代谢综合征及相关因素与结直肠息肉相关性研究

发布时间：2018-04-22 10:03

本文选题：代谢综合征 + 结直肠息肉　；参考：《大连医科大学》2015年硕士论文

【摘要】：目的:结直肠息肉(Colorectal polyps)是一类突出于肠道黏膜的赘生物,是结直肠粘膜上皮的隆起性病变。依据Morsom组织病理学分类,结直肠息肉可以分为腺瘤性(Colorectal adenomat polyps,CAP)及非腺瘤性息肉(non Colorectal adenomatpolyps,NCAP),非腺瘤性息肉包括炎性息肉、增生性息肉、脂肪瘤及错构瘤等,临床最常见的为腺瘤性息肉。结直肠腺瘤现被认为是结直肠癌癌前病变之一,现已形成“腺瘤-癌”序列。结直肠癌发病率现逐年上升,在全世界恶性肿瘤的发病率中,男性为第三位,女性为第二位,在我国的发病率以每年4.2%的速度增长。结直肠癌早期多无明显症状,出现症状多为消化道常见症状,由于临床症状不典型,常被患者所忽视。早期发现结直肠癌及其癌前病变,研究其影响因素,并进行干涉,则有望进一步降低结直肠癌的发病率。目前已有研究证明代谢综合征是结直肠腺瘤性息肉的危险因素之一,并研究证实代谢综合征及其相关因素与结直肠息肉的出现有关,且与结直肠息肉复发有关。对于代谢综合征与结直息肉的相关研究国内报道较少,尤其非腺瘤性息肉研究更为少见。本文将进一步研究代谢综合征及其相关因素与结直肠息肉的关系。从而进一步确定结直肠息肉发生的危险因素,对结直肠癌的预防提供依据。方法:选取2011年04月20日至2014年10月20日于大连医科大学附属第一医院三部肠镜室行结肠镜检查的住院患者为研究对象。整理肠镜相关资料,记录诊断、息肉大小及病理类型。按病理结果分腺瘤性结直肠息肉组(CAP组)和非腺瘤性结直肠息肉组(NCAP组),并选取行结肠镜检查未见异常患者为对照组。根据既往病史及影像学检查等,记录是否患有高血压、冠心病、糖尿病、脂肪肝,并记录相关生化检查资料,包括血尿酸、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白等数值。应用spss 17.0进行分析,分别将CAP组、NCAP与对照组组间各项临床参数进行比较分析。结果:1.CAP组与NCAP组患者平均年龄均高于对照组,均具有统计学差异(P0.05)。腺瘤组及非腺瘤组男性患者检出率分别为64.94%、50%,腺瘤组差异具备统计学意义(P0.05),非腺瘤组与对照组比较差别无统计学意义(P0.05)。2.CAP组及NCAP组甘油三酯、胆固醇及低密度脂蛋白平均水平均高于对照组,高密度脂蛋白平均水平较对照组低。CAP组甘油三酯及高密度脂蛋白差异具备统计学意义(P0.05)。NCAP组仅甘油三酯差别具有统计学意义(P0.05),其他三项均无差异(P0.05)。3.CAP组高血压、脂肪肝、冠心病阳性检出率分别为37.96%、25.77%、8.76%,与对照组相比脂肪肝及高血压差异具有统计学意义(P0.05)。非腺瘤组高血压、脂肪肝、冠心病阳性检出率分别为30.49%、17.07%、8.53%,差异均不具有统计学意义(P0.05)。4.CAP组2型糖尿病检出率为25.77%,高于对照组的检出率(11.76%),具有统计学差异(P0.05),NCAP组检出率为15.85,与对照组差异无统计学意义(P0.05)。两组空腹血糖平均水平均与对照组相比对,均不具有统计学差异(P0.05)。5.CAP组及NCAP组血尿酸平均水平与对照组相比,差异均不具备统计学意义(P0.05)。6.多因素非条件Logistic回归分析显示,CAP组性别,年龄,糖尿病,TG,HDL是腺瘤发生的危险因素,其OR值分别为:1.939(95%CI为1.192-3.154);1.043(95%CI为1.021-1.066);2.287(95%CI为1.192-4.390);5.993(95%CI为3.438-10.447);3.936(95%CI为01.193-8.098),此时P值小于0.05。NCAP组年龄,TG为危险因素,其OR值分别为:1.054(95%CI为1.026-1.082);9.428(95%CI为4.327-20.543),差异有统计学意义。结论:年龄、性别、脂肪肝、高血压、2型糖尿病、甘油三酯、高密度脂蛋白与结直肠腺瘤性息肉发生差异有统计学意义。非腺瘤性息肉仅与年龄及甘油三酯有关。多因素回归分析显示,性别,年龄,糖尿病,TG,HDL为腺瘤性息肉的危险因素,非腺瘤组年龄,TG为危险因素。
[Abstract]:Objective: colorectal polyps (Colorectal polyps) is a neoplasm of the intestinal mucosa, which is a protuberant lesion of the epithelium of the colorectal mucosa. According to the histopathological classification of Morsom, colorectal polyps can be divided into adenomatous (Colorectal adenomat polyps, CAP) and non adenomatous polyps (non Colorectal adenomatpolyps, NCAP) and non adenomatous. Polyps, including inflammatory polyps, hyperplastic polyps, lipoma and hamartoma, are the most common adenomatous polyps. Colorectal adenomas are now considered to be one of the precancerous lesions of colorectal cancer, and the "adenoma cancer" sequence has been formed. The incidence of colorectal cancer is increasing year by year, and the incidence of malignant tumors in the world is third, female The incidence of the disease is second in China at a rate of 4.2% per year. There are no obvious symptoms in the early stage of colorectal cancer and most of the symptoms are common symptoms in the digestive tract. The patients are often ignored because of the untypical clinical symptoms. The early detection of colorectal cancer and its precancerous lesions, the study of its influencing factors, and intervention are expected to be further reduced. Current studies have shown that metabolic syndrome is one of the risk factors for colorectal adenomatous polyps, and studies have confirmed that metabolic syndrome and its related factors are associated with the appearance of colorectal polyps and are associated with recrudescence of colorectal polyps. The study of non adenomatous polyps is particularly rare. This article will further study the relationship between metabolic syndrome and its related factors and colorectal polyps, and further determine the risk factors for colorectal polyps, and provide a basis for the prevention of colorectal