非酒精性脂肪性肝病与结直肠腺瘤性息肉的相关性分析

钏莉雪; 常江; 赵锦涵; 李洛华; 杨旭瑶; 余荻

doi:10.3969/j.issn.1001-5256.2020.06.022

非酒精性脂肪性肝病与结直肠腺瘤性息肉的相关性分析

DOI: 10.3969/j.issn.1001-5256.2020.06.022

昆明医科大学第二附属医院消化内科

基金项目:

昆明医科大学2019年研究生创新基金(2019S164)；

详细信息

中图分类号: R575.5;R735.34
计量
- 文章访问数: 912
- HTML全文浏览量: 13
- PDF下载量: 175
- 被引次数: 0
出版历程
- 出版日期: 2020-06-20

Association between nonalcoholic fatty liver disease and colorectal adenomatous polyps

Research funding:

摘要

摘要:
目的探讨非酒精性脂肪性肝病（NAFLD）与结直肠腺瘤性息肉的相关性及NAFLD严重程度与结直肠腺瘤性息肉发生风险的关系。方法选取2019年3月-2019年8月在昆明医科大学第二附属医院消化内科住院的结直肠腺瘤性息肉患者67例为腺瘤组,另选取同期就诊的结肠镜检查正常或病理学检查为炎性、增生性息肉者45例为对照组。比较2组基线资料及肝受控衰减参数（CAP）的差异。根据FibroTouch检测结果将所有研究对象分为无脂肪肝组及轻度、中度、重度NAFLD组,分析NAFLD严重程度与结直肠腺瘤性息肉发病风险的关系。正态分布的计量资料两组间比较采用t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。非正态分布的计量资料两组间比较采用Mann-Whitney U检验;多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Nemenyi法。计数资料组间比较采用χ2检验。采用logistic回归分析结直肠腺瘤的危险因素。结果腺瘤组中男性（51. 11%vs 73. 13%,χ2=5. 687,P=0. 017）、年龄[（56...
- 非酒精性脂肪性肝病 /
- 结肠腺瘤息肉病 /
- 危险性评估
Abstract:
Objective To investigate the association between nonalcoholic fatty liver disease( NAFLD) and colorectal adenomatous polyps and the correlation of NAFLD severity with the risk of colorectal adenomatous polyps. Methods A total of 67 patients with colorectal adenomatous polyps who were hospitalized in Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,from March to August 2019 were enrolled as adenoma group,and 45 patients who attended our hospital during the same period of time and had normal results of colonoscopy or were diagnosed with inflammatory and proliferative polyps based on pathology were enrolled as control group.The two groups were compared in terms of baseline data and controlled attenuation parameter( CAP) of the liver. All subjects were divided into non-fatty liver group and mild,moderate,and severe NAFLD groups according to FibroTouch,and the correlation of the severity of NAFLD with the risk of colorectal adenomatous polyps was analyzed. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. For non-normally distributed continuous data,the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups,and the Nemenyi method was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the risk factors for colorectal adenoma. Results Compared with the control group,the adenoma group had significantly higher proportion of male patients [49( 73. 13%) vs23( 51. 11%),χ2= 5. 687,P = 0. 017],age( 56. 24 ± 12. 44 years vs 50. 84 ± 11. 49 years,t =-2. 319,P = 0. 022),body mass index( BMI)( 24. 69 ± 3. 36 kg/m2 vs 22. 54 ± 3. 31 kg/m2,t =-3. 346,P = 0. 001),waist circumference( 89. 45 ± 10. 51 cm vs 83. 44 ±10. 30 cm,t =-2. 753,P = 0. 007),systolic pressure( 128. 78 ± 16. 92 mm Hg vs 117. 00 ± 15. 91 mm Hg,t =-3. 698,P < 0. 001),alanine aminotransferase( ALT) [24. 00( 18. 00 ～ 40. 00) U/L vs 22. 00( 16. 00 ～ 29. 00) U/L,Z =-1. 957,P = 0. 022 ],total cholesterol( TC)( 4. 73 ± 0. 96 mmol/L vs 4. 27 ± 0. 90 mmol/L,t =-2. 537,P = 0. 013),low-density lipoprotein( LDL)( 2. 92 ± 0. 78 mmol/L vs 2. 59 ± 0. 68 mmol/L,t =-2. 295,P = 0. 024),and CAP( 257. 51 ± 34. 22 d B/m vs 238. 67 ± 33. 44 d B/m,t =-2. 789,P= 0. 006). The logistic regression analysis showed that age( odds ratio [OR]= 1. 054,95% confidence interval [CI]: 1. 009-1. 102,P= 0. 019),BMI( OR = 1. 191,95% CI: 1. 026-1. 382,P = 0. 021),LDL( OR = 2. 058,95% CI: 1. 034-4. 097,P = 0. 040),ALT( OR = 1. 038,95% CI: 1. 008-1. 070,P = 0. 013),and CAP( OR = 1. 320,95% CI: 1. 163-1. 481,P = 0. 001) were independent risk factors for colorectal adenomatous polyps. The severe,moderate,and mild NAFLD groups had a significantly higher proportion of patients with colorectal adenomatous polyps than the non-fatty liver group [73. 08%( 19 patients)/73. 08%( 19 patients)/53. 85%( 14 patients) vs 40. 74%( 11 patients),χ2= 8. 088,P = 0. 040]. The logistic regression analysis showed that in the models 1 and 2,moderate NAFLD( model 1: OR = 1. 044,95% CI: 1. 007-1. 083,P = 0. 019; model 2: OR = 1. 011,95% CI: 1. 001-1. 022,P = 0. 033) and severe NAFLD( model 1: OR = 1. 183,95% CI: 1. 034-1. 354,P = 0. 015; model 2: OR = 1. 129,95% CI: 1. 030-1. 236,P = 0. 009)were risk factors for colorectal adenomatous polyps. In model 3,after adjustment for age,sex,BMI,smoking history,hypertension,diabetes mellitus,uric acid,triglyceride,LDL,and ALT,severe NAFLD( OR = 1. 078,95% CI: 1. 023-1. 136,P = 0. 005) was still a risk factor for colorectal adenomatous polyps. Conclusion NAFLD is an independent risk factor for colorectal adenomatous polyps,and patients with higher severity of NAFLD tend to have a higher risk of colorectal adenomatous polyps. Therefore,NAFLD patients,especially those with severe NAFLD,should undergo regular colonoscopy for early identification and treatment of colorectal adenomatous polyps,so as to eventually reduce the incidence rate and mortality rate of colorectal tumor in China.
- non-alcoholic fatty liver disease /
- adenomatous polyposis coli /
- risk assessment

