不同年龄段结直肠息肉患者临床特点及病理对比分析

赵宁; 王园园; 姜霞; 赵增仁

doi:10.16766/j.cnki.issn.1674-4152.003448

不同年龄段结直肠息肉患者临床特点及病理对比分析

doi: 10.16766/j.cnki.issn.1674-4152.003448

赵宁¹,
王园园^{1, 2},
姜霞^{1, 2},
赵增仁^{1, 2, ,}

1.
河北医科大学第一医院胃肠病诊疗中心，河北石家庄 050031
2.
河北省大肠癌精准诊断与治疗重点实验室，河北石家庄 050031

基金项目:

国家自然科学基金项目 82203623

河北省引进国外专家智力项目 YZ202201

河北省引进国外专家智力项目 YZ202305

河北省自然科学基金项目 H2020206374

河北省临床医学优秀人才项目 LS202001

详细信息

通讯作者:
赵增仁，E-mail：zhaozengren@hebmu.edu.cn

中图分类号: R657.1
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- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-02
- 网络出版日期: 2024-05-29

Analysis clinical characteristics and pathology of colorectal polyps in various age groups

ZHAO Ning¹,
WANG Yuanyuan^{1, 2},
JIANG Xia^{1, 2},
ZHAO Zengren^{1, 2
, ,}

1.
Gastrointestinal Disease Center, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China

摘要

摘要: 目的探讨不同年龄人群结直肠息肉发病特点，为肠道肿瘤的早期筛查提供临床依据。方法回顾性分析河北医科大学第一医院2022年4月—2023年3月收治的571例结直肠息肉患者临床资料，按照不同年龄分为青年组75例(≤44岁)、中年组256例(45~59岁)和老年组240例(≥60岁)，采用χ²检验分析3组患者结直肠息肉的生物学特性。结果青、中年组男性患者多见，老年组女性患者多见(P < 0.001)。3组间比较，升结肠息肉发生率在老年组中最高(P=0.002)，直肠息肉发生率在青年组中最高(P=0.001)，但老年组直肠肿瘤性息肉发生率显著高于中、青年组[64.7%(139/215) vs. 34.9%(60/172) vs. 21.2%(14/66)，P < 0.001]。多发息肉、≥1.0 cm息肉、管状腺瘤的发生率均在老年组中最高(P < 0.05)，但各年龄组间不同病理类型息肉中息肉的长径大小差异均无统计学意义(P>0.05)。长径≤0.5 cm和0.6~0.9 cm的息肉中管状腺瘤发生率均在老年组中最高(P＜0.001)，增生性息肉发生率在老年组中最低(P＜0.001)，但长径≥1.0 cm息肉的病理类型在各年龄组间差异无统计学意义，均以管状腺瘤多见(P>0.05)。结论不同年龄人群中结直肠息肉的生物学特性不同，伴随年龄的增长，结直肠息肉的好发人群、生长部位、息肉大小、息肉数量及病理类型呈现一定的趋势变化。
- 结直肠息肉 /
- 年龄 /
- 临床特点 /
- 病理特征
Abstract: Objective This study aims to investigate the characteristics of colorectal polyps in different age populations, providing a clinical foundation for early screening of intestinal tumors. Methods We conducted a retrospective analysis of clinical data from 571 patients with colorectal polyps at the First Hospital of Hebei Medical University, covering the period from April 2022 to March 2023. These patients were divided into three groups based on age: young group (75 patients, ≤44 years old), middle-aged group (256 patients, 45-59 years old), and elderly group (240 patients, ≥60 years old). The biological characteristics of colorectal polyps in each group were analyzed using the Chi-squared test. Results Male patients were more common in the young and middle-aged groups, whereas female patients were more prevalent in the elderly group (P < 0.001). Comparing the three groups, the incidence of polyps in the ascending colon was highest in elderly group (P=0.002), and the incidence of rectal polyps was highest in young group (P=0.001). Notably, the elderly group exhibited a significantly higher incidence of neoplastic rectal polyps compared to the middle-aged and young group [64.7% (139/215) vs. 34.9% (60/172) vs. 21.2% (14/66), P < 0.001]. Additionally, the incidence of multiple polyps, polyps with a size ≥1.0 cm, and tubular adenomas were highest in elderly group (P < 0.05), while there was no significant difference in the lengths among different pathological types of polyps (P>0.05). The incidence of tubular adenomas in polyps with ≤0.5 cm and 0.6-0.9 cm were highest in elderly group (P < 0.001), while the incidence of hyperplastic polyps was lowest in elderly group (P < 0.001). However, there was no significant difference in the pathological types of polyps with a size ≥1.0 cm among the three groups, with tubular adenomas being the most common for this size polyps (P>0.05). Conclusion The biological characteristics of colorectal polyps exhibit variations across different age groups, including changes in the risk population, growth position, size, number, and pathological types, which tend to follow a discernible trend with increasing age.
- Colorectal polyp /
- Age /
- Clinical characteristics /
- Pathological features

