结直肠息肉与血脂水平的相关性研究

目的:探讨高脂血症与结直肠息肉的相关性,分析结直肠息肉发生的相关危险因素。方法:检测160例结直肠息肉患者和153例对照组患者血清总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白(LDL-C)的水平,分别比较结直肠息肉组与对照组、不同病理类型息肉组间、不同部位的结直肠息肉组间、不同性别的结直肠息肉组间以及不同大小息肉组间患者的血脂水平。结果:结直肠息肉组高脂血症发生率高于对照组,男性结直肠息肉组高脂血症发生率高于女性,差异均有统计学意义(P0.05)。不同病理类型息肉患者血清TC、TG和LDL-C水平比较差异均无统计学意义(P0.05)。左半结肠+直肠息肉组高脂血症发生率高于右半结肠组,体重超重者(BMI≥24 kg/m2)结肠息肉发生率较BMI正常者高,息肉大于1 cm患者高脂血症发生率高于息肉小于1 cm者,差异有统计学意义(P0.05)。结论:高脂血症、肥胖及男性是发生结直肠息肉的高危因素,而息肉大小、部位均与高脂血症的发生风险密切有关。     

结肠息肉镜下特征、病理分型及癌变规律分析

目的:探讨结肠息肉镜下特征、病理类型及血清学特点与癌变的相关性。方法:收集我院2011年6月~2013年6月肠镜证实的640名结肠息肉患者资料。对年龄、性别、息肉特征(部位、大小、数量、分型、病理等)分析,并将息肉者癌胚抗原与健康人比较。结果:检出息肉1144枚;年龄在41岁~60岁的占52.9%;发生在乙状结肠和直肠的占47.3%;多发及多部位息肉比例为56.9%和46.9%;腺瘤样息肉占87%;随年龄、息肉体积增加,癌变率增加;无蒂息肉癌变率高于有蒂息肉;两组血清癌胚抗原值差异有统计学意义。结论:结肠息肉多发生在乙状结肠和直肠;以腺瘤息肉为主;癌变与年龄、腺瘤大小、形态、病理类型有关。癌胚抗原可能在腺瘤样息肉的筛查及监测癌变存在意义。     

结直肠息肉切除术患者肠道微生态失调分析及其与癌变进展的相关性

目的分析结直肠息肉切除术患者肠道微生态失调情况及其与癌变进展的相关性。方法前瞻性选择2015年7月至2016年7月在我院行结直肠息肉切除术的89例患者为研究对象,评价所有研究对象手术前后肠道菌群计数、肠道菌群失调情况,采用单因素和多因素Logistic回归分析结直肠息肉切除术患者癌变的影响因素。结果结直肠息肉患者术后大肠埃希菌计数(10.85±0.50)、粪肠球菌计数(10.12±0.55)显著高于术前(8.34±0.41,7.76±0.37)(均P0.01),结直肠息肉患者术后双歧杆菌计数(2.56±0.68)、乳杆菌计数(2.83±0.71)显著低于术前(5.20±1.06,5.93±0.88)(均P0.01)。结直肠息肉患者术后Ⅰ度菌群失调比例(23.60%)显著低于术前(55.06%)(P0.05),结直肠息肉患者术后Ⅱ、Ⅲ度菌群失调比例(50.56%,25.84%)显著高于术前(34.83%,10.11%)(均P0.05)。随访3年显示89例结直肠息肉切除术患者癌变率为33.71%,性别、病理类型不同的结直肠息肉切除术患者癌变率差异无统计学意义(均P0.05),年龄、遗传史、息肉直径、肠道菌群失调程度不同的结直肠息肉切除术患者癌变率差异具有统计学意义(均P0.05)。年龄、遗传史、肠道菌群失调程度是结直肠息肉切除术患者癌变的影响因素(均P0.05)。结论结直肠息肉切除术患者存在明显肠道微生态失调情况,肠道微生态失调是结直肠息肉切除术患者癌变的危险因素,这对临床防治结直肠息肉切除术患者癌变有重要指导意义。     

