溃疡性结肠炎患者随访期间异型增生发生率及危险因素分析  

Incidence and risk factors of dysplasia in patients with ulcerative colitis during follow-up

作　　者：李静[1] 李文智[2] 陈红梅[1] 朱姣[3] 路德艳[1] 尚琳娜 王娟[1] LI Jing;LI Wen-zhi;CHEN Hong-mei;ZHU Jiao;LU De-yan;SHANG Lin-na;WANG Juan(Department of infection,First Affiliated Hospital of Xi′an Jiaotong University,Shaanxi Xi′an,710068,China;Chang′an District Hospital,the First Affiliated Hospital of Xi′an Jiaotong University,Shaanxi Xi′an,710018,China;Department of Gastroenterology,the First Affiliated Hospital of Xi′an Jiaotong University,Shaanxi Xi′an,710068,China)

机构地区：[1]西安交通大学第一附属医院感染科,710068 [2]西安交通大学第一附属医院肝胆外科,710068 [3]西安交通大学第一附属医院消化科,710068

出　　处：《现代消化及介入诊疗》2021年第10期1230-1233,1238,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：陕西省自然科学基础研究计划项目(2018KJ0512-3)。

摘　　要：目的观察溃疡性结肠炎(UC)患者随访期间异型增生发生率及危险因素。方法前瞻性纳入西安交通大学第一附属医院收治的UC患者332例,于患者出院后持续随访1年,随访期间观察异型增生发生情况,将332例UC患者中发生异型增生者分为增生组,未发生异型增生者分为未增生组。统计两组性别、年龄、病程、身体质量指数(BMI)、高血压、糖尿病、冠心病、吸烟史、饮酒、辛辣饮食、油腻饮食、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白介素-6(IL-6)、白介素-8(IL-6)、肿瘤坏死因子-α(TNF-α)、黏膜炎症程度、结直肠癌家族史、蒙特利尔分型(左半结肠型、广泛结肠型)、合并原发性硬化性胆管炎(PSC)各项信息。对比增生组和未增生组基础资料差异,将有差异的单因素息纳入Logistic模型,行量化赋值,明确UC患者随访期间异型增生发生的危险因素。结果332例UC患者中,随访期间发生异型增生的有37例,异型增生发生率为11.14%。增生组年龄≥50岁、诊断年龄<30岁、吸烟史、辛辣饮食、油腻饮食、中重度黏膜炎症、广泛结肠型患者占比显著高于未增生组,IL-6、IL-8、TNF-α水平显著高于未增生组(P均<0.05)。多因素Logistic回归分析显示,年龄≥50岁、诊断年龄<30岁、吸烟史、辛辣饮食、油腻饮食、IL-6≥40.23 ng/L、IL-8≥40.23 ng/L、TNF-α≥40.23 ng/L、中重度黏膜炎症、广泛结肠型是UC患者随访期间异型增生发生的独立危险因素(P均<0.05)。结论UC患者治疗后异型增生发生率较高,约为11%,其中年龄较大、诊断年龄较小、吸烟史、辛辣饮食、油腻饮食、血清炎症因子水平较高、中重度黏膜炎症、广泛结肠型的患者发生异型增生可能性较高,临床应加强对具有以上特征患者的癌变监测。Objective To observe the incidence and risk factors of intestinal mucosal dysplasia in patients with ulcerative colitis(UC).Methods A total of 332 UC patients were prospectively enrolled in our hospital.They were followed up for 1 year after discharge,and during the follow-up period,the occurrence of intestinal mucosal dysplasia was observed.We divided 332 UC patients with dysplasia into hyperplasia group and non-hyperplasia group according to whether intestinal mucosal dysplasia occurred.Gender,age,course of disease,body mass index(BMI),hypertension,diabetes,coronary heart disease,smoking history,alcohol drinking,spicy diet,greasy diet,total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),interleukin-6(IL-6),interleukin-8(IL-6),serum lipid level(HDL-C),serum lipid level(HDL-C),serum lipid level(IL-6),serum lipid level(HDL-C),serum lipid level(HDL-C),serum lipid level(IL-6),serum lipid level(IL-8),tumor necrosis factor-α(TNF-α)、the degree of mucosal inflammation,family history of colorectal cancer,Montreal classification(left hemicolon type,extensive colon type)and primary sclerosing cholangitis(PSC)were analyzed.Results Among 332 UC patients,37 cases had dysplasia during the follow-up period,and the incidence of dysplasia was 11.14%.The proportion of patients with aged≥50 years old,age of diagnosis<30 years old,smoking history,spicy diet,greasy diet,moderate to severe mucosal inflammation and extensive colon type in hyperplasia group was significantly higher than that in non-hyperplasia group,and the levels of IL-6,IL-8 and TNF-αin hyperplasia group were significantly higher than those in non-hyperplasia group(P<0.05).Multivariate logistic regression analysis confirmed that age≥50 years old,diagnostic age<30 years old,smoking history,spicy diet,greasy diet,IL-6≥40.23 ng/L,IL-8≥40.23 ng/L,TNF-α≥23 ng/L,moderate to severe mucosal inflammation and extensive colon type were risk factors of dysplasia in UC patients during follow-u

关 键 词：溃疡性结肠炎 异型增生 危险因素 结直肠癌 

分 类 号：R574.62[医药卫生—消化系统]