老年结直肠腺瘤合并2型糖尿病病人的临床特点分析

Clinical characteristics of elderly patients with colorectal adenoma complicated with type 2 diabetes mellitus

目的分析老年结直肠腺瘤合并2型糖尿病病人的临床特点。方法回顾性分析2013~2015年255例在我院行内镜下黏膜切除术的老年结直肠腺瘤病人的病例资料,根据口服葡萄糖耐量试验(OGTT)及胰岛素释放试验筛查结果分为血糖正常组(对照组)142例和2型糖尿病(T2DM)组113例,根据肠镜及病理结果统计结直肠腺瘤大小、数目、分布位置、病理类型、异型增生程度。结果与对照组比较,T2DM组男性比例增高,2组性别构成差异有统计学意义(85.0%比66.9%,χ2=10.91,P=0.001)。与对照组比较,T2DM组腺瘤发病部位为全结直肠的检出率明显增高(42.5%比24.6%,χ2=8.146,P=0.005),腺瘤直径≥1 cm的病人检出率增高(49.6%比36.6%,χ2=4.314,P=0.042),且多发性腺瘤检出率明显增高(70.8%比55.6%,χ2=6.163,P=0.014)。2组病人的年龄、病理类型、异型增生程度差异无统计学意义。高血压病、高脂血症、男性为T2DM病人结直肠腺瘤发病的危险因素。结论老年结直肠腺瘤合并T2DM者临床特点包括男性病人多、病变范围广、腺瘤多发,故对老年男性T2DM病人进行肠镜筛查并内镜下治疗是预防结直肠腺瘤进展的主要措施。

Objective To analyze the clinical characteristics of elderly patients with colorectal adenoma complicated with T2 DM. Methods A retrospective analysis was conducted,and 255 cases of elderly patients from 2013 to 2015 in our hospital undergoing endoscopic mucosal resection with colorectal adenoma were divided into normal blood glucose group（ control group,142 cases） and T2 DM group（ 113cases） according to OGTT and insulin releasing test screening results. The size,number,location,pathological type,degree of dysplasia of colorectal adenoma were recorded according to colonoscopy and pathology and compared between the two groups. Results Compared with the control group,patients in T2 DM group showed a higher proportion of males（ 85% vs 66. 9%,χ^2= 10. 91,P = 0. 001）. The detection rate of total colorectal in T2 DM group was significantly higher than that of the control group（ 42. 5% vs 24. 6%,χ^2= 8. 146,P = 0. 005）. Compared with the control group,detection rate of diameter more than 1 cm and multiple adenoma in T2 DM group were significantly higher（ 49. 6% vs36. 6%,χ^2= 4. 314,P = 0. 042; 70. 8% vs 55. 6%,χ^2= 6. 163,P = 0. 014）. There were no statistically significant difference between the two groups in age,histological type and degree of dysplasia. Patients with colorectal adenoma in group T2 DM were often associated with hypertension, hyperlipidemia,especially in men. Conclusions High proportion of male,adenoma and large diameter were the clinical characteristics of colorectal adenoma complicated with T2 DM in the elderly. Colonoscopy screening and endoscopic therapy in elderly patients with T2 DM,especially in male,may be the main method to prevent the progression of colorectal adenomas.