本文選題：代謝綜合征 + 結(jié)直腸息肉��； 參考：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:結(jié)直腸息肉(Colorectal polyps)是一類突出于腸道黏膜的贅生物,是結(jié)直腸粘膜上皮的隆起性病變。依據(jù)Morsom組織病理學(xué)分類,結(jié)直腸息肉可以分為腺瘤性(Colorectal adenomat polyps,CAP)及非腺瘤性息肉(non Colorectal adenomatpolyps,NCAP),非腺瘤性息肉包括炎性息肉、增生性息肉、脂肪瘤及錯構(gòu)瘤等,臨床最常見的為腺瘤性息肉。結(jié)直腸腺瘤現(xiàn)被認(rèn)為是結(jié)直腸癌癌前病變之一,現(xiàn)已形成“腺瘤-癌”序列。結(jié)直腸癌發(fā)病率現(xiàn)逐年上升,在全世界惡性腫瘤的發(fā)病率中,男性為第三位,女性為第二位,在我國的發(fā)病率以每年4.2%的速度增長。結(jié)直腸癌早期多無明顯癥狀,出現(xiàn)癥狀多為消化道常見癥狀,由于臨床癥狀不典型,常被患者所忽視。早期發(fā)現(xiàn)結(jié)直腸癌及其癌前病變,研究其影響因素,并進(jìn)行干涉,則有望進(jìn)一步降低結(jié)直腸癌的發(fā)病率。目前已有研究證明代謝綜合征是結(jié)直腸腺瘤性息肉的危險因素之一,并研究證實代謝綜合征及其相關(guān)因素與結(jié)直腸息肉的出現(xiàn)有關(guān),且與結(jié)直腸息肉復(fù)發(fā)有關(guān)。對于代謝綜合征與結(jié)直息肉的相關(guān)研究國內(nèi)報道較少,尤其非腺瘤性息肉研究更為少見。本文將進(jìn)一步研究代謝綜合征及其相關(guān)因素與結(jié)直腸息肉的關(guān)系。從而進(jìn)一步確定結(jié)直腸息肉發(fā)生的危險因素,對結(jié)直腸癌的預(yù)防提供依據(jù)。方法:選取2011年04月20日至2014年10月20日于大連醫(yī)科大學(xué)附屬第一醫(yī)院三部腸鏡室行結(jié)腸鏡檢查的住院患者為研究對象。整理腸鏡相關(guān)資料,記錄診斷、息肉大小及病理類型。按病理結(jié)果分腺瘤性結(jié)直腸息肉組(CAP組)和非腺瘤性結(jié)直腸息肉組(NCAP組),并選取行結(jié)腸鏡檢查未見異�；颊邽閷φ战M。根據(jù)既往病史及影像學(xué)檢查等,記錄是否患有高血壓、冠心病、糖尿病、脂肪肝,并記錄相關(guān)生化檢查資料,包括血尿酸、空腹血糖、甘油三酯、總膽固醇、高密度脂蛋白、低密度脂蛋白等數(shù)值。應(yīng)用spss 17.0進(jìn)行分析,分別將CAP組、NCAP與對照組組間各項臨床參數(shù)進(jìn)行比較分析。結(jié)果:1.CAP組與NCAP組患者平均年齡均高于對照組,均具有統(tǒng)計學(xué)差異(P0.05)。腺瘤組及非腺瘤組男性患者檢出率分別為64.94%、50%,腺瘤組差異具備統(tǒng)計學(xué)意義(P0.05),非腺瘤組與對照組比較差別無統(tǒng)計學(xué)意義(P0.05)。2.CAP組及NCAP組甘油三酯、膽固醇及低密度脂蛋白平均水平均高于對照組,高密度脂蛋白平均水平較對照組低。CAP組甘油三酯及高密度脂蛋白差異具備統(tǒng)計學(xué)意義(P0.05)。NCAP組僅甘油三酯差別具有統(tǒng)計學(xué)意義(P0.05),其他三項均無差異(P0.05)。3.CAP組高血壓、脂肪肝、冠心病陽性檢出率分別為37.96%、25.77%、8.76%,與對照組相比脂肪肝及高血壓差異具有統(tǒng)計學(xué)意義(P0.05)。非腺瘤組高血壓、脂肪肝、冠心病陽性檢出率分別為30.49%、17.07%、8.53%,差異均不具有統(tǒng)計學(xué)意義(P0.05)。4.CAP組2型糖尿病檢出率為25.77%,高于對照組的檢出率(11.76%),具有統(tǒng)計學(xué)差異(P0.05),NCAP組檢出率為15.85,與對照組差異無統(tǒng)計學(xué)意義(P0.05)。兩組空腹血糖平均水平均與對照組相比對,均不具有統(tǒng)計學(xué)差異(P0.05)。5.CAP組及NCAP組血尿酸平均水平與對照組相比,差異均不具備統(tǒng)計學(xué)意義(P0.05)。6.多因素非條件Logistic回歸分析顯示,CAP組性別,年齡,糖尿病,TG,HDL是腺瘤發(fā)生的危險因素,其OR值分別為:1.939(95%CI為1.192-3.154);1.043(95%CI為1.021-1.066);2.287(95%CI為1.192-4.390);5.993(95%CI為3.438-10.447);3.936(95%CI為01.193-8.098),此時P值小于0.05。NCAP組年齡,TG為危險因素,其OR值分別為:1.054(95%CI為1.026-1.082);9.428(95%CI為4.327-20.543),差異有統(tǒng)計學(xué)意義。結(jié)論:年齡、性別、脂肪肝、高血壓、2型糖尿病、甘油三酯、高密度脂蛋白與結(jié)直腸腺瘤性息肉發(fā)生差異有統(tǒng)計學(xué)意義。非腺瘤性息肉僅與年齡及甘油三酯有關(guān)。多因素回歸分析顯示,性別,年齡,糖尿病,TG,HDL為腺瘤性息肉的危險因素,非腺瘤組年齡,TG為危險因素。
[Abstract]:Objective: colorectal polyps (Colorectal polyps) is a neoplasm of the intestinal mucosa, which is a protuberant lesion of the epithelium of the colorectal mucosa. According to the histopathological classification of Morsom, colorectal polyps can be divided into adenomatous (Colorectal adenomat polyps, CAP) and non adenomatous polyps (non Colorectal adenomatpolyps, NCAP) and non adenomatous. Polyps, including inflammatory polyps, hyperplastic polyps, lipoma and hamartoma, are the most common adenomatous polyps. Colorectal adenomas are now considered to be one of the precancerous lesions of colorectal cancer, and the "adenoma cancer" sequence has been formed. The incidence of colorectal cancer is increasing year by year, and the incidence of malignant tumors in the world is third, female The incidence of the disease is second in China at a rate of 4.2% per year. There are no obvious symptoms in the early stage of colorectal cancer and most of the symptoms are common symptoms in the digestive tract. The patients are often ignored because of the untypical clinical symptoms. The early detection of colorectal cancer and its precancerous lesions, the study of its influencing factors, and intervention are expected to be further reduced. Current studies have shown that metabolic syndrome is one of the risk factors for colorectal adenomatous polyps, and studies have confirmed that metabolic syndrome and its related factors are associated with the appearance of colorectal polyps and are associated with recrudescence of colorectal polyps. The study of non adenomatous polyps is particularly rare. This