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表 1 不同年龄段患者性别、息肉类型、息肉大小比较

Table 1. Comparison of gender composition, number and size of polyps in patients of different age groups

组别	例数	性别[例(%)]		息肉类型[例(%)]		息肉数量 (枚)	息肉大小[枚(%)]
组别	例数	男性	女性	单发	多发	息肉数量 (枚)	≤0.5 cm	0.6~0.9 cm	≥1.0 cm
青年组	75	49(65.3)	26(34.7)	36(48.0)	39(52.0)	199	94(47.2)	74(37.7)	31(15.1)
中年组	256	171(66.8)	85(33.2)	96(37.5)	160(62.5)	818	335(41.0)	311(38.0)	172(21.0)
老年组	240	110(45.8)	130(54.2)	58(24.2)	182(75.8)	993	331(33.3)	412(41.5)	250(25.2)
χ²值		24.330		18.350			21.952
P值		<0.001		<0.001			＜0.001

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表 2 不同年龄段患者结直肠息肉分布部位比较[枚(%)]

Table 2. Comparison of the sites of colorectal polyps in patients of different age groups[pieces(%)]

组别	息肉数量	回盲部	升结肠	横结肠	降结肠	乙状结肠	直肠
青年组	199	9(4.5)	20(10.1)^a	30(15.1)^a	32(16.1)	42(21.1)	66(33.1)^a
中年组	818	30(3.7)	115(14.1)^a	194(23.7)^a	153(18.7)	154(18.8)	172(21.0)^a
老年组	993	36(3.6)	184(18.5)^a	234(23.6)^a	149(15.0)	175(17.6)	215(21.7)^a
注：3组结直肠息肉分布部位比较，χ²=32.575, P＜0.001；3组间比较，^aP＜0.05。

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表 3 不同年龄段患者结直肠息肉病理类型比较[枚(%)]

Table 3. Comparison of the pathological types of colorectal polyps in patients of different age groups[pieces(%)]

组别	息肉数量	炎性息肉	增生性息肉	管状腺瘤	绒毛状腺瘤	锯齿状腺瘤
青年组	199	41(20.6)^a	71(35.7)^a	69(34.7)^a	15(7.5)	3(1.5)
中年组	818	177(21.6)^a	175(21.4)^a	415(50.7)^a	46(5.7)	5(0.6)
老年组	993	165(16.6)^a	161(16.2)^a	599(60.3)^a	65(6.6)	3(0.3)
注：3组结直肠息肉病理类型比较，χ²=66.584, P＜0.001；3组间比较，^aP＜0.05。

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表 4 不同年龄段患者结直肠各部位肿瘤性/非肿瘤性息肉发生情况比较[枚(%)]

Table 4. Comparison of the incidence of neoplastic/nonneoplastic polyps in patients of different age groups[pieces(%)]

组别	息肉数量	回盲部	升结肠	横结肠	降结肠	乙状结肠	直肠
青年组	87^a	1(11.1)	14(70.0)	18(60.0)	18(56.2)	22(52.4)	14(21.2)
	112^b	8(88.9)	6(30.0)	12(40.0)	14(43.8)	20(47.6)	52(78.8)
中年组	466^a	14(46.7)	74(64.3)	135(69.6)	91(59.5)	92(59.7)	60(34.9)
	352^b	16(53.3)	41(35.7)	59(30.4)	62(40.5)	62(40.3)	112(65.1)
老年组	667^a	13(36.1)	110(59.8)	170(72.6)	109(73.2)	126(72.0)	139(64.7)
	326^b	23(63.9)	74(40.2)	64(27.4)	40(26.8)	49(28.0)	76(35.3)
χ²值		3.785	1.197	2.189	7.499	8.532	54.645
P值		0.151	0.550	0.335	0.024	0.014	<0.001
注：^a为肿瘤性息肉，^b为非肿瘤性息肉。

