Logistic回归调整年龄与性别的影响。结果:结肠镜首发症状情况分析:在2994例患者首发症状中,腹痛者最多(29.8%),其次为腹泻者(21.5%)、多症状者(19.6%),便血者(13.3%)、便秘者(10.6%)。结肠息肉基本情况分析:1、结肠息肉部位分析:在1019例结肠息肉患者中,息肉位于乙状结肠的最多(32.4%),其次是直肠(19.3%)、升结肠(13.1%)。2、结肠息肉类型分析:在1019例结肠息肉患者中,以管状腺瘤类型最多见(47.4%),其次是炎性息肉(29.8%)、增生性息肉(10.4%)。不同诊断组影响因素分析:1、年龄分析:全体个体平均年龄为52.63±12.67岁。与正常结肠相比,活动性结肠炎、炎症性肠病(IBD)、感染性结肠炎与低龄相关(所有P0.05,OR1),结肠憩室病、结肠黑变病与高龄相关(所有P0.05,OR1),缺血性结肠炎与年龄无关(P0.05)。2、性别分析:活动性结肠炎、结肠憩室病、IBD、结肠黑变病患者发病与性别相关(所有P0.05),感染性结肠炎、缺血性结肠炎患者发病与年龄无关(所有P0.05)。不同诊断组与结肠息肉关系的分析:1、不同诊断组结肠息肉患病率分析:结肠息肉患病率最高的为正常结肠(37%),其次为缺血性结肠炎和结肠憩室病(均为25%),此后依次为活动性结肠炎(22%),感染性结肠炎(18%),UC和CD(均为11%),IBD和结肠黑变病(均为6%)。2、慢性结肠炎与结肠息肉关系:与正常结肠相比,活动性结肠炎、UC、IBD、感染性结肠炎的患者与低结肠息肉患病率有关(所有P0.05,OR1)。经多项Logistic回归分析调整性别、年龄因素影响后,以上结论仍成立(所有OR1)。其中CD、缺血性结肠炎没有得出与以上一致的结论(所有P0.05)。3、结肠憩室病与结肠息肉的关系:与正常结肠相比,结肠憩室病的患者与低结肠息肉患病率有关(P0.05,OR1)。经调整影响因素后,得出与以上相反结论(OR1)。4、结肠黑变病与结肠息肉的关系:与正常结肠相比,结肠黑变病的患者与低结肠息肉患病率有关(P0.05,OR1)。经调整影响因素后,以上结论仍成立(所有OR1)。结论:结肠息肉患病率的降低与慢性结肠炎、结肠黑变病环境有关,结肠息肉患病率的增高与结肠憩室病环境有关。
[Abstract]:Objective: to investigate the relationship between colonic environment and colonic polyps. Methods: a total of 2994 patients who underwent electronic colonoscopy from June 1, 2015 to May 31, 2016 in the endoscopy room of Nanchang University were retrospectively collected and divided into two groups: the case group and the control group. 2518 patients with normal colonic mucosa were selected as control group. The patients were divided into active colitis, inflammatory bowel disease (IBD),) infectious colitis, ischemic colitis, colonic diverticulum disease and colonic melanosis. There were 1019 patients with colonic polyps. The age of the two groups was compared with Student's t-test. multiple Logistic regression, the sex of the two groups was compared with multiple Logistic regression, the prevalence of polyp was analyzed by odds ratio and 95% confidence interval. The influence of age and sex was adjusted by multiple Logistic regression. Results: the first symptom of colonoscopy: among the 2994 patients, abdominal pain was the most (29.8%), diarrhea was the second (21.5%), multi-symptom (19.6%), blood stool (13.3%). Constipation (10.6%). Analysis of colonic polyps: 1. Analysis of colonic polyps: in 1019 patients with colonic polyps, polyps were found in sigmoid colon (32.4%), followed by rectum (19.3%), ascending colon (13.1%), colonic polyps (32.4%), colon polyps (19.3%), ascending colon (13.1%). Analysis of colonic polyps: tubular adenoma was the most common type of colonic polyps (47.4%), inflammatory polyps (29.8%) and proliferative polyps (10.4%) in 1019 patients with colonic polyps. Analysis of influencing factors in different diagnostic groups: 1. Age analysis: the average age of all individuals was 52.63 卤12.67 years old. Active colitis, inflammatory bowel disease (IBD),) infective colitis was associated with younger age (all P0.05 OR1), colonic diverticulum disease, and colonic melanosis were associated with advanced age (all P0.05 OR1). Ischemic colitis was not associated with age (P0.05). 2Sex analysis: active colitis, colonic diverticulum disease, IBD, colonic melanosis were associated with sex (all P0.05). The incidence of ischemic colitis was not related to age (all P0.05). Analysis of the relationship between different diagnostic groups and colonic polyps: 1. The prevalence of colonic polyps in different diagnostic groups was the highest in normal colon (37%), followed by ischemic colitis and colonic diverticulum disease (25%). Then active colitis (22%), infectious colitis (18%), UC and CD) (both 11%), IBD and colonic melanosis (6%). 2. The relationship between chronic colitis and colonic polyps: compared with normal colon, Active colitis, UC,IBD, infective colitis was associated with the prevalence of low colonic polyps (all P 0.05 OR1). After multiple Logistic regression analysis adjusted gender, age factors, the above conclusion still holds (all OR1). Among them, CD, ischemic colitis did not reach the same conclusion (all P0.05). 3. The relationship between colonic diverticulum disease and colonic polyps: compared with normal colon, The incidence of colonic polyps in patients with colonic diverticulum disease was associated with low incidence of colonic polyps (P0.05 OR1). After adjusting the influencing factors, the opposite conclusion (OR1). 4. The relationship between colonic melanosis and colonic polyps: compared with normal colon, the patients with colonic melanosis were associated with low prevalence of colonic polyps (P0.05OR1). After adjusting the influencing factors, the above conclusion still holds (all OR1). Conclusion: the decrease of the prevalence of colonic polyps is related to the chronic colitis and the environment of colonic melanosis, and the increase of the prevalence of colonic polyps is related to the environment of colonic diverticulum disease.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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