不同病理类型胃息肉的临床特征及合并结肠息肉的危险因素分析

Clinical features of different pathological types of gastric polyps and risk factors of gastric polyps concurrent with colon polyps

目的分析不同病理类型胃息肉患者的临床病理特征,并探讨胃息肉合并结肠息肉的危险因素。方法采用回顾性研究。收集2017年1月—2020年12月间于上海市嘉定区中心医院接受胃镜检查并检出胃息肉的3049例患者资料。根据病理类型,将胃息肉患者分为4组(炎性息肉组、增生性息肉组、胃底腺息肉组、腺瘤性息肉组)。收集并比较不同病理类型组间患者的一般资料和内镜报告数据(胃息肉的数量、部位、大小)。记录患者是否存在萎缩性胃炎、肠上皮化生,以及幽门螺杆菌(H.pylori)感染情况。收集患者同期的结肠镜检查结果。采用单因素和多因素logistic回归分析胃息肉患者合并结肠息肉的危险因素。结果2017、2018、2019、2020年内镜下胃息肉检出率分别4.5%、5.1%、7.0%、7.5%,检出率呈逐年上升趋势,4年间胃息肉检出率的差异有统计学意义(χ^(2)=134.270,P<0.001)。与2017年相比,2020年胃息肉的检出率显著增高(χ^(2)=89.883,P<0.05)。4年间胃底腺息肉和炎性息肉的构成比的差异均存在统计学意义(χ^(2)=12.708、13.898,P值均<0.05)。与2017年相比,2020年胃底腺息肉的构成比显著增高(χ^(2)=12.644,P<0.05),2020年炎性息肉的构成比显著降低(χ^(2)=13.811,P<0.05)。腺瘤性息肉患者的年龄显著高于其他3组(F=11.98,P<0.001)。不同病理类型间老年(年龄≥65岁)与非老年(<65岁)患者构成比的差异有统计学意义(χ^(2)=32.90,P<0.05)。不同病理类型组间有无临床症状的患者构成比的差异有统计学意义(χ^(2)=103.00,P<0.05)。不同病理类型组间患者胃息肉的数量、部位和大小,以及H.pylori感染率、有无胃黏膜萎缩、有无肠化生的差异均有统计学意义(P值均<0.001)。74.6%(2274/3049)患者为单发息肉,较多发息肉[25.4%(775/3049)]常见。与胃底腺息肉组比较,炎性息肉、增生性息肉组的多发率均显著降低(χ^(2)=58.416、17.624,P值均<0.001)。炎性息肉和胃底腺息肉组胃息肉<0.5 cm的患者构成比均显著高于增生性息肉(χ^(2)=80.850、53.801,P值均<0.05)。胃底腺息肉患者的H.pylori感染率显著低于炎性息肉和增生性息肉(χ^(2)=42.714、6.704,P<0.001或0.05)。增生性息肉患者的胃黏膜萎缩发生率显著高于炎性息肉和胃底腺息肉(χ^(2)=20.879、16.436,P值均<0.001)。炎性息肉患者的肠化生发生率显著高于增生性息肉和胃底腺息肉(χ^(2)=12.897、81.467,P值均<0.001)。同期共383例胃息肉患者接受了结肠镜检查,其中129例(33.7%)患者检出结肠息肉。老年(年龄≥65岁)患者合并结肠息肉的检出率显著高于非老年(<65岁)患者(P<0.05);有临床症状的患者合并结肠息肉的检出率显著高于无症状患者(P<0.05)。将胃息肉患者合并结肠息肉的相关变量分别纳入单因素分析,结果显示,年龄≥65岁、腺瘤性息肉是胃息肉患者合并结肠息肉的危险因素。进一步行多因素分析,结果显示,年龄(OR=1.634,95%CI为1.042~2.563,P=0.032)和腺瘤性息肉(OR=3.743,95%CI为1.295~10.819,P=0.015)是胃息肉患者合并结直肠息肉的独立危险因素。结论不同病理类型胃息肉在患者年龄,息肉部位、大小、数量,H.pylori感染、胃黏膜萎缩及肠化等方面均存在差异;建议老年或胃息肉病理类型为腺瘤性息肉的患者可行结直肠镜筛查是否合并结直肠息肉。

