不同年龄患者结直肠锯齿状病变的临床病理特征及相关因素分析  

Clinicopathological features of colorectal serrated lesions and associated risk factors in patients of different ages

作　　者：王娜 贾兴芳[1] 王凯[1] 刘成霞[1] WANG Na;JIA Xingfang;WANG Kai;LIU Chengxia(Department of Gastroenterology,Affiliated Hospital of Binzhou Medical College,Shandong Binzhou 256603,China)

机构地区：[1]滨州医学院附属医院消化内科,山东滨州256003

出　　处：《现代肿瘤医学》2023年第17期3227-3231,共5页Journal of Modern Oncology

基　　金：山东省教育厅“临床医学+X”学科建设项目资助课题(编号:200375);山东省省级临床重点学科建设(编号:SLCZDZK-13);山东省滨州市科技发展计划项目(编号:2015ZC0319)。

摘　　要：目的:分析不同年龄患者的结直肠锯齿状病变(colorectal serrated lesions,CSL)临床、内镜、病理特征,并讨论各年龄组CSL发生高级别异型增生的相关危险因素。方法:回顾性分析2019年01月至2021年12月761例CSL患者的临床资料,按年龄分组,分为青年组、中年组、老年组。分析并比较3组临床、内镜、病理特点。根据是否发生高级别异型增生,通过单因素及Logistic回归分析,评估各年龄组CSL发生高级别异型增生的相关危险因素及可能的独立影响因素。结果:共检出1141枚息肉,其中老年组627枚,中年组386枚,青年组128枚。老年组便血及便秘发生率高于中年组和青年组;三组病变多位于直肠与左半结肠,内镜形态均以扁平型居多(P>0.05)。增生性息肉(hyperplastic polyp,HP)无异型增生,无蒂锯齿状病变(sessile serrated lesions,SSLs)伴高级别异型增生在三组中差异无统计学意义(P>0.05),而传统锯齿状腺瘤(traditional serrated adenoma,TSA)伴高级别异型增生只在老年组中发现。经Logistic回归分析,吸烟、胆囊切除后是各年龄组中CSL发生高级别异型增生的独立危险因素。结论:CSL的发生率随年龄增大逐渐增加,吸烟、胆囊切除后可能增加CSL发生高级别异型增生的风险。Objective:To analyze the clinical,endoscopic and pathological features of patients with colorectal serrated lesions(CSL)of different ages,and to discuss the risk factors for high-grade dysplasia of CSL in different age groups.Methods:The clinical data of 761 patients with CSL from January 2019 to December 2021 were retrospectively analyzed and divided into young group,middle group and old group according to age group.The clinical,endoscopic and pathological characteristics of the three groups were analyzed and compared.According to whether high-grade dysplasia occurred,Logistic regression analysis was performed to evaluate the risk factors and possible independent influencing factors for high-grade dysplasia of CSL in each age group.Results:A total of 1141 polyps were detected,including 627 in the elderly group,386 in the middle age group and 128 in the young group.The incidence of blood in stool and constipation in the aged group was higher than that in the middle-aged group and the young group.The lesions in the three groups were mostly located in the rectum and left colon,and the endoscopic morphology was mostly flat type(P>0.05).hyperplastic polyp(HP)had no dysplasia,sessile serrated lesions(SSLs)with high-grade dysplasia had no significant difference among the three groups(P>0.05),and traditional serrated adenoma(TSA)with high-grade dysplasia was only found in the elderly group.Logistic regression analysis showed that smoking and cholecystectomy were independent risk factors for high-grade dysplasia of CSL in all age groups.Conclusion:The incidence of CSL increases with age.Smoking and cholecystectomy may increase the risk of high-grade dysplasia of CSL.

关 键 词：结直肠锯齿状病变 临床特点 内镜表现 病理学特征 异型增生 危险因素 

分 类 号：R735.35[医药卫生—肿瘤]