结直肠癌患者血浆甲基化Sept9基因的表达及临床意义

目的:探讨甲基化Sept9基因在结直肠癌患者血浆中的表达及临床意义。方法:选择2015年1月~2017年3月经陕西省人民医院病理证实的结直肠癌患者87例(结直肠癌组)、结直肠息肉患者79例(结直肠息肉组)、健康体检者93例(健康对照组)作为研究对象,采用实时荧光定量聚合酶链式反应(PCR)技术检测其外周血血浆Sept9基因甲基化情况,比较三组甲基化Sept9基因阳性表达率,分析甲基化Sept9基因阳性表达与结直肠癌病理特征的关系。结果:血浆甲基化Sept9基因在结直肠癌组、结直肠息肉组、健康对照组的阳性表达率分别为71.26%(62/87)、5.06%(4/79)、3.23%(3/93),差异有统计学意义(P0.05);血浆甲基化Sept9基因阳性表达与结直肠癌患者的性别、年龄、肿瘤部位、病理分型、血管侵犯、神经侵犯无关(P0.05),与肿瘤最大径、浸润深度、分化程度、淋巴结转移、TNM分期有关(P0.05);结直肠癌患者血浆甲基化Sept9基因阳性表达率为71.26%(62/87),高于血清CEA的54.02%(47/87)、CA199的35.63%(31/87)、CA724的33.33%(29/87)、CA125的21.84%(19/87),差异有统计学意义(P0.05)。结论:结直肠癌患者外周血血浆甲基化Sept9基因呈高表达状态,早期检测甲基化Sept9基因表达水平在结直肠癌的诊断及病情评估中有重要意义。     

行胶囊内镜检查67 例患者临床结果分析

目的:评价胶囊内镜在小肠疾病中的诊断价值,总结胶囊内镜临床应用策略。方法:回顾性分析上海市第一人民医院胃肠镜室2009年7月-2011年4月67例行胶囊内镜检查患者的检查结果,结合其中32名患者双气囊小肠镜检查结果及手术病理,分析胶囊内镜在小肠疾病的检出率,诊断率和不良事件发生率,总结胶囊内镜检查时的注意事项。结果:1例胶囊内镜操作失败,66例受检者检出率80.3%,诊断率为66.7%,发现病变中血管病变为主要诊断,占62.1%,其次为肠道占位(息肉、肿瘤)为14.6%,克罗恩病占10.9%,所有患者均未出现严重不良事件。结论:胶囊内镜在小肠疾病检查中安全,无创,诊断率较高,临床胶囊内镜检查时建议充分肠道准备,实时监控及结合双气囊小肠镜检查。     

大肠息肉的危险因素分析

目的:探讨大肠息肉在人群中的年龄、性别、病理类型的分布,并探讨体质量指数、吸烟饮酒、血脂水平、相关疾病、饮食习惯及运动状况对大肠息肉发生的影响。方法:选择2011年4月至2013年4月在海军总医院进行电子结肠镜检查的542例患者,将结肠镜检查发现大肠息肉并住院治疗的患者纳入息肉组,将内镜检查无明显异常的患者纳入对照组。比较两组患者的体质量指数、吸烟饮酒、血脂水平、相关疾病、饮食习惯及运动状况等。结果:大肠息肉人群中男性多于女性,40岁以上高发,超重及肥胖者达55.56%;经常饮酒、较少进食蔬菜、水果、粗纤维食物、运动量少及患有高脂血症、高血压、糖尿病、脂肪肝、胆系疾病者易发大肠息肉。结论:高体质量指数、吸烟、高血脂水平、相关疾病、不良饮食习惯、运动量小是大肠息肉发生的危险因素。     

结直肠息肉经内镜下黏膜切除术后出血的危险因素分析

目的探讨结直肠息肉内镜下黏膜切除(EMR)术后出血的相关危险因素。方法 833例接受EMR切除术的肠息肉患者作为研究对象,根据术后是否发生出血分为出血组(41例)和未出血组(792例),纳入基本人口学因素、病理因素及治疗因素作为单因素分析项目,采用Logistic多因素分析法探讨术后出血的高危因素。结果共41例患者发生术后出血,出血发生率为4.92%。单因素分析结果显示:性别、息肉直径、息肉形态、术中出血、禁食程度、息肉病理类型、钛夹数量、禁食时间可能与术后出血有关(P0.05),其中男性、息肉直径2cm、有蒂息肉、术中出血、息肉合并黏膜内癌或重度异性增生的患者术后出血风险更高;患者年龄、门诊或住院、术者技术水平、肠道清洁度、息肉发生部位、创面处理方式、息肉数量对术后出血无影响(P0.05)。多因素非条件Logistic回归分析结果显示:男性、息肉直径2cm、术中出血为EMR术后出血的独立危险因素(P0.05),钛夹使用数量为保护因素(P0.05)。结论肠息肉MER术后并发出血与性别、息肉直径、术中出血、钛夹数量明显相关,针对性预防、减少术中出血、增加夹闭创面的钛夹数量可以降低术后出血的发生。     

