瘦素和脂联素在老年结直肠腺瘤合并非酒精性脂肪肝患者中的表达及意义

Significance of plasma levels of adiponectin and leptin in elderly patients with colorectal adenomas and nonalcoholic fatty liver disease

目的:研究老年结直肠腺瘤合并非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)患者结直肠腺瘤的临床特征及探讨瘦素、脂联素的表达与有潜在恶变风险的结直肠腺瘤的关系.方法:82例老年结直肠腺瘤合并NAFLD患者为研究组,286例老年结直肠腺瘤非NAFLD患者为对照组.统计两组患者合并高血压、糖尿病情况,比较两组患者体质量指数(body mass index,BMI)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白-胆固醇(highdensity lipoprotein-cholesterol,HDL-C)、低密度脂蛋白-胆固醇(low-density lipoproteincholesterol,LDL-C)、脂蛋白a(lipoprotein a,Lpa)及腺瘤发生部位、大小、数目、病理类型、上皮内瘤变.酶联免疫吸附试验法法检测两组患者瘦素和脂联素的表达.结果:老年结直肠腺瘤合并NAFLD组患者同非NAFLD组相比,吸烟、患有糖尿病、高血压、高甘油三酯血症、高低高密度脂蛋白患者更多(P<0.05),且BMI明显高于非N A F L D结直肠腺瘤组(P<0.05).结肠腺瘤合并NAFLD组老年患者腺瘤个数多于非NAFLD组(P<0.05),绒毛状腺瘤比例也高于非NAFLD组结肠腺瘤患者(P<0.05).脂联素在NAFLD组表达高于非NAFLD组(P<0.05),而瘦素的表达与之相反(P<0.05).脂联素在2个及其以上息肉数组的表达高于单个息肉组(P<0.05),在绒毛状息肉组的表达低于非绒毛状息肉组(P<0.05),在息肉有高级别瘤样变组的表达高于非高级别瘤样变组(P<0.05).瘦素在绒毛状息肉组的表达高于非绒毛状息肉组(P<0.05),在息肉有高级别瘤样变组的表达低于非高级别瘤样变组(P<0.05).结论:老年结直肠腺瘤合并NAFLD患者腺瘤恶变风险更高,脂联素分泌减少及瘦素水平的升高是可能的原因之一.

AIM： To investigate the clinical characters of colorectal adenomas in elder patients with nonalcoholic fatty liver disease（NAFLD）, and to explore the relationship between adiponectin and leptin levels and colorectal adenomas which likely undergo malignant transformation.METHODS： The information of past medical history and personal medical history were provided. Body mass index（BMI）, aspartate aminotransferase（AST）, alanine aminotransferase（ALT）, triglyceride（TG）, total cholesterol（TC）,high-density lipoprotein（HDL-C）, low-density lipoprotein（LDL-C）, lipoprotein a（Lpa）, as well as position, size, number, and pathology of colorectal adenomas were detected and collected statistic between elderly patients with and without NAFLD. ELISA was used to detect plasma adiponectin and leptin levels. RESULTS： More elderly patients with NAFLD had smoking history, diabetes mellitus,hypertension, hypertriglyceride, high LDL-C level and high BMI（P 〈 0.05） than in those without NAFLD. The numbers of colorectal adenomas（P 〈 0.05） and villous adenomas（P〈 0.05） in patients with NAFLD were more than those in patients without NAFLD. Higher levels of adiponectin and lower levels of leptin were detected in patients with NAFLD, and in the villous adenomas group and high grade dysplasia group.CONCLUSION： Adenomas in elderly patients with NAFLD have more chances to undergo malignant transformation than those in patientswithout NAFLD. The low expression of adiponectin and high expression of leptin may be one of the possible mechanisms.