中老年男性人群代谢综合征与结直肠息肉切除术后进展性结直肠新生物检出的相关性研究

廖涵; 杜海涛; 石卉; 万军

doi:10.3969/j.issn.2095-5227.2023.06.011

中老年男性人群代谢综合征与结直肠息肉切除术后进展性结直肠新生物检出的相关性研究

Correlation between metabolic syndrome and detection of advanced neoplasia after colorectal polypectomy in middle-aged and elderly males

摘要

摘要:
背景代谢综合征(metabolic syndrome，MS)与结直肠肿瘤风险增加相关，但其对中老年男性人群结直肠息肉切除术后进展性结直肠新生物(advanced neoplasia，AN)发生的影响尚不明确。
目的探讨MS对中老年男性人群结直肠息肉切除术后AN检出的影响。
方法采用回顾性队列分析研究方法，收集2007年1月 - 2013年4月就诊于解放军总医院第二医学中心行内镜下结直肠息肉切除的≥40岁中老年男性病例(376例)资料。根据MS诊断标准，将患者分为MS(+)组(n=91)和MS(-)组(n=285)，Kaplan-Meier法绘制两组AN累积发病风险曲线，Cox比例风险回归模型分析影响AN检出的因素。
结果随访期间，MS(+)组AN检出的发病密度为3.06/100人年，高于MS(-)组的1.65/100人年。AN累积发病风险曲线提示，MS(+)组AN累积发病风险始终高于MS(-)组，经log-rank法检验，差异有统计学意义(P＜0.05)。根据患者合并的异常MS组分个数(0个、1个、2个和3 ~ 4个)进一步分层分析。单因素Cox回归模型显示：年龄≥76岁、基线肠镜检出进展期结直肠腺瘤(advanced adenoma，AA)、合并异常MS组分个数和高血压是影响AN检出的因素；调整年龄≥76岁、基线肠镜检出AA的影响后，与不合并任何异常MS组分的患者相比，合并1个(HR=4.50，95% CI：1.01 ~ 20.02，P=0.048)、2个(HR=4.44，95% CI：1.02 ~ 19.29，P=0.047)和3 ~ 4个异常MS组分(HR=5.65，95% CI：1.30 ~ 24.68，P=0.021)的患者AN检出风险均显著升高，相较于非高血压患者，高血压患者AN检出风险也显著升高(HR=3.18，95% CI：1.71 ~ 5.91，P＜0.001)。
结论在中老年男性人群中，基线合并MS的患者结直肠息肉切除术后AN检出风险显著升高。相较于不合并任何异常MS组分的患者，合并3 ~ 4个异常组分的MS(+)患者AN检出风险最高。此外，高血压、基线AA检出也可能是AN检出的危险因素。

Abstract:
Background Metabolic syndrome (MS) is associated with increased risk of colorectal tumors, but its influence on the occurrence of advanced neoplasia (AN) after colorectal polypectomy in middle-aged and elderly males is not clear.
Objective To investigate the effect of MS on the detection of AN after colorectal polypectomy in middle-aged and elderly males.
Methods A retrospective cohort study was used to collect clinical data about 376 middle-aged and elderly males who underwent colonoscopy in the Second Medical Center of Chinese PLA General Hospital from January 2007 to April 2013. According to the diagnostic criteria of MS, the patients were divided into MS (+) group (n=91) and MS (-) group (n=285). The cumulative hazard curve of AN in the two groups was drawn by Kaplan-Meier method and tested by log-rank method. Cox regression analysis was used to analyze the factors affecting AN detection.
Results During the follow-up period, the incidence density of AN in the MS (+) group was 3.06/100 person-years, which was higher than 1.65/100 person-years in the MS(-) group. The cumulative hazard curve of AN showed that the cumulative hazard of AN in the MS (+) group was higher than that in the MS (-) group, and the difference was statistically significant by log-rank test (P<0.05). According to the number of abnormal MS components (0, 1, 2 and 3-4), the patients were further stratified and analyzed. Univariate Cox regression analysis showed that age ≥ 76 years old, detection of advanced adenoma (AA) at baseline, the number of abnormal MS components and hypertension were the factors affecting the detection of AN. After adjusting for the influence of detection of AA at baseline and ≥ 76 years old, the risk of AN detection in patients with 1, 2, and 3-4 abnormal MS components was significantly higher than that in patients without any abnormal MS components (HR=4.50, 95%CI: 1.01-20.02, P=0.048; HR=4.44, 95%CI: 1.02-19.29, P=0.047; HR=5.65, 95%CI: 1.30-24.68, P=0.021). At the same time, the risk of AN detection in patients with hypertension was significantly higher than that in patients without hypertension (HR=3.18, 95%CI: 1.71-5.91, P<0.001).
Conclusion In middle-aged and elderly males, the risk of AN detection after colorectal polypectomy increases significantly in patients with MS at baseline. Compared with patients without any abnormal MS components, MS (+) patients with 3-4 abnormal components have the highest detection risk of AN. In addition, hypertension and detection of AA at baseline are risk factors for AN detection during follow-up.

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