无症状糜烂性食管炎与结直肠息肉的关系

doi:10.16138/j.1673-6087.2022.03.011

摘要/Abstract

摘要：

目的：探索无症状糜烂性食管炎（asymptomatic erosive esophagitis, AEE）与结直肠息肉的关系。方法：采用病例对照研究,选取无胃食管反流症状且在我院接受胃肠镜联合检查的患者,其中糜烂性食管炎患者为AEE组,无内镜下糜烂性食管炎的患者为对照组。AEE组与对照组按年龄和性别进行1∶3配对。收集2组的人口统计学、胃镜、结肠镜和组织病理学结果进行比较。结果：共纳入1 176例患者,其中AEE组有294例,对照组有882例。与对照组相比,AEE组更容易合并结直肠息肉（P<0.001）,息肉主要分布在左半结肠（P<0.001）,且AEE组更易发生高危腺瘤（P=0.034）。此外,与轻度AEE相比,中重度AEE更容易发生高危腺瘤（P=0.003）和多发息肉（P<0.001）,且息肉主要分布在左半结肠（P=0.038）。结论：AEE患者合并结直肠息肉的比例显著升高,且息肉主要分布在左半结肠,中重度AEE更容易合并高危腺瘤。

关键词: 食管炎, 结直肠息肉, 腺瘤, 高危腺瘤, 胃食管反流病

Abstract:

Objective To explore the correlation between asymptomatic erosive esophagitis(AEE) and colorectal polyps. Methods In this case-control study, the individuals without gastroesophageal reflux symptoms who underwent esophagogastroduodenoscopy(EGD) and colonoscopy in our hospital for a routine health checkup were included in the study and divided into two groups. The AEE group consisted of the patients with erosive esophagitis and without gastroesophageal reflux symptoms. The control group consisted of age-and gender-matched(1∶3) individuals with neither gastroesophageal reflux symptoms nor endoscopic erosive esophagitis. The results of demographics, gastroscopy, colonoscopy, and histopathology were collected. Results A total of 1 176 patients were included in the study, including 294 cases in AEE group and 882 cases in control group. Compared with the control group, the AEE group was more likely to have colorectal polyps(P<0.001), which were mainly distributed in left colon(P<0.001); and the AEE group was more likely to develop high-risk adenomas(P=0.034). In addition, compared with mild AEE, moderate to severe AEE was more possibly to develop high-risk adenomas (P=0.003) and multiple polyps (P<0.001), and the polyps were mainly distributed in left colon(P=0.038). Conclusions The AEE patients are more likely to have polyps, which are mainly distributed in left colon. The moderate to severe AEE patients are more possibly to have high-risk adenomas.

Key words: Esophagitis, Colonic polyps, Adenomas, High-risk adenomas, Gastroesophageal reflux disease

中图分类号:

R571
R574.6

孙超, 黄佳, 朱颖, 姚玮艳, 汤玉茗. 无症状糜烂性食管炎与结直肠息肉的关系[J]. 内科理论与实践, 2022, 17(03): 233-237.

SUN Chao, HUANG Jia, ZHU Ying, YAO Weiyan, TANG Yuming. Correlation between asymptomatic erosive esophagitis and colorectal polyps[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(03): 233-237.

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参考文献 22

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临床特征	对照组（n=882）	AEE组（n=294）	t/χ²	P
年龄（岁）	52.42±8.38	51.71±8.55	0.103	0.951
年龄区间（岁）	19~80	18~78
性别[n（%）]
男性	753（85.4）	251（85.4）
女性	129（14.6）	43（14.6）
BMI（kg/m²）	23.03±0.12	24.06±0.19	4.125	<0.001
BMI区间（kg/m²）	17.14~42.67	16.53~44.12
食管炎等级[n（%）]		294
轻度食管炎		212（72.1）
中重度食管炎		82（27.9）
合并肠道息肉[n（%）]	210（23.8）	101（34.4）	4.142	<0.001
有息肉病理（n）	175	81

变量	单因素Logistic分析			多因素Logistic分析
变量	OR	95% CI	P	OR	95% CI	P
肠道息肉	1.675	1.258~2.230	0.002	1.611	1.207~2.151	0.001
BMI	1.924	1.472~2.526	<0.001	1.087	1.046~1.131	<0.001

指标	对照组（n=882）	AEE组（n=294）	χ²	P
合并结直肠息肉	210（23.9）	101（34.4）	12.603	<0.001
合并不同数量息肉
1	117（55.7）	50（49.5）	3.312	0.069
2	42（20.0）	19（18.8）	0.061	0.805
3	11（5.2）	11（10.9）	3.315	0.069
4	8（3.8）	1（1）	1.056	0.304
>4	32（15.2）	20（19.8）	1.020	0.312
合并不同大小息肉
<5 mm	88（41.9）	34（33.7）	1.943	0.163
5~10 mm	81（38.6）	42（41.6）	0.259	0.611
>10 mm	41（19.5）	25（24.8）	1.115	0.291
有息肉病理	175	81
不同病理类型
炎性息肉	2（1.3）	4（4.9）	2.024	0.155
增生性息肉	64（36.4）	26（32.1）	0.486	0.486
无蒂锯齿状腺瘤/息肉	1（0.5）	0	0	1.000
传统锯齿状息肉	0	0	0	1.000
管状腺瘤	101（57.7）	40（49.4）	1.533	0.213
绒毛状腺瘤	0	0	0	1.000
管状绒毛状腺瘤	7（4.0）	9（11.1）	4.779	0.029
腺癌	0	2（2.5）		0.198
高级别异型增生	0	1（1.2）	0	1.000
低级别异型增生	45（25.7）	14（17.3）	2.219	0.136
高危腺瘤	50（28.6）	34（42.0）	4.512	0.034

指标	轻度食管炎（n=212）	中重度食管炎（n=82）	χ²	P
合并结直肠息肉	71（33.5）	30（36.6）	0.251	0.616
合并不同数量息肉
1	41（57.7）	9（30.0）	6.495	0.011
2	13（18.3）	6（20.0）	0.039	0.843
3	6（8.5）	5（16.7）	0.742	0.389
4	1（1.4）	0	0	1.000
>4	10（14.1）	10（33.3）	4.920	0.027
合并不同大小息肉
<5 mm	27（38.0）	7（23.3）	2.039	0.153
5~10 mm	30（42.3）	12（40.0）	0.044	0.834
>10 mm	14（19.7）	11（36.7）	3.252	0.071
有息肉病理	57	24
不同病理类型
炎症息肉	3（5.3）	1（4.2）	0.000	1.000
增生性息肉	21（36.8）	5（20.8）	1.986	0.159
管状腺瘤	26（45.6）	14（58.3）	1.093	0.296
绒毛状腺瘤	0	0	0.000	1.000
管状绒毛状腺瘤	5（8.8）	4（16.7）	1.093	0.296
腺癌	2（3.5）	0	0.021	0.885
高级别异型增生	1（1.8）	0	0.000	1.000
低级别异型增生	7（12.3）	7（29.2）	2.291	0.130
高危腺瘤	18（31.6）	16（66.7）	8.537	0.003