摘要
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.
作者
杨超
张志永
YANG Chao;ZHANG Zhiyong(Department of Colorectal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《天津医药》
CAS
北大核心
2023年第1期95-99,共5页
Tianjin Medical Journal
关键词
糖尿病
2型
腺瘤
结直肠肿瘤
二甲双胍
危险因素
联合预测因子
diabetes mellitus,type 2
adenoma
colorectal neoplasms
metformin
risk factor
combined predictor
