南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (05): 673-.

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锯齿状息肉与传统腺瘤风险因素对比及结直肠癌适宜筛查年龄

代倩,刘江,钟慕晓,朱薇,张亚历   

  • 出版日期:2017-05-20 发布日期:2017-05-20

Comparison of risk factors for serrated polyps and conventional adenoma and the suitable age to start colorectal cancer screening

  • Online:2017-05-20 Published:2017-05-20

摘要: 目的对锯齿状息肉(SPs)及传统腺瘤(CA)相关风险因素进行分析、对比,探讨两类息肉风险因素间异同。方法收集南 方医院消化内镜中心2012~2015行全结肠镜及息肉病理检查的病例。随机选取健康对照103例,SPs 100例,CA 115例,采集各 病例性别、年龄、身高、体质量等临床数据。运用SPSS软件,先对各因素进行组间多重比较,对具有显著性的因素再纳入多因素 logistic回归分析,得到风险因素及其OR值。结果SPs平均发病年龄48.87岁(95%CI 47.22-50.52),较CA更早(P=0.038)。以 青年组为参照,中年组发生SPs风险增加2.31倍(95%CI 1.46-3.65)、CA风险增加4.10倍(95%CI 2.50-6.72);老年组发生SPs风 险增加2.77倍(95%CI 1.52-5.04)、CA风险增加6.00倍(95%CI 3.26-11.05)。其中,年龄与CA的发生较SPs关系更为密切(老年 组:OR=2.14,95%CI 1.21-3.78,P=0.009)。男性较女性SPs 发病风险增加2.75 倍(95%CI 1.50-5.07)、CA增加2.19 倍(95%CI 1.22-3.95)。BMI每增加1个单位,SPs发病风险增加1.18倍(95%CI 1.06-1.30)、CA增加1.20倍(95%CI 1.09-1.32)。结论两类 息肉风险因素类别相同,可使用同一方案进行高危人群筛查。SPs平均发病年龄早于50岁且有可能快速进展为癌,提早CRC筛 查年龄值得考虑。

Abstract: Objective To compare the risk factors associated with serrated polyps (SPs) and conventional adenoma (CA). Methods One hundred and three healthy control subjects, 100 patients with pathologically confirmed SPs and 115 with CA were randomly selected from individuals undergoing colonoscopy in Nanfang Hospital from 2012 to 2015. The demographic and clinical data were collected from the subjects, including age, gender, height, weight, hypertension, diabetes, smoking status, alcohol use, family history of colorectal cancer (CRC) and blood lipids. Results Among the enrolled subjects, the mean onset age of SPs was 48.87 years (95%CI: 47.22-50.52 years), significantly younger than that of CA (P=0.038). The risk factors both for SPs and CA include an advanced age, a male gender (OR=2.75 [95%CI: 1.50-5.07] for SPs, and OR=2.19 [95%CI: 1.22-3.95] for CA), and a high body mass index (OR=1.18 [95%CI: 1.06-1.30] for SPs and OR=1.20 [95%CI: 1.09-1.32] for CA. Relative to the young individuals (below 45 years of age), the middle-aged individuals (45-60 years of age) had increased risks for SPs and CA by 2.31 [95% CI: 1.46-3.65] folds and 4.10 [95%CI: 2.50-6.72] folds, respectively, and in the elderly (beyond 60 years of age), the risks further increased by 2.77 [95%CI: 1.52-5.04] folds for SPs and by 6.00 [95%CI: 3.26-11.05] folds for CA. Age was more strongly associated with CA than with SPs (OR=2.14 [95%CI: 1.21-3.78], the elderly vs the young, P=0.009). Conclusion SPs and CA have common risk factors, thus the screening strategy for CA may also be applicable to SPs. As the mean onset age of SPs is earlier than 50 years and SPs may rapidly progress to a carcinogenic state, an earlier screening age needs to be considered.