發(fā)布時間：2018-04-14 14:29

  本文選題：結(jié)直腸腺瘤性息肉 + 非酒精性脂肪肝　； 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景代謝綜合征和胰島素抵抗與結(jié)直腸腺瘤性息肉的發(fā)病密切相關(guān)，非酒精性脂肪肝（NAFLD）被認(rèn)為是代謝綜合征在肝臟的表現(xiàn)，我們推測非酒精性脂肪肝是結(jié)直腸腺瘤性息肉發(fā)病的重要影響因素之一。 目的分析結(jié)直腸腺瘤性息肉發(fā)病的危險(xiǎn)因素，并探討NAFLD與結(jié)直腸腺瘤性息肉的相關(guān)性。 方法選擇我院2007年10月--2013年5月住院完善腸鏡檢查和相關(guān)輔助檢查資料完整的患者2165例,劃分為結(jié)直腸腺瘤組(n=413)及對照組(1752)。記錄分析患者的一般資料（姓名、性別、年齡、血壓值，既往有無高血壓病、2型糖尿病、吸煙、飲酒情況）；血生化檢查結(jié)果（空腹血糖、總膽固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、γ-谷氨酰轉(zhuǎn)肽酶、血尿酸）；已完善的上腹部B超或CT檢查了解有無NAFLD。根據(jù)腸鏡檢查及病理學(xué)檢查結(jié)果分為結(jié)直腸腺瘤組和對照組，對兩組各項(xiàng)指標(biāo)先行t或X2檢驗(yàn)，比較兩組間的NAFLD發(fā)病率有無差異；應(yīng)用非條件Logistic回歸分析進(jìn)行單因素及多因素分析NAFLD是否為結(jié)直腸腺瘤性息肉的危險(xiǎn)因素，并對NAFLD與結(jié)直腸腺瘤性息肉的位置、數(shù)目、大小、病理類型進(jìn)行非條件Logistic回歸分析。 結(jié)果（1）與對照組相比，結(jié)直腸腺瘤性息肉組的年齡平均值、男性發(fā)病率、舒張壓平均值均高于對照組，且差異存在統(tǒng)計(jì)學(xué)意義（P＜0.05）；結(jié)直腸腺瘤組的收縮壓平均值雖高于對照組，但差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 （2）比較兩組間的血生化指標(biāo)發(fā)現(xiàn)結(jié)直腸腺瘤組的谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、尿酸、空腹血糖、甘油三脂的平均值高于對照組，高密度脂蛋白低于對照組，差異存在統(tǒng)計(jì)學(xué)意義（P＜0.05）；而低密度脂蛋白、γ-谷氨酰轉(zhuǎn)肽酶、總膽固醇的值雖高于對照組，但差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。 （3）結(jié)直腸腺瘤組與對照組高血壓病的發(fā)病率分別為18.4%、12.9%；2型糖尿病發(fā)病率分別為10.5%、6.1%；吸煙率分別為20.3%、14.4%，NAFLD的發(fā)病率分別為30.7%、23.1%；兩組間差異均有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 （4）采用Logistic回歸法對數(shù)據(jù)分析后顯示,年齡、性別、吸煙病史、NAFLD是結(jié)直腸腺瘤性息肉的危險(xiǎn)因素,其OR值及95%CI分別為（2.1395%CI1.70-2.65、1.8895%CI1.45-2.47、1.5495%CI1.18-2.04、1.1695%CI1.04-1.58）(P＜0.05);而高血壓病、2型糖尿病與結(jié)直腸腺瘤性息肉的發(fā)生無明顯相關(guān)性,其OR值及95%CI分別為（1.050.82-1.45、1.330.86-2.25）（P＞0.05）。 （5）采用Logistic回歸對數(shù)據(jù)分析腺瘤性息肉位置、大小、數(shù)目、高危腺瘤與NAFLD的相關(guān)性：僅結(jié)直腸腺瘤性息肉的數(shù)目與NAFLD有相關(guān)性(OR,1.82,95%CI,1.06-3.15)，而息肉大小、位置、是否為高危腺瘤與NAFLD無先關(guān)性，，其OR值及95%CI分別為（1.360.68~2.23；0.780.62~1.15；0.820.62~1.83）。（校正年齡、性別、吸煙病史的混雜因素影響） 結(jié)論男性、高齡、代謝綜合征部分因素及NAFLD和結(jié)直腸腺瘤性息肉相關(guān)，多因素回歸分析顯示年齡、性別、吸煙、NAFLD是結(jié)直腸腺瘤性息肉發(fā)生的獨(dú)立危險(xiǎn)因素，NAFLD患者更易發(fā)生結(jié)直腸多發(fā)的腺瘤性息肉。
[Abstract]:The background of the metabolic syndrome and insulin resistance syndrome patients with colorectal adenomatous polyps are closely related, nonalcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of the metabolic syndrome, we hypothesized that nonalcoholic fatty liver is an important effect of colorectal adenomatous polyps factor.
