初查结肠镜阴性人群结直肠肿瘤发生风险研究

Risk of colorectal tumor after negative baseline screening colonoscopy

目的 调查初查结肠镜结果阴性人群再次进行结肠镜检查情况,探讨不同性别、年龄、风险等级人群在不同时间间隔结直肠肿瘤的发生风险.方法 采用双向性队列研究设计,利用自制调查表对1995年1月1日至2005年12月31日在长海医院初查结肠镜结果阴性无症状平均风险人群进行电话随访.调查内容包括初次结肠镜检查以后所有结肠镜检查情况、结直肠癌危险分层相关因素（年龄、性别、吸烟情况、糖尿病病史、绿色蔬菜摄人情况、腌制食品摄人情况、油炸熏制食品摄人情况、白肉摄人情况）等.采用寿命表生存分析法研究不同性别、年龄、风险等级人群发生结直肠肿瘤的累积风险.结果 共纳入455例研究对象,有91例发生息肉病变,24例发生腺瘤病变,9例发生进展期肿瘤病变,初查结肠镜阴性人群5年后结直肠息肉、腺瘤、进展期肿瘤的累积发生率分别为11.9％、4.2％和2.0％.12年进展期肿瘤的累积发生率为3.9％.男性发生息肉病变的风险高于女性（x2=8.142,P=0.004）;年龄≥60岁人群发生息肉病变的风险高于年龄＜60岁人群（x2=6.321,P=0.012）;高风险组人群发生息肉病变的风险高于低风险组人群（x2=4.082,P=0.043）.结论 对于初查结肠镜结果阴性人群,结直肠息肉、腺瘤、进展期肿瘤5年的累积发生率均较低,12年内发生进展期肿瘤的风险也较低.

Objective To review the following colonoscopy of negative baseline screening colonoscopy crowd,and to explore the risk of colorectal tumor at different time intervals in different gender,age and risk levels.Methods With bi-cohort study design,self-made questionnaire was used to survey the following colonoscopy of the asymptomatic average-risk population with negative baseline screening colonoscopy from January 1,1995 to December 31,2005.The survey contents included all the following colonoscopy,the risk stratification factors of colorectal cancer （age,gender,smoking status,history of diabetes,green vegetables intake,pickled food intake,fried smoked food intake,white meat intake）.The life table survival analysis method was used to study the cumulative risk of colorectal tumor in different gender,age,risk levels.Results Four hundred and fifty-five cases were included,and there were 91 cases of colorectal polyp,24 cases of adenoma and 9 cases of advanced tumor.The cumulative prevalence rates of colorectal polyp,adenoma and advanced tumor during 5 years for negative baseline screening colonoscopy crowd were 11.9％,4.2％ and 2.0％ respectively.The cumulative prevalence rate of advanced tumor during 12 years was 3.9％.The risk of colorectal polyp of men was higher than that of female （x2 =8.142,P =0.004）.The risk of colorectal polyp of ≥60 years group was higher than that of ＜60 years group （x2 =6.321,P =0.012）.The risk of colorectal polyp of high risk group was higher than that of low risk group （x2 =4.082,P =0.043）.Conclusion In the negative baseline screening colonoscopy crowd,5-year cumulative prevalence rates of colorectal polyp,adenoma,advanced tumor are low,and 12-year cumulative prevalence rate of colorectal advanced tumor is low too.