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表 5 不同年龄段患者各病理类型息肉长径大小比较[枚(%)]

Table 5. Comparison of the sizes of polyps of different pathological types in patients of different age groups[pieces(%)]

组别	息肉数量	炎性息肉			增生性息肉				管状腺瘤
组别	息肉数量	≤0.5 cm	0.6~0.9 cm	≥1.0 cm	≤0.5 cm	0.6~0.9 cm	≥1.0 cm		≤0.5 cm	0.6~0.9 cm	≥1.0 cm
青年组	199	27(65.9)	13(31.7)	1(2.4)	41(57.8)	28(39.4)	2(2.8)		23(33.4)	27(39.1)	19(27.5)
中年组	818	107(60.4)	58(32.8)	12(6.8)	92(52.6)	70(40.0)	13(7.4)		131(31.6)	166(40.0)	118(28.4)
老年组	993	96(58.2)	56(33.9)	13(7.9)	79(49.1)	67(41.6)	15(9.3)		149(24.8)	270(45.1)	180(30.1)
χ²值		1.827			3.631				6.676
P值		0.768			0.458				0.154

组别	息肉数量	绒毛状腺瘤					锯齿状腺瘤
组别	息肉数量	≤0.5 cm	0.6~0.9 cm		≥1.0 cm		≤0.5 cm	0.6~0.9 cm			≥1.0 cm
青年组	199	2(13.3)	6(40.0)		7(46.7)		1(33.3)	0			2(66.7)
中年组	818	5(10.9)	16(34.8)		25(54.3)		0	1(20.0)			4(80.0)
老年组	993	6(9.3)	19(29.2)		40(61.5)		1(33.3)	0			2(66.7)
χ²值		1.337
P值		0.855					0.758^a
注：^a为采用Fisher精确检验。

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表 6 不同年龄段患者各长径大小息肉病理类型比较[枚(%)]

Table 6. Comparison of the pathological types of polyps of different sizes in patients of different age groups[pieces(%)]

组别	息肉数量	≤0.5 cm
组别	息肉数量	炎性息肉	增生性息肉^b	管状腺瘤^b	绒毛状腺瘤	锯齿状腺瘤
青年组	94	27(28.7)	41(43.6)	23(24.5)	2(2.1)	1(1.1)
中年组	335	107(31.9)	92(27.5)	131(39.1)	5(1.5)	0
老年组	331	96(29.0)	79(23.9)	149(45.0)	6(1.8)	1(0.3)
P值				0.036^a

组别	息肉数量	0.6~0.9 cm
组别	息肉数量	炎性息肉	增生性息肉^b	管状腺瘤^b	绒毛状腺瘤	锯齿状腺瘤
青年组	74	13(17.6)	28(37.8)	27(36.5)	6(8.1)	0
中年组	311	58(18.6)	70(22.5)	166(53.5)	16(5.1)	1(0.3)
老年组	412	56(13.6)	67(16.3)	270(65.5)	19(4.6)	0
P值				＜0.001^a

组别	息肉数量	≥1.0 cm
组别	息肉数量	炎性息肉	增生性息肉	管状腺瘤	绒毛状腺瘤	锯齿状腺瘤
青年组	31	1(3.2)	2(6.5)	19(61.2)	7(22.6)	2(6.5)
中年组	172	12(7.0)	13(7.6)	118(68.6)	25(14.5)	4(2.3)
老年组	250	13(5.2)	15(6.0)	180(72.0)	40(16.0)	2(0.8)
P值				0.385^a
注：^a为采用Fisher精确检验；3组间比较，^bP＜0.05。

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参考文献(18)

