肥胖与大肠腺瘤关系的临床及分子机制  

Clinical and molecular mechanism of the relationship between obesity and colorectal adenoma

作　　者：王娜[1] 黄志刚[2] 陈锡美[2] 叶荣菊 王讳[2] 张霞[2] 张建培[2] 

机构地区：[1]上海长宁区中心医院消化内科,上海市200336 [2]上海同济大学医学院附属同济医院消化内科,上海市200065 [3]上海静安区老年医院消化内科,上海市200040

出　　处：《世界华人消化杂志》2008年第29期3283-3288,共6页World Chinese Journal of Digestology

摘　　要：目的:初步了解肥胖人群患大肠腺瘤的危险性,并进一步深入探讨肥胖与大肠肿瘤的关系及其防治.方法:选择2006-12/2007-12在我院行结肠镜检查的患者539例,分为大肠腺瘤组(n=250)和正常对照组(n=289),测量身高、体质量、腰围及臀围,利用多因素Logistic回归进行相关性分析;从大肠腺瘤组中选择4例病理为管状腺瘤或绒毛管状腺瘤的大肠息肉组织,2例BMI>24kg/m2,WC>85cm;2例BMI<24kg/m2,WC<85cm,进行信号通路功能芯片基因筛查.结果:肥胖或腹型肥胖(以BMI和WC划分)患大肠腺瘤的调整后OR值分别为2.48(95%CI:1.19-5.20,P=0.016)和1.75(95%CI:1.15-2.66,P=0.009),其中男性调整后的OR值分别为4.10(95%CI:1.26-13.31,P=0.019)和1.70(95%CI:1.00-2.88,P=0.019),以BMI划分的超重组差异无统计学意义;以WHR划分的腹型肥胖在各种分析中均无统计学意义.基因芯片杂交结果显示,两组差异表达的基因共23个,其中BMI>24kg/m2组比BMI<24kg/m2组表达上调有6个,下调有17个,脂肪细胞因子Foxa2表达上调,IL-8和Leptin表达下调.结论:肥胖或腹型肥胖与大肠腺瘤的发生存在显著相关性,肥胖男性的患病风险明显大于女性;患大肠腺瘤肥胖人群的腺瘤组织中存在一些异常表达的因子.AIM： To investigate the relationship between obesity and the colorectal precancerous lesionadenoma, and to further investigate relationship between obesity and colon cancer and its prevention and treatment. METHODS： A total of 539 subjects who underwent colonoscopy in Tongji Hospital from December 2006 to December 2007 were selected, and divided into the adenoma group （n = 250） and the control group （n = 289）. Body height, weight, waist and hip circumference were measured, respectively. All data were analyzed using logistic multi-factors regression. Four adenomatous tissues, pathologically-confirmed as tubular adenoma or tubulovillous adenoma, 2 with BMI 〉 24, WC 〉 85 cm, and the others with BMI 〈 24, WC 〈 85 cm, were selected from adenoma group, and used to screen the differentially expressed gene by Oligo Signal Transduction Pathway Microarray. RESULTS： Obesity （by using BMI cut-offs） （ORadj = 2.48, 95% CI = 1.19-5.20, P = 0.016） and abdom- inal adiposity （by using WC cut-offs） （ORadj = 1.75, 95% CI = 1.15-2.66, P = 0.009） were significantly associated with an increased risk of colorectal adenomas, especially in men（ORadj = 4.10 and 1.70, 95% CI = 1.26-13.31 and 1.00-2.88, P = 0.019 and 0.019, respectively）, but there was no association in overweight group. Abdominal adiposity based on WHR showed no significant difference. Genomic hybridization showed 23 differentially ex- pressed genes between the two groups. Among them, there were 6 genes up-regulated in BMI 〉 24 group, and 17 genes down-regulated in BMI 〈 24 group. Foxa2 was up-regulated, and IL-8 and Leptin were down-regulated. CONCLUSION： Obesity or abdominal adiposity is positively associated with colorectal adenomas; the risk is highly increased in men. It is presumed that there are several abnormally expressed factors in the colorectal adenomous tissues of obesity.

关 键 词：肥胖 大肠腺瘤 流行病学 功能分类基因芯片 

分 类 号：R735.34[医药卫生—肿瘤] R587.1[医药卫生—临床医学]