炎症性肠病结肠隆起型异型增生影响因素的回顾性研究

Retrospective Analysis of Relevant Influencing Factors for the Occurrence of Uplift Type Dysplasia in the Colons of Patients With Inflammatory Bowel Disease

背景随着我国炎症性肠病发病率的上升,炎症性肠病相关结直肠癌及癌前病变的发病情况值得关注。目的探讨炎症性肠病结肠隆起型异型增生发生的相关影响因素。方法选取2007年1月—2014年1月在北京大学第一医院进行内镜随访的393例炎症性肠病患者为研究对象,收集患者临床资料和病理学检查结果。以发生结肠隆起型异型增生为结局事件,以患者的病程为时间变量,采用Cox比例风险回归分析炎症性肠病患者结肠隆起型异型增生发生的影响因素。结果 393例炎症性肠病患者中13例发生结肠隆起型异型增生,其中溃疡性结肠炎12例、克罗恩病1例;腺瘤样病变或肿物（ALM）10例、异型增生相关病变或肿物（DALM）3例。Cox比例风险回归模型结果显示,炎症性肠病家族史、疾病活动程度和疾病复发情况与结肠隆起型异型增生有回归关系（P〉0.05）。Log-rank检验结果显示,无炎症性肠病家族史者、中度活动者及疾病偶发患者的累计生存率高于有炎症性肠病家族史者、重度活动者及疾病频发/持续活动患者（χ~2值分别为4.631、7.382、13.438,P值分别为0.031、0.007、〈0.001）。10例ALM患者中9例行内镜下黏膜切除、1例多发ALM患者行全结肠切除;3例DALM患者1例行全结肠切除,2例因病情较重或全身情况差未行手术治疗。结论炎症性肠病患者结肠隆起型异型增生的发生率随着病程的延长而增加;影响其发生的高危因素有炎症性肠病家族史、疾病活动程度和疾病复发情况。

Background As the prevalence of inflammatory bowel disease（ IBD） in China is increasing,the morbidity of IBD associated colorectal cancer and precancerous lesions are worth noticing. Objective To investigate relevant influencing factors for the occurrence of IBD colon uplift type dysplasia. Methods A total of 393 IBD patients who were followed up by endoscope in Peking University First Hospital from January 2007 to January 2014 were enrolled in the study. Clinical data and pathological results of the patients were collected. With uplift type dysplasia as outcome event and disease duration as time variable,the influencing factors for the occurrence of IBD colon uplift type dysplasia were analyzed and screened by Cox proportional hazards regression. Results A total of 13 cases had colon uplift type dysplasia among the 393 IBD cases. Among the13 cases,12 cases were ulcerative colitis and 1 case was Crohn＇s disease; 10 cases had adenoma- like lesion or mass（ ALM）and 3 cases had dysplasia associated lesion or mass（ DALM）. The result of Cox proportional hazards regression model showed that regression correlation existed between colon uplift type dysplasia and IBD family history,disease activity degree and disease relapse（ P〈0. 05）; regression correlation did not exist between colon uplift type dysplasia and gender, onset age, family history of colon cancer, smoking, scope of lesions and receiving maintenance treatment of 5- aminosalicylic acid（ 5-ASA）/ Salazosulfapyridine（ SASP） for at least two years（ P〉0. 05）. Log- rank test result showed that cumulative survival rate of patients who had no IBD family history and had moderate activity and accidental symptoms was higher than that of patients who had IBD family history, severe activities and frequent symptoms / persistent activity（ χ~2= 4. 631,7. 382,13. 438; P = 0. 031,0. 007, 0. 001）. Among 10 cases of ALM,9 cases were given tumor resection by endoscope and 1 case with multiple ALM was given total colectomy. Among 3 cases of DALM,1 case was given total colectomy and 2 cases were not given operative treatment because of serious disease or poor general physical condition. Conclusion The incidence of IBD colon uplift type dysplasia increases with prolonged disease duration. High risk factors include IBD family history, disease activity degree and disease relapse.