结直肠腺瘤危险因素的倾向评分匹配分析

Propensity score matching analysis of risk factors of colorectal adenoma

目的探讨内镜下结直肠息肉切除术后结直肠腺瘤发生的危险因素。方法回顾性分析2014年1月至2019年12月在四川大学华西医院日间手术中心接受内镜下结直肠息肉切除术的6 430例患者(20 351枚息肉)资料。根据是否包含≥1枚腺瘤性息肉,将患者分为腺瘤患者组(4 573例)和非腺瘤患者组(1 857例);根据结直肠息肉术后病理结果,将息肉分为腺瘤性息肉组(10 656枚)和非腺瘤性息肉组(9 695枚)。采用倾向评分匹配(PSM)法对腺瘤患者组和非腺瘤患者组、腺瘤性息肉组和非腺瘤性息肉组进行1∶1匹配,共1 824对患者和7 362对息肉成功匹配。PSM后,对患者因素如性别(男)、年龄(<40和40~60岁)、息肉个数(>2个)、肥胖(BMI≥28 kg/m2)、有结直肠黑变病、有一级亲属结直肠癌家族史,以及息肉相关因素如最大径(6~10和>10 mm)、分布情况(远端结肠)和形态学分类(无蒂和扁平)进行结直肠腺瘤危险因素分析。统计学方法采用单因素分析和多因素logistic回归分析。结果 6 430例结直肠息肉患者中腺瘤检出率为71.12%(4 573/6 430)。PSM后,单因素分析结果显示,肥胖、有一级亲属结直肠癌家族史和息肉最大径>10 mm均与腺瘤发生有关(OR=1.483、1.426、1.503,95%CI 1.063~2.067、1.015~2.004、1.198~1.887,P均<0.05)。多因素logistic回归分析结果显示,肥胖、有一级亲属结直肠癌家族史、息肉最大径>10 mm、息肉形态学分类为无蒂和扁平均为结直肠腺瘤发生的独立危险因素(OR=1.425、1.411、1.629、1.165、1.151,95%CI 1.019~1.994、1.001~1.988、1.290~2.058、1.030~1.316、1.012~1.310,P均<0.05)。结论肥胖、有一级亲属结直肠癌家族史、息肉最大径>10 mm、息肉形态呈无蒂或扁平状均为结直肠腺瘤发生的独立危险因素。

Objective To explore the risk factors of occurrence of colorectal adenoma after endoscopic polypectomy.Methods From January 2014 to December 2019,at the Department of Day Surgery Centre in West China Hospital,Sichuan University,6430 patients with 20351 polyps who underwent endoscopic colorectal polypectomy were retrospectively analyzed.Patients were divided into adenomas group(4573 patients)and non-adenomas group(1857 patients)according to whether they had at least one adenomatous polyp.According to the results of postoperative histopathology,colorectal polyps were divided into adenomatous polyp group(10656 polyps)and non-adenomatous polyp group(9695 polyps).The propensity score matching(PSM)method was applied,with 1∶1 matching,in the patients with adenoma group and the patients with non-adenoma group,as well as in adenomatous polyps group and non-adenomatous polyps group.A total of 1824 pairs of patients and 7362 pairs of colorectal polyps were successfully matched.After PSM,patients-related factors as gender(male),age(<40 and 40 to 60 years old),number of polyps(>2),obesity(body mass index≥28 kg/m2),melanosis,family history of colorectal cancer in first-degree relatives,polyps-related factors as the maximum diameter(6 to 10 and>10 mm),distribution(distal colon),and morphological classification(sessile and flat polyps)were included in the analysis of risk factors of colorectal adenoma.Univariate analysis and multivariate logistic regression were used for statistical analysis.Results Among 6430 patients with colorectal polyps,the detection rate of adenoma was 71.12%(4573/6430).After PSM,the results of univariate analysis showed that obesity,family history of colorectal cancer in first-degree relatives,the maximum diameter of polyps>10 mm were all correlated with the occurrence of adenoma(odds ratio(OR)=1.483,1.426 and 1.503,95%confidence interval(CI)1.063 to 2.067,1.015 to 2.004,1.198 to 1.887,all P<0.05).The results of multivariate logistic regression analysis indicated that obesity,family history of colorectal cancer in first-degree relatives,the maximum diameter of polyps>10 mm,sessile or flat polyps in morphological classification were independent risk factors of the occurence of colorectal adenomas(OR=1.425,1.411,1.629,1.165 and 1.151,95%CI1.019 to 1.994,1.001 to 1.988,1.290 to 2.058,1.030 to 1.316 and 1.012 to 1.310,all P<0.05).Conclusions Obesity,family history of colorectal cancer in first-degree relatives,maximum diameter of polyps>10 mm,sessile polyps or flat polyps were the independent risk factors of the occurrence of colorectal adenomas.