结肠息肉大小、异型增生与胃发生肠上皮化生的相关性分析

Correlation analysis of colon polyps' size,dysplasia and intestinal metaplasia

回顾性研究同时行胃镜和肠镜检查患者的临床资料,将研究对象分为胃肠上皮化生(GIM)组(n=397)和无胃肠上皮化生(GIM)组(n=360),比较两组间结肠息肉大小、数目、部位及异型增生的差异。在GIM组中,息肉直径<0. 5cm、0. 5～1. 0 cm、1. 0～2. 0 cm、> 2. 0 cm间息肉发生率及结肠息肉异型增生发生率显著高于无GIM组(P <0. 05),而结肠息肉生长部位及数目在两组间比较差异无统计学意义;经二元logistic回归分析,与无GIM组比较,年龄≥50岁、男性、HP感染、结肠息肉> 2. 0 cm、结肠息肉出现异型增生患者胃镜检查出现GIM的可能性大(OR> 1,P <0. 05),结肠息肉大小为1. 0～2. 0 cm者胃镜检查无GIM的可能性大(OR <1,P <0. 05),而结肠息肉<0. 5 cm、结肠息肉0. 5～1. 0 cm发生率的差异无统计学意义。不仅年龄、性别、HP感染与GIM的发生有关,结肠息肉> 2. 0 cm、息肉出现异型增生者GIM发生的风险增加,在肠镜检查时发现结肠息肉> 2. 0 cm、息肉病理有异型增生者建议行胃镜检查,以期及早发现GIM并进行随访以提高早期胃癌的检出率。

The patients undergoing gastroscope and enteroscopy examination were respectively divided into gastric intestinal metaplasia group( n = 397) and non gastric intestinal metaplasia group( n = 360),and the differences in size,number,location and dysplasia of colonic polyps between the two groups were compared. In GIM group,the polyps incidence after classification of polyp size and colonic dysplasia was significantly higher than that in non GIM group( P < 0. 05),while the number and location of colonic polyps were no significant difference between two groups. By the logistic regression analysis,more than 50 years old of age,male,HP infection,the diameter of polyps are larger than 2. 0 cm,or dysplasia showed high possibility to appear gastric intestinal metaplasia( OR > 1,P< 0. 05),the diameter of colonic polyps are 1. 0 ~ 2. 0 cm which showed high possibility to non intestinal metaplasia( OR < 1,P < 0. 05),and there was no significant difference between the two groups in the incidence of GIM in colonic polyps less than 0. 5 cm or 0. 5 ~ 1. 0 cm in diameter. Not only age,gender and HP infection were related to the occurrence of IM,but the risk of GIM increased in patients with colonic polyps’ diameter more than 2. 0 cm and dysplasia. Those who found colonic polyps > 2. 0 cm in diameter and polyps with dysplasia were suggested to undergo gastroscopy in order to find GIM early and follow up to improve the detection rate of early gastric cancer.