HTML全文

参考文献(18)

[1] BRAY F,FERLAY J,SOERJOMATARAM I,et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2018,68(6):394-424.

[2] KANG H,YANG Y,QIU J,et al. Incidence and distribution of advanced colorectal adenomas in patients undergoing colonoscopy for screening,surveillance,and symptoms[J].Cancer Manag Res,2018,10:3875-3880.

[3] National Workshop on Fatty Liver and Alcoholic Liver Disease,Chinese Society of Hepatology,Chinese Medical Association;Fatty Liver Expert Committee,Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease:A 2018 update[J]. J Clin Hepatol,2018,34(5):947-957.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组，中国医师协会脂肪性肝病专家委员会．非酒精性脂肪性肝病防治指南(2018年更新版)[J]．临床肝胆病杂志，2018,34(5):947-957.

[4] YANG YJ,BANG CS,SHIN SP,et al. Clinical impact of nonalcoholic fatty liver disease on the occurrence of colorectal neoplasm:Propensity score matching analysis[J]. PLo S One,2017,12(8):e0182014.

[5] BLACKETT JW,VERNA EC,LEBWOHL B. Increased prevalence of colorectal adenomas in patients with nonalcoholic fatty liver disease:A cross-sectional study[J]. Dig Dis,2020,38(3):222-230.

[6] LIU X,LI WL,SUN JL,et al. Association between non-alcoholic fatty liver disease and colorectal adenomatous polyps[J]. Zhejiang Med J,2019,41(5):453-456.(in Chinese)刘晓，李文丽，孙建莉，等．非酒精性脂肪性肝病与结直肠腺瘤性息肉的关系研究[J]．浙江医学，2019,41(5):453-456.

[7] ZHANG P,LI B,HAN Y. Risk factors of colorectal polyps in elderly patients and its correlation with fatty liver[J]. Pract Geriatr,2019,33(7):697-700.(in Chinese)张鹏，李斌，韩怡．老年结直肠息肉的危险因素及其与脂肪肝的相关性分析[J]．实用老年医学，2019,33(7):697-700.

[8] XU Y. Clinical study on the correlation between nonalcoholic fatty liver disease and gastrointestinal polyps[D]. Shanghai:Shanghai Jiaotong University,2017.(in Chinese)徐言．非酒精性脂肪性肝病与胃肠道息肉相关性的临床研究[D]．上海:上海交通大学，2017.

[9] GUNN NT,SHIFFMAN ML. The use of liver biopsy in nonalcoholic fatty liver disease:When to biopsy and in whom[J]. Clin Liver Dis,2018,22(1):109-119.

[10] MARENGO A,JOUNESS RI,BUGIANESI E. Progression and natural history of nonalcoholic fatty liver disease in adults[J].Clin Liver Dis,2016,20(2):313-324.

[11] AHN JS,SINN DH,MIN YW,et al. Non-alcoholic fatty liver diseases and risk of colorectal neoplasia[J]. Aliment Pharmacol Ther,2017,45(2):345-353.

[12] KANG HW,KIM D,KIM HJ,et al. Visceral obesity and insulin resistance as risk factors for colorectal adenoma:A crosssectional,case-control study[J]. Am J Gastroenterol,2010,105(1):178-187.

[13] GRIVENNIKOV SI. Inflammation and colorectal cancer:Colitis-associated neoplasia[J]. Semin Immunopathol,2013,35(2):229-244.

[14] ARMSTRONG MJ,ADAMS LA,CANBAY A,et al. Extrahepatic complications of nonalcoholic fatty liver disease[J]. Hepatology,2014,59(3):1174-1197.

[15] KIM AY,LEE YS,KIM KH,et al. Adiponectin represses colon cancer cell proliferation via AdipoR1-and-R2-mediated AMPK activation[J]. Mol Endocrinol,2010,24(7):1441-1452.

[16] YAMAJI T,IWASAKI M,SASAZUKI S,et al. Interaction between adiponectin and leptin influences the risk of colorectal adenoma[J]. Cancer Res,2010,70(13):5430-5437.

[17] LEE T,YUN KE,CHANG Y,et al. Risk of colorectal neoplasia according to fatty liver severity and presence of gall bladder polyps[J]. Dig Dis Sci,2016,61(1):317-324.

[18] MANDAL P. Molecular mechanistic pathway of colorectal carcinogenesis associated with intestinal microbiota[J]. Anaerobe,2018,49:63-70.

施引文献

资源附件(0)

访问统计