无症状人群结直肠息肉检出情况及危险因素分析

Detection rate and risk factors of colorectal polyps in asymptomatic individuals

目的探讨不同病理类型结直肠息肉在无症状人群中的检出情况及相关危险因素。方法收集我院2013-2016年接受结直肠镜检查但无临床症状的体检者702例的临床资料[年龄、性别、体质量指数(BMI)、吸烟情况、一级亲属结直肠癌家族史、2型糖尿病及胆囊结石病史]和肠镜结果。根据肠镜结果和息肉病理类型分组,分析不同病理类型息肉的检出情况及危险因素。结果腺瘤、增生性息肉(hyperplasic polyp,HP)、广基锯齿状腺瘤/息肉、传统锯齿状腺瘤、炎性息肉的检出率分别为14.0%(98/702)、8.8%(62/702)、0.6%(4/702)、0.1%(1/702)、0.9%(6/702),进展期腺瘤的检出率为2.7%(19/702)。年龄≥50岁(50~<60岁:OR=1.712,95%CI=1.048~2.798,P=0.032;≥60岁:OR=2.151,95%CI=1.146~4.036,P=0.017)、吸烟≥400支/年(OR=1.866,95%CI=1.120~3.109,P=0.017)、一级亲属结直肠癌家族史(OR=1.853,95%CI=1.038~3.310,P=0.037)是腺瘤的独立危险因素;BMI≥24.0 kg/m^2(OR=3.150,95%CI=1.069~9.280,P=0.037)、2型糖尿病(OR=4.430,95%CI=1.248~15.721,P=0.021)是进展期腺瘤的独立危险因素;吸烟≥400支/年(OR=2.200,95%CI=1.203~4.024,P=0.010)是HP唯一的独立危险因素。结论腺瘤及HP是无症状人群结直肠息肉的主要病理类型。吸烟、50岁以上、一级亲属结直肠癌家族史是腺瘤的危险因素,若同时合并2型糖尿病或体质量超重则增加进展期腺瘤的风险。吸烟也是HP的危险因素,且对HP的促进作用可能更显著。

Objective To investigate the detection rate and risk factors of colorectal polyps of different histological types in asymptomatic individuals. Methods From January 2013 to December 2016,a total of 702 individuals without clinical symptoms underwent colonoscopy in our hospital. The clinical data[including age,gender,body mass index（ BMI）,smoking status,first-degree family history of colorectal cancer,type 2 diabetes and gallstone disease] and results of colonoscopy were obtained from each subject.The detection rate and risk factors of colorectal polyps of different histological types were analyzed in the subjects with different colonoscopic and histopathological findings. Results Among the 702 individuals,the detection rates of adenoma,hyperplasic polyp,sessile serrated adenoma/polyp,traditional serrated adenoma and inflammatory polyp were 14. 0%（ 98/702）,8. 8%（ 62/702）,0. 6%（ 4/702）,0. 1%（ 1/702） and 0. 9%（ 6/702）,respectively; the detection rate of advanced adenoma was 2. 7%（ 19/702）. An age over50 years（ 50- 60 years： OR = 1. 712,95% CI = 1. 048-2. 798,P = 0. 032; over 60 years： OR = 2. 151,95% CI = 1. 146-4. 036,P = 0. 017）,smoking more than 20 pack-year（ OR = 1. 866,95% CI = 1. 120-3. 109,P = 0. 017）,and first-degree family history of colorectal cancer（ OR = 1. 853,95% CI = 1. 038-3. 310,P = 0. 037） were identified as the independent risk factors of adenoma. A BMI over 24. 0 kg/m^2（ OR = 3. 150,95% CI = 1. 069-9. 280,P = 0. 037） and type 2 diabetes（ OR = 4. 430,95% CI = 1. 248 ~15. 721,P = 0. 021） were independently correlated with advanced adenoma. Smoking more than 20 pack-year（ OR = 2. 200,95% CI = 1. 203-4. 024,P = 0. 010） was found to be the only independent risk factor of hyperplasic polyp. Conclusion Adenoma and hyperplasic polyp are the main histological types of colorectal polyps in asymptomatic individuals. Smoking,age over 50 years and first-degree family history of colorectal cancer are all risk factors of adenoma,and concurrent type 2 diabetes or overweight are associated with an increased risk of advanced adenoma. Smoking is an independent risk factor of hyperplasic polyp and adenomas,and may produce a stronger influence than adenoma on the development of hyperplasic polyp.