摘要
背景结直肠息肉是消化系统常见疾病,但具体形成机制及癌变原因尚未完全阐明,有研究发现其可能与脂代谢水平存在关联。目的研究结直肠息肉患者的脂代谢特征。方法选取2021年10月1日-2022年3月31日在解放军总医院第一医学中心行结肠镜检查的患者。根据结肠镜检查有无息肉将研究对象分为息肉组和对照组。分析不同病理类型、息肉部位、单发或多发结直肠息肉患者的体质量指数、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白等脂代谢指标。结果共纳入418例进行分析,其中男性257例,女性161例,年龄19~89(56.18±11.84)岁。息肉组370例,其中增生性息肉101例,腺瘤性息肉213例,结直肠癌56例;无息肉对照组48例。与对照组比较,增生性息肉组总胆固醇水平显著升高(P<0.05);腺瘤性息肉组空腹血糖、低密度脂蛋白显著升高(P<0.05);结直肠癌组总胆固醇、三酰甘油、低密度脂蛋白水平显著低于腺瘤性息肉组,总胆固醇显著低于增生性息肉组(P<0.05)。Logistic回归显示:空腹血糖每升高1 mmol/L,发生结直肠癌的风险降低32%(OR=0.680,95%CI:0.492~0.941,P=0.020);三酰甘油每升高1 mmol/L,发生结直肠癌的风险降低59%(OR=0.410,95%CI:0.183~0.919,P=0.030)。在370例息肉患者中,男性患者中各脂代谢指标在不同位置分组中均无统计学差异(P>0.05)。女性患者中,横结肠息肉组体质量指数显著低于乙状结肠组(P<0.05);盲肠息肉组血清总胆固醇水平显著高于直肠、降结肠、横结肠、升结肠与回盲部息肉组(P<0.05);盲肠息肉血清三酰甘油水平显著高于其余各组(P<0.05)。男性患者中,多发性息肉组总胆固醇及低密度脂蛋白水平显著高于单发息肉组(P<0.05);女性患者中各脂代谢指标在单发与多发息肉患者中均无统计学差异(P>0.05)。结论息肉恶性程度与血清空腹血糖和三酰甘油水平相关;盲肠息肉和乙状结直肠息肉的发生与高脂代谢水平显著相关;息肉数量在男性患者中与血清胆固醇和低密度脂蛋白水平相关。结果提示脂代谢水平变化是结直肠恶性病变的潜在危险因素。
Background Colorectal polyp is a common disease of the digestive system,but the specific formation mechanism and cause of carcinogenesis have not been fully elucidated.Some studies have found that it may be related to lipid metabolism level.Objective To study the characteristics of lipid metabolism in patients with colorectal polyp.Methods Patients who underwent colonoscopy in the First Medical Center of Chinese PLA General Hospital from October 1,2021 to March 31,2022 were selected.The subjects were divided into polyp group and control group according to whether they had polyps by colonoscopy.The body mass index,fasting blood glucose,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein and other lipid metabolism of patients with single or multiple colorectal polyps were retrospectively analyzed.Results A total of 418 cases were selected,including 257 males and 161 females,aged 19-89(56.18±11.84)years.Polyp were detected in 370 cases,including 101 cases with hyperplastic polyp,213 cases with adenomatous polyp,and 56 cases with colorectal cancer;another 48 cases with no polyps were selected as control group.Compared with the control group,total cholesterol level in the hyperplastic polyp group increased significantly(P<0.05);fasting blood glucose and low-density lipoprotein in the adenomatous polyp group increased significantly(P<0.05).Total cholesterol,triglyceride and low-density lipoprotein in the colorectal cancer group were significantly lower than those in the adenomatous polyp group,and total cholesterol was significantly lower than that in the proliferative polyp group(P<0.05).Logistic regression showed that the risk of colorectal cancer decreased by 32%for each 1 mmol/L increase of fasting blood glucose(OR=0.680,95%CI:0.492-0.941,P=0.020).For each 1 mmol/L increase of triglycerides,the risk of colorectal cancer decreased by 59%(OR=0.410,95%CI:0.183-0.919,P=0.030).Of the 370 patients with polyps,there were no significant differences in lipid metabolism indexes among different location groups in the male patients(P>0.05).In the female patients,the body mass index in the group with polyps in transverse colon was significantly lower than that those with polyps in sigmoid colon(P<0.05).The serum total cholesterol level was significantly higher in the group with polyp in cecum than those with polyps in rectum,descending colon,transverse colon,ascending colon or ileocecum(P<0.05).The serum triglyceride level of the patients with polyps in cecum was significantly higher than the patients with polyps in the other parts(P<0.05).In male patients,the levels of total cholesterol and low density lipoprotein in the multiple polyp group were significantly higher than those in the single polyp group(P<0.05).There were no significant differences in lipid metabolism indexes between the single and the multiple polyps in female patients(P>0.05).Conclusion The malignant degree of polyp was correlated with the level of serum fasting blood glucose and triglyceride.The occurrence of cecal polyp and sigmoid colorectal polyp was associated with the level of high lipid metabolism.The number of polyps was correlated with serum cholesterol and low density lipoprotein levels in male patients.The results suggest that the change of lipid metabolism is a potential risk factor for malignant colorectal lesions.
作者
董晓宇
徐世平
石卉
杜海涛
万军
DONG Xiaoyu;XU Shiping;SHI Hui;DU Haitao;WAN Jun(Chinese PLA Medical School,Beijing 100853,China;The Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
北大核心
2023年第6期575-580,593,共7页
Academic Journal of Chinese PLA Medical School
基金
国家自然科学基金项目(82002483)
解放军总后勤部卫生部科研基金(17BJZ46)
中央保健科研课题(W2017BJ17)。
关键词
结直肠息肉
结直肠癌
三酰甘油
胆固醇
脂代谢
colorectal polyp
colorectal cancer
triglyceride
cholesterol
lipometabolism