article will further study the relationship between metabolic syndrome and its related factors and colorectal polyps, and further determine the risk factors for colorectal polyps, and provide a basis for the prevention of colorectal cancer. Methods: from 20 to October 20, 2014 2011 to Dalian Medical University in Dalian Medical University. In the three enteroscopy room of the first hospital, the patients with colonoscopy were studied. Enteroscopy related data, records of diagnosis, polyp size and pathological type were recorded. According to the pathological results, the adenomatous colorectal polyp group (group CAP) and non adenomatous colorectal polyp group (group NCAP) were divided, and the patients who did not have abnormal colonoscopy were selected as the control group. According to previous medical history and imaging examination, records of hypertension, coronary heart disease, diabetes, and fatty liver were recorded, including blood uric acid, fasting blood glucose, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein and so on. SPSS 17 was used to analyze group CAP, NCAP and control group, respectively. Results: the average age of the 1.CAP group and the NCAP group was higher than the control group (P0.05). The detection rate of the adenoma group and the non adenoma group was 64.94%, 50%, and the difference of the adenoma group was statistically significant (P0.05), and there was no statistical difference between the non adenoma group and the control group (P 0.05) the average level of triglyceride, cholesterol and low density lipoprotein in group.2.CAP and NCAP was higher than that of the control group. The average level of HDL was higher than that of the control group. The difference of triglyceride and high density lipoprotein in the lower.CAP group was statistically significant (P0.05) in group.NCAP, the difference between triglyceride and triglyceride was statistically significant (P0.05), and there was no difference in the other three items. (P0.05) the positive rates of hypertension, fatty liver and coronary heart disease in group.3.CAP were 37.96%, 25.77%, 8.76% respectively. The difference of fatty liver and hypertension was statistically significant (P0.05) compared with the control group. The positive rates of non adenoma hypertension, fatty liver and coronary heart disease were 30.49%, 17.07%, 8.53%, respectively, and the difference was not statistically significant (P0.05).4.CAP group 2 The detection rate of type 2 diabetes was 25.77%, higher than that of the control group (11.76%), with statistical difference (P0.05), the detection rate in group NCAP was 15.85, and there was no significant difference between the control group (P0.05). The average level of fasting blood glucose in the two groups was not statistically different from the control group (P0.05) and the average level of serum uric acid in.5.CAP and NCAP groups. Compared with the control group, the difference was not statistically significant (P0.05).6. multiple factors unconditional Logistic regression analysis showed that sex, age, diabetes, TG, HDL were risk factors for adenoma in CAP group, and the OR values were 1.939 (95%CI to 1.192-3.154), 1.043 (95%CI 1.021-1.066); 2.287 (95%CI was); 3; 3 .936 (95%CI 01.193-8.098), at this time the P value is less than the 0.05.NCAP group age, TG is a risk factor, its OR value is 1.054 (95%CI is 1.026-1.082); 9.428 (95%CI is 4.327-20.543), the difference is statistically significant. Conclusion: age, sex, fatty liver, hypertension, type 2 diabetes, triglyceride, high density lipoprotein and colorectal adenomatous polyps The differences were statistically significant. Non adenomatous polyps were associated with age and triglycerides only. Multivariate regression analysis showed that sex, age, diabetes, TG, HDL were risk factors for adenomatous polyps, non adenomatous age, and TG as a risk factor.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.34;R589

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