幽门螺杆菌感染与高血糖对结直肠腺瘤行内镜下切除术患者腺瘤复发的影响

Effect of Helicobacter pylori infection and hyperglycemia on the recurrence of adenoma in patients with colorectal adenoma undergoing endoscopic resection

目的探讨Hp感染和高血糖在结直肠腺瘤复发中的作用。方法回顾性分析242例2004年6月~2016年6月在蛇口人民医院及南山人民医院首次结肠镜检查中切除结直肠腺瘤的患者,然后进行结肠镜检查直至结直肠腺瘤复发或随访的最后期限。结果 Hp阳性的患者其结直肠腺瘤复发率为74/99(74.7%),Hp阴性的患者其结直肠腺瘤的复发率为38/143(24.6%),有明显差异(P<0.01)。多因素Cox回归分析显示,Hp感染[OR(95%CI)4.18(2.44~7.15)]、Hb A1c≥6.5%[OR(95%CI)1.92(1.04~3.55)]、BMI≥25 kg/m2[OR(95%CI)7.63(3.14~18.53)]、饮酒[OR(95%CI)3.73(2.17~6.42)]是结直肠腺瘤复发的独立危险因素。随着Hb A1c水平的升高,Hp感染患者结直肠腺瘤复发的危险性进行性增加。结论 Hp感染与高血糖在结直肠腺瘤复发中起协同作用。

Objective To explored the role of Hp infection and hyperglycemia in the recurrence of colorectal adenomas.Methods A total of 242 cases of colorectal adenoma excision during the first colonoscopy at Shekou People＇s Hospital and Nanshan People＇s Hospital from June 2004 to June 2016 were retrospectively analyzed. Then the patients underwent colonoscopy examination until the recurrence of colorectal adenoma or the deadline of follow-up. Results The re currence rate of colorectal adenoma was 74/99（74.7%）in Hp positive patients and 38/143（24.6%） in Hp negative patients,and there was a significant difference（P 0.01）. Multivariate Cox regression analysis showed that Hp infection [OR（95% CI） 4.18（2.44-7.15）], Hb A1 c≥6.5%[OR（95%CI） 1.92（1.04-3.55）], BMI ≥25 kg/m2[OR（95% CI） 7.63（3.14-18.53）], drinking [OR（95% CI） 3.73（2.17-6.42）] were independent risk factors for recurrence of colorectal adenoma.With the increase of Hb A1 c levels, the risk of colorectal adenoma recurrence in Hp infection patients progressively increased. Conclusion Hp infection and hyperglycemia play a synergistic role in the recurrence of colorectal adenoma.