炎性肠病相关性结直肠癌的危险因素分析  

Study on risk factors of colorectal cancer associated with inflammatory bowel disease

作　　者：刘媛[1] 熊颖[1] 夏培 郭芳 田爱霞[2] LIU Yuan;XIONG Ying;XIA Pei;GUO Fang;TIAN Ai-xia(Department of Gastroenterology,Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Gastroenterology,Xiangyang Central Hospital,Hubei,Xiangyang 441021,China)

机构地区：[1]华中科技大学同济医学院附属协和医院消化内科,武汉430022 [2]襄阳市中心医院湖北文理学院附属医院消化内科,湖北襄阳441021

出　　处：《中国医学前沿杂志（电子版）》2019年第10期144-148,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨炎性肠病相关性结直肠癌的危险因素。方法选取华中科技大学同济医学院附属协和医院和襄阳市中心医院2010年3月至2013年8月就诊的400例炎性肠病患者进行5年的观察随访,然后将其中结直肠癌患者纳入观察组(37例),其余患者纳入对照组(363例),采用单因素和多因素Logistic回归分析明确炎性肠病相关性结直肠癌的危险因素,并采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)的曲线下面积(area under the curve,AUC)。结果观察组年龄> 40岁、病程> 6年、有结直肠癌家族史、体质指数(body mass index,BMI)> 24 kg/m^2、合并糖尿病、病变部位广泛、伴发原发性硬化性胆管炎(primarysclerosing cholangitis,PSC)患者占比和CRP、PCT水平均显著高于对照组(均P < 0.05),应用生物制剂和免疫抑制剂的患者占比均显著低于对照组(均P < 0.05)。病程> 6年、有结直肠癌家族史、合并糖尿病、病变部位广泛、伴PSC高CRP水平、高PCT水平、BMI > 24 kg/m2均是炎性肠病相关性结直肠癌的危险因素(均P < 0.05),应用生物制剂和免疫抑制剂是其保护因素(均P < 0.05)。CRP和PCT诊断炎性肠病相关性结直肠癌的AUC比较差异无统计学意义(P > 0.05)。结论病程>6年、有结直肠癌家族史、BMI >24kg/m^2、合并糖尿病、伴发PSC、病变部位广泛、血清CRP、PCT水平升高的炎性肠病患者均应及早进行结直肠癌筛查,并合理应用生物制剂和免疫抑制剂。Objective To investigate the risk factors of colorectal cancer associated with inflammatory bowel disease. Method From March 2010 to August 2013, 400 patients with inflammatory bowel disease were selected and followed up for 5 years. The patients with colorectal cancer were selected into observation group (37 cases) and the remaining patients were included into control group (363 cases). Identification of risk factors of colorectal cancer associated with inflammatory bowel disease by univariate and multivariate Logistic regression analysis, and the area under the curve (AUC) of C-reactive protein (CRP) and procalcitonin (PCT) were analyzed by receiver operator characteristic curve (ROC curve). Result In observation group, the proportion of patients the age > 40 years, the course of disease > 6 years, with a family history of colorectal cancer, body mass index (BMI)> 24 kg/m^2, complicated with diabetes mellitus, the lesion involves the whole colon, primary sclerosing cholangitis (PSC) and the levels of CRP and PCT were significantly higher than those in control group (all P < 0.05), the proportion of patients treated with biological agents and immunosuppressants were significantly lower than those in control group (all P < 0.05). The course of disease > 6 years, with a family history of colorectal cancer, complicated with diabetes mellitus, the location of the lesion was extensive, PSC, high CRP level, high PCT level and high BMI were all risk factors of colorectal cancer associated with inflammatory bowel disease (all P < 0.05), the application of biological agents and immunosuppressants were protective factors (all P < 0.05). There was no significant difference in AUC between CRP and PCT (P > 0.05). Conclusion Inflammatory bowel disease patients with the course of disease > 6 years, with a family history of colorectal cancer, BMI > 24 kg/m^2, complicated with diabetes mellitus, with the PSC the location of the lesion was extensive, high CRP level, high PCT level should be screened for colorectal cancer as early

关 键 词：炎性肠病 结直肠癌 危险因素 

分 类 号：R574[医药卫生—消化系统] R735.34[医药卫生—内科学]