Objective to analyze the risk factors of colorectal adenomatous polyps and to explore the correlation between NAFLD and colorectal adenomatous polyps.
Methods in our hospital in October 2007 --2013 year in May 2165 cases of hospitalized complete colonoscopy and related auxiliary examination with complete data, divided into colorectal adenoma group (n=413) and control group (1752). Analysis of records of patients with general information (name, gender, age, blood pressure, history of hypertension, type 2 diabetes mellitus. Smoking, alcohol); blood biochemical tests (fasting blood glucose, total cholesterol, glycerin three fat, high density lipoprotein, low density lipoprotein, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transpeptidase, uric acid); have perfect abdominal ultrasound or CT examination to understand whether NAFLD. according to the colonoscopy and pathological examination were divided into colorectal adenoma group and control group, two groups of indicators of the first t or X2 test, compared the incidence of NAFLD between the two groups was no difference; the application of non conditional Logistic regression analysis of single factor and multiple factors To analyze whether NAFLD is a risk factor for colorectal adenomatous polyps, and to make an unconditional Logistic regression analysis of the location, number, size and pathological types of NAFLD and colorectal adenomatous polyps.
Results (1) compared with the control group, colorectal adenomatous polyp group average age, male incidence rate, average blood pressure values were higher than the control group, and the difference wasstatistically significant (P < 0.05); colorectal adenoma group mean systolic pressure was higher than the control group, but the difference was not statistically significant (P > 0.05).
(2) the comparison between two groups of blood biochemical indexes of colorectal adenoma group, alanine aminotransferase, aspartate transaminase, uric acid, fasting blood glucose, average value of glycerin three greases was higher than the control group, the high density lipoprotein is lower than the control group, the difference was statistically significant (P < 0.05); low density lipoprotein, gamma glutamyl transpeptidase, total cholesterol values are higher than the control group, but the difference was not statistically significant (P > 0.05).
(3) the incidence of hypertension in colorectal adenoma group and control group was 18.4% and 12.9% respectively; the incidence of type 2 diabetes was 10.5% and 6.1%, smoking rates were 20.3% and 14.4%, respectively, and the incidence of NAFLD was 30.7% and 23.1%, respectively, and the difference between two groups was statistically significant (P < two).
(4) using Logistic regression method for data analysis showed that age, gender, smoking history, NAFLD is a risk factor for colorectal adenomatous polyps, the values of OR and 95%CI respectively (2.1395%CI1.70-2.65,1.8895%CI1.45-2.47,1.5495%CI1.18-2.04,1.1695%CI1.04-1.58) (P < 0.05); and hypertension, there is no significant association between type 2 diabetes and colorectal adenomatous polyps. The values of OR and 95%CI respectively (1.050.82-1.45,1.330.86-2.25) (P > 0.05).
(5) using Logistic regression adenomatous polyp location, size of data analysis, the number of correlation between high-risk adenomas and NAFLD: correlation of only colorectal adenomatous polyp number and NAFLD (OR, 1.82,95%CI, 1.06-3.15), and the polyp size, location, whether high-risk adenoma and NAFLD without first off, the value of OR and 95%CI respectively (1.360.68~2.23; 0.780.62~1.15; 0.820.62~1.83). (adjusted for age, sex, smoking history confounding effects)
Conclusion male, age, metabolic syndrome factors and NAFLD and colorectal adenomatous polyps, multi factor regression analysis showed that age, gender, smoking, NAFLD is an independent risk factor for colorectal adenomatous polyps, NAFLD patients are more susceptible to multiple colorectal polyps gland tumor.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.5;R735.34

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本文編號：1749746