- 學位論文
運動習慣對異時性大腸直腸腫瘤生成的影響
Impact of Physical Activity on the Risk of Metachronous Colorectal Neoplasm
摘要
研究背景論述: 過去相當多研究結果已經證明運動量和大腸直腸腫瘤的發生率呈現負相關,然而患者在接受息肉切除之後,未來會產生異時性高風險大腸直腸腫瘤的風險是否會隨運動量的改變而被影響仍不清楚.因此,本研究便是針對被診斷有大腸直腸腫瘤並切除後的患者,在到達下一次追蹤大腸鏡前的追蹤時間內,其自身的運動狀況是否與未來產生異時性高風險大腸直腸腫瘤之風險有相關. 研究方法： 本研究納入台大醫院內視鏡資料庫於2009 到 2016 年間,40 歲以上並且有接受一次篩檢性大腸鏡和至少一次追蹤性大腸鏡之患者.其中在篩檢性大腸鏡中必須發現任一種大腸直腸腫瘤並接受完整切除, 並且篩檢和追蹤大腸間的間隔必須大於一年.若患者本身過去有大腸直腸癌病史,發炎性大腸疾病,遺傳性大腸直腸癌家族史或是家族性息肉增多症病史之高風險患者將被排除.此外,在每次內視鏡檢查前患者須回答一份和生活習慣相關之問卷,若無問卷資料者也將被排除. 研究分析方法採Kaplan-Meier curve做存活分析,並用COX迴歸分析來尋找異時性高風險大腸直腸腫瘤發生之危險因子. 結果與討論: 本研究一共納入1820未受檢者,其中86位(4.73%) 於追蹤性大腸鏡檢查中發現至少有一個高風險大腸直腸腫瘤.經過存活以及迴歸分析後發現,在追蹤時間內提升或保持自身運動量至較高水平者,其產生異時性高風險大腸直腸腫瘤之風險將顯著降低 [adjusted hazard ratio (aHR) 0.57, 95%CI=0.35-0.91]. 此外,此保護力在篩檢性大腸鏡便已經診斷有高風險息肉之患者尤為明顯[aHR 0.32, 95%CI=0.11-0.94]. 結論: 一個良好的運動習慣應該建議給所有接受大腸鏡檢查並且有接受息肉切除者.若受檢者已經有高風險腫瘤的發現,則透過運動習慣調整來達到未來腫瘤生成的初級預防更有重要腳色.此外,此運動習慣不牽涉在第一次內視鏡檢查之運動狀況.因此,即便在息肉切除後才增加其運動量仍然是有益的 .
並列摘要
Background: Physical activity is associated with a lower risk of colorectal neoplasm but its association with metachronous advanced colorectal neoplasm development after polypectomy remains unclear.We aimed to investigate associations between subjects’ physical activity habits and the risk of metachronous advanced colorectal neoplasm. Method: This study analyzed subjects older than 40 years who received screening colonoscopy with polypectomy and surveillance colonoscopy between January 2009 and December 2016.All participants completed a standard questionnaire containing physical activity habits before surveillance colonoscopy.Subjects’ physical activity habits were quantified as weekly exercise amounts (MET-day/week) and dichotomized (active/sedentary exercise habit) using averages as the cut-off point.The associations between incidence of metachronous advanced colorectal neoplasm and physical activity habits were evaluated using Kaplan-Meier analysis and Cox regression models. Results: A total of 1820 subjects comprised the study cohort and 86 (4.73%) of them developed metachronous advanced colorectal neoplasm during surveillance period.An active physical activity habit after polypectomy was associated with a lower risk of metachronous advanced colorectal neoplasm [adjusted hazard ratio (aHR) 0.57, 95%CI=0.35-0.91].Furthermore,this protective effect from physical activity was specific for subjects having advanced neoplasm at screening colonoscopy [aHR 0.32, 95%CI=0.11-0.94]. Conclusion: An active physical activity habit after polypectomy,a surrogate for a more active lifestyle,is associated with a lower risk for developing metachronous advanced colorectal neoplasm.A positive lifestyle modification, such as maintaining /establishing an active physical activity habit,should be advised after polypectomy,especially for those with advanced colorectal neoplasm during screening.