石家庄地区大肠息肉流行病学特征调查及影响因素分析

摘要 目的：调查分析石家庄地区大肠息肉流行病学特征及发病影响因素。方法：选取2015年1月~2020年1月期间来我院进行结肠镜检查的石家庄地区人群2630例作为调查研究对象,检查期间发放大肠息肉调查问卷,对研究对象的大肠息肉检出情况、流行病学特征进行统计分析,并根据人群的大肠息肉检测结果分为息肉组和对照组,对两组的临床资料进行统计对比,采用单因素和多因素Logistic回归分析大肠息肉发生的影响因素。结果：共回收2611份有效问卷,有效率为99.28%,其中大肠息肉患者共有300例,大肠息肉发生率为11.49%。经流行病学调查显示,300例大肠息肉患者中以男性居多,年龄以＞60岁为主,息肉高发部位主要为直肠和乙状结肠,病理类型主要为腺瘤型,息肉大小以≤5 cm为主。单因素分析显示,息肉组和对照组在年龄、性别、体质量指数(BMI)、吸烟史、高脂血症病史、高脂饮食方面对比有显著性差异(P<0.05)。经多因素分析显示,年龄＞60岁、男性、BMI≥25 kg/m²、吸烟史、高脂血症病史、高脂饮食均为大肠息肉发生的危险因素(P<0.05)。结论：石家庄地区大肠息肉具有较高的发病率,其流行病学与患者性别、年龄、息肉部位、病理类型及息肉大小相关。     

甘油二酯激酶α在结直肠癌中的表达及其与PKC、TNFα的相关性

目的探讨甘油二酯激酶α(DGKα)在结直肠癌中的表达及其与蛋白激酶C(PKC)、肿瘤坏死因子α(TNFα)表达的相关性。方法应用免疫组化方法检测DGKα、PKC和TNFα在48例结直肠癌、癌旁正常组织和9例腺瘤性息肉中的表达。结果 DGKα在结直肠癌组织和癌旁正常组织有表达,结直肠癌组织中DGKα阳性表达率(79.2%)显著高于腺瘤性息肉(阴性)和癌旁正常组织(33.3%,P0.05);PKC主要分布在结直肠癌和癌旁正常组织中,结直肠癌组织中PKC阳性表达率(35.4%)显著高于腺瘤性息肉(阴性),与癌旁正常组织(20.8%)相比无显著性差异(P0.05);TNFα在三种组织中均表达阳性,结直肠癌组织中TNFα阳性表达率(95.8%)显著高于腺瘤性息肉(55.6%,P0.05),与癌旁正常组织(87.5%)相比无显著性差异(P0.05);结直肠癌组织中,DGKα与PKC的表达呈负相关(r=-0.437,P0.05),与TNFα的表达没有相关性(r=0.185,P0.05)。结论DGKα在结直肠癌组织中的表达高于腺瘤性息肉,DGKα可能抑制了PKC的活性,但对TNFα没有明显的抑制作用,在临床病理鉴别诊断中有辅助价值。     

CCNB2在结直肠癌中的表达及临床意义

目的:探讨细胞周期蛋白B2(Cyclin B2,CCNB2)在结直肠癌组织中的表达及其临床意义。方法:选择45对结直肠癌组织及癌旁正常结直肠组织样本,分别采用实时定量PCR(qRT-PCR)方法和免疫组织化学技术检测CCNB2的mRNA和蛋白表达,并进一步分析CCNB2的表达与结直肠癌临床病理特征之间的关系。结果:结直肠癌组织中CCNB2 mRNA的表达显著高于癌旁正常结直肠组织,差异有统计学意义(P0.001),且CCNB2的mRNA表达与结直肠癌的肿瘤大小、浸润深度及TNM分期显著相关(P0.05),与年龄、性别、肿瘤位置、分化程度、脉管神经浸润、淋巴结转移和远处转移均无关(P0.05)。45例结直肠癌标本中39例表达(+~+++),6例表达(-)。CCNB2蛋白主要表达于结直肠癌细胞质中,少量见于细胞核。结直肠癌组织中CCNB2蛋白的阳性表达率为86.7%,显著高于癌旁正常结直肠组织,并与患者的性别、年龄、分化程度和肿瘤转移均无显著相关性(P0.05),但与肿瘤分期、浸润程度均显著相关(P0.05)。结论:CCNB2在结直肠癌中呈异常高表达,且与结直肠癌的发生发展相关,有望作为结直肠癌的诊断和预后预测参考指标。     

