大肠腺瘤性息肉特点及肿瘤坏死因子-α在大肠息肉癌变中的作用研究  

The characteristics of colorectal adenoma polyp and the effect of TNF-αin colorectal polyp canceration

作　　者：郑娟 罗锦斌 张丹丹 伍纹蝶 潘雯婷 Zheng Juan;Luo Jinbin;Zhang Dandan;Wu Wendie;Pan Wenting(Department of Gastroenterology,the People'Hospital of QianNan,Guizhou 558000,China)

机构地区：[1]黔南州人民医院消化内科,558000

出　　处：《山西医药杂志》2020年第19期2563-2567,共5页Shanxi Medical Journal

基　　金：黔南民族医学高等专科学校校基金(QNYZ201841)。

摘　　要：目的探讨大肠腺瘤性息肉(CAP)的临床及内镜病理特点以及肿瘤坏死因子α(TNF-α)在息肉癌变中的作用。方法收集2015年1月至2018年5月在黔南州人民医院消化科及普外科就诊的514例CAP患者的外周血和息肉组织标本,收集患者临床病理信息,并进行风险分层,比较低危腺瘤组患者和高危腺瘤组患者的一般病理特征、疾病史、家族肿瘤史、血清总胆固醇(TC)和甘油三酯(TG)水平以及内镜下息肉病理特征。分别采用免疫组织化学法和ELISA法检测CAP患者组织和外周血TNF-α表达量,并经Cox风险比例回归模型分析高危腺瘤发生的危险因素。结果经电子结肠镜检查,288例(56.0%)患者为低危腺瘤,226例(44.0%)患者为高危腺瘤患者,其中32例(14.2%)患者诊断为息肉恶变。高危腺瘤组内镜下息肉黏膜改变发生率(粗糙27.4%;糜烂溃疡23.4%)以及表面发生分叶率(31.2%)明显高于低危腺瘤组患者(P<0.05)。另外,高危腺瘤组患者既往有糖尿病史(5.9%与15.0%)、高血压病史(12.8%与24.8%)、家族肿瘤病史者(3.1%与8.0%)、TC(74.0%与86.3%)和TG(2.1%与10.6%)异常升高者、BMI超重者(30.9%与43.4%)的比例分别为高于低危腺瘤组患者(P<0.05)。高危腺瘤组(排除癌变患者)息肉组织中TNF-α为(2.15±0.90)μg/L,高于低危腺瘤组(1.18±0.62)μg/L,但低于息肉癌变组患者(3.27±0.98)μg/L(P<0.05)。同样,在低危腺瘤组和高危腺瘤组(排除癌变患者)患者外周血中TNF-α分别为(32.75±18.01)μg/L、(35.12±20.97)μg/L(P>0.05),但是均低于癌变组患者(52.37±21.14)μg/L(P<0.05)。经Cox风险比例模型回归分析,家族肿瘤病史、TG和TNF-α升高是影响高危腺瘤发生的独立因素(P<0.05)。结论家族肿瘤史、甘油三酯和TNF-α水平升高是高危腺瘤发生的独立危险因素,且TNF-α可能参与了息肉恶变过程,可作为息肉恶变的检测指标。Objective To investigate the clinical characteristics of colorectal adenoma polyp(CAP)and the effect of tumor necrosis factorα(TNF-α)on the carcinogenesis of CAP.Methods The blood and tissues samples of 514 CAP patients with colonoscopic resection in our hospital from January 2015 to May 2018 were collected.The clinical information including age,gender,body mass index(BMI),history of diseases,family history of cancer,total cholesterol(TC),triglyceride(TG)and TNF-αlevels were analyzed.Immunohistochemical method and ELISA were respectively used to detected the tissue levels and plasma levels of TNF-α.The risk factors of advanced adenoma were analyzed by Cox proportional hazard model.Results There were 288 patients(56.0%)with low-risk adenoma and 226 patients(44.0%)with high-risk adenoma including 32 patients(14.2%)with malignant polyps.The patients with high-risk adenoma had higher incidence of mucosal pathological changes and more lobular than patients with low-risk(P<0.05).Besides,there were more patients with diabetes(5.9%vs.15.0%),hypertension(12.8%vs 24.8%),family history of cancer(3.1%vs 8.0%),TC≥5.85 mmol/L(74.0%vs 86.3%),TG≥1.70 mmol/L(2.1%vs 10.6%),BMI≥23.9 kg/m2(30.9%vs 43.4%)than low-risk adenoma group(P<0.05).The polyp tissue level of TNF-αin high-risk adenoma group(except of malignant polyps)was(2.15±0.90)μg/L,which was higher than that in low-risk group(1.18±0.62)μg/L,but lower than that of patients with malignant polyps(3.27±0.98)μg/L(P<0.05).Meanwhile,the serum levels of TNF-αin low-risk adenoma group and high-risk adenoma group(except of malignant polyps)were respectively(32.75±18.01)μg/L and(35.12±20.97)μg/L(P>0.05),which were lower than that of patients with malignant polyps(52.37±21.14)μg/L(P<0.05).The family history of cancer,abnormally high TG and TNF-αlevels were independent risk factors by Cox proportional hazard regression analysis(P<0.05).Conclusion The family history of cancer,abnormally high TG and high TNF-αlevels were independent risk factors of high risk aden

关 键 词：大肠腺瘤性息肉 高危腺瘤 息肉癌变 肿瘤坏死因子-Α 危险因素 

分 类 号：R735.34[医药卫生—肿瘤]