Prevalence of and Factors Associated with Colorectal Neoplastic Polyps and Sporadic Hyperplastic Polyps in a Self-paid Colonoscopy Population

自費大腸鏡檢群體中的結直腸腫瘤性息肉與偶發性增生型息肉的盛行率及相關因素

劉忠政(Chung-Cheng Liu) ； 陳宗勉(Tsung-Ming Chen) ； 鄭雅中(Ya-Chung Jeng)

《童綜合醫學雜誌》 9卷2期 (2015/12) Pp. 91-99

摘要

背景與目的：許多實證的更新使得增生型息肉分類及其與大腸直腸癌的相關性更為明確。現行大腸鏡篩檢策略將具有小的、少數偶發性增生型息肉且無大腸直腸腫瘤性息肉病史者視同無息肉。本研究探討腫瘤性息肉、增生型息肉、無息肉三類個案之臨床觀察的差異，及無症狀群體中偶發性增生型息肉與腫瘤性息肉的盛行率與相關因素。方法：以回顧性橫斷面研究設計收集755例個案，均為來自2009年1/1~9/30間於某區域醫院的自費健檢方案下接受全大腸鏡檢查的個案。藉由病歷回溯獲得人口學、常見成癮性物質使用、生化測量值、共病症及病變組織的病理診斷資料，依診斷結果將個案分入腫瘤性息肉組、增生型息肉組、對照組。結果：腫瘤性息肉與增生型息肉的總體盛行率分別為9.5%與7.4%。這兩種病變的盛行率在男性中均較高，其個案特徵大部分無顯著差異，且都與吸煙、高齡、高BMI指數具相關性。校正吸煙、年齡與BMI後，與對照組相比，有增生型息肉的個案顯著地易有較高的尿酸值（OR =1.21，95%CI：1.01-1.45，P =0.036）。討論：本研究探討本土族群中兩種腸道病變的流行病學特徵，資料來源為自費健檢資料庫，這類族群相當類似於無症狀群體。結果顯示：兩種病變都具有與大腸直腸癌相同的危險因素（吸煙、年齡和BMI），且與對照組比較下有增生型息肉的個案具有不同的特徵。因此，有增生型息肉的個案不應被視同沒有息肉的個案；然而，兩類個案的差別尚有賴進一步研究釐清。

關鍵字

大腸鏡檢 ； 腫瘤性息肉 ； 增生型息肉

並列摘要

Background and purpose: Current colonoscopy screening strategies suggest providing the same management for patients with small or few sporadic hyperplastic polyps and a negative history of colorectal neoplastic polyps and for patients without polyps. This study aimed to investigate the presence of differences in clinical characteristics among the three patient populations (i.e., neoplastic polyp, hyperplastic polyp, and non-polyp), as well as the prevalence of and factors associated with colon neoplastic polyps and sporadic hyperplastic polyps in an asymptomatic population. Methods: A retrospective cross-sectional study of 755 cases was conducted. All patients underwent full colonoscopies in participating the self-paid health examination programs at a regional hospital from January to September 2009. Data regarding demographics, common addictive substance use, biochemical measurements, comorbidities, and pathologic diagnoses of detected lesions were obtained via medical chart review. Diagnosed cases were accordingly classified as neoplastic polyps, hyperplastic polyps, or controls. Results: The overall prevalence of neoplastic and hyperplastic polyps were 9.5% and 7.4%, respectively, and were higher among men. Patients in both lesion groups were similar with respect to most characteristics, and lesions were associated with smoking, older age, and a high body mass index (BMI). After adjusting for the aforementioned three factors, cases with hyperplastic polyps tended to have higher uric acid levels compared with controls (odds ratio = 1.21, 95% confidence interval: 1.01-1.45, p = 0.036). Discussion: This study examined the epidemiologic characteristics of two types of colorectal lesions in a domestic population using data from a self-paid health examination database, which resembles an asymptomatic population. The results illustrated that both types of lesions were associated with common colorectal cancer risk factors (smoking, age, and BMI), and those with hyperplastic polyps differed from the controls. Therefore, cases with hyperplastic polyps should not be treated as polyp-free ones, while the prognosis differences between the two types of lesions will depend on further studies.

並列關鍵字

Colonoscopy ； Neoplastic polyps ； Hyperplastic polyps