血压及血脂水平与结直肠息肉内镜治疗后急性出血的关系

Correlation of blood pressure and blood lipid levels and acute bleeding after endoscopic treatment of colorectal polyps

目的 研究血压及血脂水平与结直肠息肉内镜治疗后急性出血的关系。方法 选取合肥市第一人民医院2020年10月—2022年3月结直肠息肉内镜摘除手术治疗后急性出血患者32例设为出血组,另选术后未出血患者120例设为未出血组。收集两组入院时性别、年龄、是否吸烟、是否饮酒、息肉直径、息肉形态(有蒂息肉、无蒂息肉)、组织学分型(腺瘤型、增生型、炎症型、其他)、息肉分布部位(直肠、结肠)各项信息。测定两组入院时血压指标[舒张压(SBP)、收缩压(DBP)]和血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]。对比两组基础资料和实验室指标,利用ROC曲线分析SBP、DBP、TC、LDL-C水平对结直肠息肉内镜治疗后急性出血发生的预测价值。将有差异信息纳入多因素Logistic回归模型,行量化赋值,明确结直肠息肉内镜治疗后急性出血发生的危险因素。结果 出血组息肉直径>2 cm、有蒂息肉患者占比显著高于未出血组,SBP、DBP、TC、LDL-C水平显著高于未出血组,差异有统计学意义(P<0.05)。经ROC分析,SBP、DBP、TC、LDL-C水平预测结直肠息肉内镜治疗后急性出血发生的曲线下面积分别为0.844、0.946、0.825、0.831。经多因素Logistic回归分析证实,息肉直径>2 cm、有蒂息肉、SBP≥90.165 mmHg、DBP≥107.405 mmHg、TC≥3.810 mmol/L、LDL-C≥2.090 mmol/L是结直肠息肉内镜治疗后急性出血发生的危险因素(均P<0.05)。结论 息肉直径较大、有蒂息肉、高血压、高血脂为结直肠息肉内镜治疗后急性出血发生的危险因素,临床应予以关注并及时进行干预。

Objective To study the correlation of blood pressure and blood lipid levels with acute bleeding after endoscopic treatment of colorectal polyps.Methods 152 patients with colorectal polyps were hospitalized to undergo endoscopic removal and were divided into 2 groups according to whether acute bleeding occurred after the treatment:bleeding group(n=32)and non-bleeding group(n=120).General clinical data,including gender,age,smoking history,alcohol consumption,polyp diameter,polyp form,histological type(adenoma type,proliferative type,inflammatory type,etc.),polyp distribution site(rectum,colon)was collected.Diastolic blood pressure(SBP)and systolic blood pressure(DBP)at admission were measured.Peripheral fasting venous blood samples were collected to test the levels of total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).Multivariate logistic regression was used to identify the risk factors of bleeding after endoscopic removal,and receiver operating characteristic curve was used to analyze the predictive values of the levels of blood lipid and blood pressure on the occurrence of acute bleeding after endoscopy.Results The proportions of patients with polyp diameter>2 cm and pedicled polyp in the bleeding group were both significantly higher than those in the non-bleeding group(both P<0.05),and the levels of SBP,DBP,TC and LDL-C of the bleeding group were all significantly higher than those in the non-bleeding group(all P<0.05).According to the ROC analysis,the areas under the curve of SBP,DBP,TC,and LDL-C levels predicting the occurrence of acute bleeding after endoscopic treatment were 0.844,0.946,0.825,and 0.831 respectively.Multivariate logistic regression analysis showed that polyp diameter>2 cm,pedicled polyp,SBP≥90.165 mmHg,DBP≥107.405 mmHg,TC≥3.810 mmol/L,LDL-C≥2.090 mmol/L were the risk factors of acute bleeding after endoscopic treatment of colorectal polyps(all P<0.05).Conclusion Large polyp diameter,pedicled polyp,hypertension and hyperlipidemia are the risk factors of acute bleeding after endoscopic treatment of colorectal polyps.