Objective To analyze the clinicopathological features of patients with different pathological types of gastric polyps,and to explore the risk factors of gastric polyps concurrent with colon polyps.Methods A retrospective study was conducted in 3049 patients with gastric polyps detected by gastroscopy in Jiading District Central Hospital of Shanghai from January 2017 to December 2020.According to pathological types,the patients were divided into 4 groups:inflammatory polyp group,hyperplastic polyp group,fundus glandular polyp group,and adenomatous polyp group.General information and endoscopic report data(the number,location,and size of gastric polyps)were collected and compared between patients with different pathological types.Atrophic gastritis,intestinal metaplasia,and Helicobacter pylori(H.pylori)infection were recorded.Colonoscopy results were collected during the same period.The risk factors of gastric polyp concurrent with colon polyp were investigated by univariate and multivariate logistic regression analyses.Results The detection rates of endoscopic gastric polyps in 2017,2018,2019 and 2020 were 4.5%,5.1%,7.0%and 7.5%,respectively,which showed an increasing trend year by year.There was a statistically significant difference in the detection rate of gastric polyps over the past 4 years(χ^(2)=134.270,P<0.001).The detection rate of gastric polyps in 2020 was significantly higher than that in 2017(χ^(2)=89.883,P<0.05).There were significant differences in the proportions of gastric fundus glandular polyps and inflammatory polyps in the 4 years(χ^(2)=12.708,13.898,both P<0.05).Compared with those in 2017,the proportion of fundus glandular polyps in 2020 was significantly increased(χ^(2)=12.644,P<0.05),and the proportion of inflammatory polyps in 2020 was significantly decreased(χ^(2)=13.811,P<0.05).The patients with adenomatous polyps were older than the patients with the other three types of polyps(F=11.98,P<0.001).There was significant difference in the proportions of patients aged≥65 years old and<65 years old among groups(χ^(2)=32.90,P<0.05).There was significant difference in the proportions of patients with or without clinical symptoms among groups(χ^(2)=103.00,P<0.05).There were significant differences in the number,location and size of gastric polyps,infection rate of H.pylori,gastric mucosa atrophy and intestinal metaplasia among groups(all P<0.001).Single polyp was more common than multiple polyps in these patients(74.6%[2274/3049]vs 25.4%[775/3049]).The incidence of multiple polyps in the inflammatory polyp group and hyperplastic polyp group was significantly lower than that in the fundus glandular polyp group(χ^(2)=58.416,17.624,both P<0.001).The proportions of patients with gastric polyps<0.5 cm in inflammatory polyp group and fundus glandular polyp group was significantly higher than that in the hyperplastic polyp group(χ^(2)=80.850,53.801,both P<0.05).The infection rate of H.pylori in the fundus glandular polyp group was significantly lower than those in the inflammatory polyp group and hyperplastic polyp group(χ^(2)=42.714,6.704,P<0.001 or 0.05).The incidence of gastric mucosa atrophy in the hyperplastic polyp group was significantly higher than those in the inflammatory polyp group and fundus glandular polyp group(χ^(2)=20.879,16.436,both P<0.001).The incidence of intestinal metaplasia in the inflammatory polyp group was sig nificantly higher than those in the hyperplastic polyp group and fund us gland ular polyp group(χ^(2)=12.897,81.467,both P<0.001).A total of 383 patients with gastric polyps underwent colonoscopy during the same period,and colon polyps were found in 129(33.7%)patients of them.The patients aged≥65 years old had higher detection rate of colon polyps than the patients aged<65 years old(P<0.05).The patients with clinical symptoms had higher detection rate of colon polyps than asymptomatic patients(P<0.05).Univariate logistic regression analysis showed that age≥65 years and adenomatous polyp were the risk factors for gastric polyp concurrent with colon polyp.Moreover,multivariate analysis showed that age(OR=1.634,95%CI:1.042-2.563,P=0.032)and adenomatous polyps(OR=3.743,95%CI:1.295-10.819,P=0.015)were independent risk factors for gastric polyps concurrent with colorectal polyps.Conclusion The patient’s age,the number,location and size of gastric polyps,H.pylori infection,gastric mucosa atrophy and intestinal metaplasia vary in patients with different pathological types of gastric polyps.It is suggested that elderly patients with adenomatous polyps should be screened by colonoscopy for colorectal polyps.