cancer. Methods: from 20 to October 20, 2014 2011 to Dalian Medical University in Dalian Medical University. In the three enteroscopy room of the first hospital, the patients with colonoscopy were studied. Enteroscopy related data, records of diagnosis, polyp size and pathological type were recorded. According to the pathological results, the adenomatous colorectal polyp group (group CAP) and non adenomatous colorectal polyp group (group NCAP) were divided, and the patients who did not have abnormal colonoscopy were selected as the control group. According to previous medical history and imaging examination, records of hypertension, coronary heart disease, diabetes, and fatty liver were recorded, including blood uric acid, fasting blood glucose, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein and so on. SPSS 17 was used to analyze group CAP, NCAP and control group, respectively. Results: the average age of the 1.CAP group and the NCAP group was higher than the control group (P0.05). The detection rate of the adenoma group and the non adenoma group was 64.94%, 50%, and the difference of the adenoma group was statistically significant (P0.05), and there was no statistical difference between the non adenoma group and the control group (P 0.05) the average level of triglyceride, cholesterol and low density lipoprotein in group.2.CAP and NCAP was higher than that of the control group. The average level of HDL was higher than that of the control group. The difference of triglyceride and high density lipoprotein in the lower.CAP group was statistically significant (P0.05) in group.NCAP, the difference between triglyceride and triglyceride was statistically significant (P0.05), and there was no difference in the other three items. (P0.05) the positive rates of hypertension, fatty liver and coronary heart disease in group.3.CAP were 37.96%, 25.77%, 8.76% respectively. The difference of fatty liver and hypertension was statistically significant (P0.05) compared with the control group. The positive rates of non adenoma hypertension, fatty liver and coronary heart disease were 30.49%, 17.07%, 8.53%, respectively, and the difference was not statistically significant (P0.05).4.CAP group 2 The detection rate of type 2 diabetes was 25.77%, higher than that of the control group (11.76%), with statistical difference (P0.05), the detection rate in group NCAP was 15.85, and there was no significant difference between the control group (P0.05). The average level of fasting blood glucose in the two groups was not statistically different from the control group (P0.05) and the average level of serum uric acid in.5.CAP and NCAP groups. Compared with the control group, the difference was not statistically significant (P0.05).6. multiple factors unconditional Logistic regression analysis showed that sex, age, diabetes, TG, HDL were risk factors for adenoma in CAP group, and the OR values were 1.939 (95%CI to 1.192-3.154), 1.043 (95%CI 1.021-1.066); 2.287 (95%CI was); 3; 3 .936 (95%CI 01.193-8.098), at this time the P value is less than the 0.05.NCAP group age, TG is a risk factor, its OR value is 1.054 (95%CI is 1.026-1.082); 9.428 (95%CI is 4.327-20.543), the difference is statistically significant. Conclusion: age, sex, fatty liver, hypertension, type 2 diabetes, triglyceride, high density lipoprotein and colorectal adenomatous polyps The differences were statistically significant. Non adenomatous polyps were associated with age and triglycerides only. Multivariate regression analysis showed that sex, age, diabetes, TG, HDL were risk factors for adenomatous polyps, non adenomatous age, and TG as a risk factor.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.34;R589

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