2型糖尿病患者结直肠腺瘤发病的多因素风险预测模型构建

Construction of a multiple risk factor prediction model for colorectal adenoma in patients with type 2 diabetes mellitus

目的 分析2型糖尿病患者结直肠腺瘤(CRA)发生的独立影响因素并构建风险预测模型。方法 将行结直肠镜检查的2型糖尿病患者分为腺瘤组(145例,病理诊断为CRA)和对照组(174例,结直肠黏膜无异常)。比较2组年龄、性别、体质量指数(BMI)、糖尿病病程、高血压史、糖尿病周围神经病变、脂肪肝、胃肠道症状、近5年二甲双胍与胰岛素应用情况、幽门螺杆菌(Hp)感染情况、吸烟史、饮酒史、大便隐血情况。实验室资料:肿瘤异常蛋白(TAP)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、维生素D3水平。应用多因素Logistic回归分析T2DM患者发生CRA的独立影响因素,并构建产生新的联合预测因子(L联合)。应用受试者工作特征(ROC)曲线评估L联合预测价值,采用Hosmer-Lemeshow检验评价拟合度。结果 腺瘤组年龄、男性、BMI、高血压史、Hp阳性、吸烟史、饮酒史、大便隐血阳性比例,HbA1c、TG、TAP凝聚物面积、HOMA-IR高于对照组,应用二甲双胍比例、维生素D3水平低于对照组(P<0.05)。多因素Logistic回归显示年龄、BMI、TG升高,TAP凝聚物面积增大、吸烟史、Hp阳性、大便隐血阳性是T2DM患者发生CRA的独立危险因素,而应用二甲双胍为独立保护因素(P<0.05)。ROC曲线显示L联合的AUC为0.815(95%CI:0.768~0.862,P<0.01),Hosmer-Lemeshow检验该风险模型拟合度较好(χ^(2)=10.249,P=0.248)。结论 由年龄、BMI、TAP、TG、吸烟史、Hp感染、大便隐血和应用二甲双胍构成的联合预测因子对2型糖尿病患者结直肠腺瘤发病风险的预测效能较好。

Objective To investigate independent influencing factors of colorectal adenomas(CRA) in patients with type 2 diabetes mellitus(T2DM) and to establish the risk prediction model.Methods Patients with T2DM undergoing colonoscopy were divided into the adenoma group(n=145,pathologically diagnosed as CRA) and the control group(n=174,without abnormal colorectal mucosa).Age,sex,body mass index(BMI) and diabetes course,history of hypertension,diabetic peripheral neuropathy,fatty liver,gastrointestinal symptoms,metformin and insulin use in recent 5 years,Helicobacter pylori(Hp) infection,smoking history,drinking history and fecal occult blood were compared between the two groups.Laboratory data were also compared between the two groups,including tumor abnormal protein(TAP),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),serum total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),uric acid(UA) and vitamin D3levels.Multivariate Logistic regression was used to determine the independent risk factors for CRA in T2DM patients,and a new combined predictor was constructed(Lcombined).The combined prediction value of Lcombinedwas evaluated by ROC curve,and the fit degree was evaluated by Hosmer-Lemeshow test.Results In the adenoma group,age,BMI,male,history of hypertension,history of smoking,history of drinking,positive proportion of Hp,positive proportion of stool occult blood,HbAlc,TG,TAP and HOMA-IR were significantly higher than those in the control group.The proportion of metformin use and vitamin D3levels were lower in the adenoma group than those in the control group(P<0.05).Multivariate Logistic regression showed that the increased age,BMI,TAP,TG,smoking history,positive Hp and positive occult blood were independent risk factors for CRA in T2DM patients,while metformin was an independent protective factor(P <0.05).ROC curve showed that the AUC of Lcombinedwas 0.815(95 % CI:0.768-0.862,P <0.01),and Hosmer-Lemeshow test showed a good fit of the risk model(χ^(2)=10.249,P=0.248).Conclusion The combined predictors of age,BMI,TAP,TG,smoking history,Hp infection,fecal occult blood and metformin use are effective in predicting the risk of colorectal adenoma in patients with T2DM.