结直肠进展期腺瘤的临床特点及危险因素分析

Analysis of clinical characteristics and risk factors of advanced colorectal adenoma

目的通过对结直肠进展期腺瘤(advanced colorectal adenoma,ACA)的临床资料及危险因素的分析,为筛选高危人群提供依据。方法收集2013年1月至2021年12月在上海交通大学医学院附属瑞金医院北部院区就诊的结直肠腺瘤患者4502例,根据ACA的定义分为ACA组和对照组,比较两组间临床资料的差异,并进行ACA危险因素的单因素与多因素Logistic回归分析。结果与对照组相比,症状上,ACA组中患者体检及粪隐血试验(fecal occult blood test,FOBT)阳性的比例高,两组间差异有统计学意义(P<0.05);内镜下表现,ACA组呈多发病灶、亚蒂和长蒂腺瘤占比更高,两组间差异有统计学意义(P<0.05)。单因素分析中,性别、年龄、超重(BMI≥24 kg/m^(2))、一级亲结直肠癌家族史、服用阿司匹林、吸烟、饮酒、高血压、脂肪肝方面,ACA组与对照组之间的差异有统计学意义(P<0.05);多因素分析中,高龄、超重(BMI≥24 kg/m^(2))、一级亲结直肠癌家族史、服用阿司匹林、吸烟因素增加ACA发生风险(P<0.05)。结论建议将FOBT阳性、高龄、超重、一级亲结直肠癌家族史、服用阿司匹林、吸烟等作为ACA的筛查重点。

Objective To provide the evidences for screening high-risk groups through the analysis of clinical data and risk factors of advanced colorectal adenoma(ACA).Methods A total of 4502 cases of patients with colorectal adenoma treated in Ruijin Hospital North,Shanghai Jiao Tong University School of Medicine from Jan.2013 to Dec.2021 were collected and were divided into ACA group and control group(without ACA).To compare the differences in clinical data between the two groups,and perform single factor and multivariate Logistic regression analysis of risk factors for ACA.Results Compared with control group,the proportion of physical examination and positive of fecal occult blood test(FOBT)in ACA group were higher(P<0.05);ACA group showed a higher proportion of multifocal,sub-pedicular and long-pedicled adenomas(P<0.05).A univariate analysis of advanced adenoma,including gender,age,overweight(BMI≥24 kg/m^(2)),family history of first-degree relatives colorectal cancer,taking Aspirin,smoking,drinking,hypertension,and fatty liver disease,the differences between two groups were statistically significant(P<0.05);in the multivariate analysis,older age,overweight(BMI≥24 kg/m^(2)),family history of first-degree relatives colorectal cancer,taking Aspirin and smoking increased the risk of ACA(P<0.05).Conclusion It is recommended that FOBT positive,older age,overweight,family history of first-degree relatives colorectal cancer,taking Aspirin,smoking should be the focus of screening for ACA.