[1]	SUNG H, FERLAY J, SIEGEL R, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71: 209-249. doi: 10.3322/caac.21660
[2]	PATEL S G, KARLITZ J J, YEN T, et al. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection[J]. Lancet Gastroenterol Hepatol, 2022, 7: 262-274. doi: 10.1016/S2468-1253(21)00426-X
[3]	樊启林, 张松, 文峰, 等. 1 474例不同年龄段结直肠癌患者的临床病理特征及预后分析[J]. 实用肿瘤杂志, 2023, 38(2): 127-132. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZZ202302006.htm FAN Q L, ZHANG S, WEN F, et al. Clinicopathological features and prognosis of 1 474 colorectal cancer patients of different ages[J]. Journal of Practical Oncology, 2023, 38(2): 127-132. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZZ202302006.htm
[4]	杨燕青, 芮蓉, 武鹏涛, 等. 消蕈化浊方对肠息肉伴代谢综合征的临床疗效及影响因素分析[J]. 中华全科医学, 2023, 21(4): 677-680. doi: 10.16766/j.cnki.issn.1674-4152.002958 YANG Y Q, RUI R, WU P T, et al. Clinical effect of Xiaoxun Huazhuo Recipe on colorectal polyps with metabolic syndrome and influencing factors[J]. Chinese Journal of General Practice, 2023, 21(4): 677-680. doi: 10.16766/j.cnki.issn.1674-4152.002958
[5]	武雅峰. 2 574例不同年龄段结直肠息肉患者临床及癌变特征分析[D]. 太原: 山西医科大学, 2021. WU Y F. Analysis of clinical and cancerous characteristics in 2 574 patients with colorectal polyps of different age groups[D]. Taiyuan: Shanxi Medical University, 2021.
[6]	PAN J, CEN L, XU L, et al. Prevalence and risk factors for colorectal polyps in a Chinese population: a retrospective study[J]. Sci Rep, 2020, 10: 6974. DOI: 10.1038/s41598-020-63827-6.
[7]	HUA H, JIANG Q, SUN P, et al. Risk factors for early-onset colorectal cancer: systematic review and meta-analysis[J]. Front Oncol, 2023, 5(13): 1132306. DOI: 10.3389/fonc.2023.1132306.
[8]	DITONNO I, LOSURDO G, RENDINA M, et al. Estrogen receptors in colorectal cancer: facts, novelties and perspectives[J]. Curr Oncol, 2021, 28(6): 4256-4263. doi: 10.3390/curroncol28060361
[9]	DAS P K, SAHA J, PILLAI S, et al. Implications of estrogen and its receptors in colorectal carcinoma[J]. Cancer Med, 2023, 12: 4367-4379. doi: 10.1002/cam4.5242
[10]	LI Q, CHAN H, LIU W, et al. Carnobacterium maltaromaticum boosts intestinal vitamin D production to suppress colorectal cancer in female mice[J]. Cancer Cell, 2023, 41: 1450-1465. doi: 10.1016/j.ccell.2023.06.011
[11]	WISMAYER R, KIWANUKA J, WABINGA H, et al. Colorectal adenocarcinoma in Uganda: are right-sided and left-sided colon cancers two distinct disease entities?[J]. World J Surg Oncol, 2023, 21: 215. doi: 10.1186/s12957-023-03094-7
[12]	闫超, 陕飞, 李子禹. 2020年中国与全球结直肠癌流行概况分析[J]. 中华肿瘤杂志, 2023, 45(3): 221-229. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD202212001.htm YAN C, SHAN F, LI Z Y. Prevalence of colorectal cancer in 2020: a comparative analysis between China and the world[J]. Chinese Journal of Oncology, 2023, 45(3): 221-229. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD202212001.htm
[13]	王晶, 殷云勤, 文静. 2 942例大肠息肉的临床特点及结肠癌检出率分析[J]. 中国现代医生, 2016, 54(1): 81-84. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201601026.htm WANG J, YIN Y Q, WEN J. The analysis of clinical characteristics of colorectal polyps and detective rate of colorectal carcinomol in 2 942 cases[J]. China Modern Doctor, 2016, 54(1): 81-84. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201601026.htm
[14]	SANG X, WANG Q, NING Y, et al. Age-related mucus barrier dysfunction in mice is related to the changes in Muc2 mucin in the colon[J]. Nutrients, 2023, 15(8): 1830. DOI: 10.3390/nu15081830.
[15]	PATANKAR J, BECKER C. Cell death in the gut epithelium and implications for chronic inflammation[J]. Nat Rev Gastroenterol Hepatol, 2020, 17: 543-556. doi: 10.1038/s41575-020-0326-4
[16]	MANDIC O, JOVANOVIC I, CVETKOVIC M, et al. Factors predicting malignant occurrence and polyp recurrence after the endoscopic resection of large colorectal polyps: a single center experience[J]. Medicina(Kaunas), 2022, 58(10): 1440.
[17]	LIANG S, MAO Y, LIAO M, et al. Gut microbiome associated with APC gene mutation in patients with intestinal adenomatous polyps[J]. Int J Biol Sci, 2020, 16: 135-146.
[18]	ZHAO H, MING T, TANG S, et al. Wnt signaling in colorectal cancer: pathogenic role and therapeutic target[J]. Mol Cancer, 2022, 21: 144.