上海冠心病患者结肠直肠腺瘤患病率的横断面调查  

Prevalence of colorectal adenoma in patients with coronary artery disease: A cross-sectional study in Shanghai

作　　者：许庆玲[1] 杨肖波[1] 吴超[1] 唐陈月 俞丽芬[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化科,上海200025

出　　处：《诊断学理论与实践》2016年第1期47-52,共6页Journal of Diagnostics Concepts & Practice

基　　金：国家自然科学基金项目(30872973);上海慈善癌症研究中心基金

摘　　要：目的 ：探讨结肠直肠癌（colorectal cancer,CRC）家族史与冠心病（coronary artery disease,CAD）患者结肠直肠肿瘤患病率的关系。方法：本研究是一项横断面调查,以首次接受冠状动脉（冠脉）血管造影且无CRC相关症状、疑诊CAD者为研究对象。根据亚太地区结肠直肠肿瘤筛查评分（Asia-Pacific colorectal screening score,APCS）对高风险者行结肠镜检查,同时测量其腰围、身高和体重。结果：总计1 157名对象参与本研究,其中54.8%（634/1 157）为高风险者,高风险者中又有91.0%（577/634）为男性吸烟者,而存在CAD的患者占81.5%（517/634）。与高风险人群中非CAD者相比,CAD患者的结肠直肠腺瘤（32.1%比22.2%,P〈0.05）和进展期腺瘤（14.7%比8.6%,P〈0.05）的患病率都显著升高,而CRC患病率在2组间差异则无统计学意义。剔除有一级亲属CRC家族史的83例患者后,结果显示CAD患者仅有结肠直肠腺瘤的患病率高于非CAD者（25.5%比16.0%,P〈0.01）。体质量指数（body mass index,BMI）≥25与CAD患者结肠直肠腺瘤的发生相关（比值比=2.133,95%可信区间为1.219-3.730,P=0.008）。结论：即使无CRC家族史,APCS评分为高风险的CAD患者仍有较高的结肠直肠腺瘤的患病率,且其结肠直肠腺瘤的发生与CAD之间的相关性在超重（BMI≥25）患者中更明显。Objective： To investigate the prevalence of colorectal neoplasms in coronary artery disease（CAD） patients with or without family history of colorectal cancer（CRC）. Methods： In this cross-sectional study, individuals with suspected CAD but no CRC-related symptoms undergoing a coronary angiography for the first time were enrolled. The individuals were divided into CAD and non-CAD according to the results of coronary angiography. Colonoscopy was performed in individuals at high-risk based on their Asia-Pacific colorectal screening（APCS） score. Waist circumference, height and body weight were recorded. Results： Overall, 634 of 1 157（54.8%） individuals were in the high-risk group, 91.0%（577/634） of them were male smokers. The proportion of CAD patients was 81.5%（517/634）. Compared with non-CAD individuals, the prevalence of adenomas（32.1 % vs. 22.2%, P〈0.05） and advanced adenomas（14.7% vs. 8.6%, P〈0.05） were significantly higher in CAD patients. After the exclusion of 83 individuals with a family history of CAD in first degree relatives, the prevalence of adenoma was still significantly higher in CAD patients than in non-CAD individuals（25.5% vs.16.0%, P〈0.01）. Body mass index（BMI）≥25 was positively correlated with the occurrence of adenoma（odds ratio=2.133, 95% CI：1.219-3.730, P=0.008） in CAD patients. Conclusions： Even in the absence of family history of CRC, CAD patients at high-risk as classified by the APCS score still show a remarkably higher prevalence of colorectal adenoma. Moreover, the association between the occurrence of adenoma and CAD is stronger in overweight（BMI≥25） individuals.

关 键 词：亚太地区结肠直肠肿瘤筛查评分 体质量指数 结肠直肠腺瘤 冠心病 家族史 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]