大肠息肉的危险因素分析

目的：探讨大肠息肉在人群中的年龄、性别、病理类型的分布,并探讨体质量指数、吸烟饮酒、血脂水平、相关疾病、饮食习惯及运动状况对大肠息肉发生的影响。方法：选择2011年4月至2013年4月在海军总医院进行电子结肠镜检查的542例患者,将结肠镜检查发现大肠息肉并住院治疗的患者纳入息肉组,将内镜检查无明显异常的患者纳入对照组。比较两组患者的体质量指数、吸烟饮酒、血脂水平、相关疾病、饮食习惯及运动状况等。结果：大肠息肉人群中男性多于女性,40岁以上高发,超重及肥胖者达55．56％;经常饮酒、较少进食蔬菜、水果、粗纤维食物、运动量少及患有高脂血症、高血压、糖尿病、脂肪肝、胆系疾病者易发大肠息肉。结论：高体质量指数、吸烟、高血脂水平、相关疾病、不良饮食习惯、运动量小是大肠息肉发生的危险因素。     

Hereditary site-specific colon cancer in a Canadian kindred.

A large kindred with colorectal cancer unaccompanied by polyposis coli and characterized by autosomal dominant inheritance has been identified in eastern Canada. Ten family members from three successive generations have presented 17 documented colorectal cancers. The clinical features of the kindred are characteristic of hereditary site-specific colon cancer (HSSCC) (Lynch syndrome I): absence of multiple polyposis, autosomal dominant inheritance, onset of colorectal cancer at an early age and a high incidence of synchronous and metachronous colorectal cancers. A unique feature of this family is the high incidence of sporadic adenomatous polyps in affected members and their relatives. Patients with HSSCC have been managed by means of segmental colectomy followed by annual colonoscopic surveillance. All five patients with localized (Dukes'' stage A or B) cancer at initial diagnosis were alive and free of disease after 2 to 12 years of follow-up, although three had required further colonic resection for metachronous carcinomas. Five young family members without cancer have had sporadic adenomatous polyps removed and are being followed with annual colonoscopy. It is not known whether polypectomy will alter the subsequent incidence of colon cancer. Subtotal colectomy is recommended for patients with HSSCC because of the high incidence of multiple lesions. An aggressive screening protocol, including colonoscopy, is recommended for all adult first- and second-degree relatives of patients with HSSCC. Identification of a biomarker, which is currently being sought in this kindred, would help identify those at greatest risk of development of cancer and allow earlier intervention.     

120例胶囊内镜检查的结果分析

目的:对胶囊内镜检查的安全性、检查结果及诊断价值进行讨论分析。方法:对2011年1月~2013年4月在我院进行胶囊内镜检查的120例患者及健康体检者的临床病例资料进行回顾性分析。结果:所有受检者均顺利完成检查,不明原因消化道出血、慢性腹痛及健康查体者的检出率分别为82.76%、59.26%及40.90%,结肠镜检查阴性者中检出结肠息肉4例,肠易激综合征患者中检出小肠器质性疾病4例。结论:胶囊内镜检查安全无痛苦,对于不明原因消化道出血及慢性腹痛患者的诊断优于传统检查方法,对于区分功能性胃肠病及器质性疾病以及小肠疾病的筛查有一定的参考价值。     

Anthropometric risk factors for colorectal polyps in African-American women

Objective: Colorectal adenomas are thought to be precursor lesions to colorectal cancer, a leading cause of cancer incidence and mortality in African‐American women. Studies suggest that obesity is associated with risk of adenomas in white women, but little is known about the relation in African‐American women. We prospectively examined the association between selected anthropometric factors and colorectal polyps in African‐American women. Methods and Procedures: Data were obtained from the Black Women's Health Study (BWHS), a prospective cohort study of African‐American women. From 1997 to 2003, we followed 33,403 women aged ≥30 years with no prior diagnosis of cancer or polyps. Cox regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for risk of polyps, with adjustment for potential confounders. Results: After 211,797 person‐years of follow‐up, 1,189 cases of colorectal polyps were reported. The IRR comparing women with a current BMI ≥35 to <25 kg/m² was 1.35 (95% CI = 1.12–1.62), after adjustment for covariates including waist‐to‐hip ratio (WHR). Women who gained ≥30 kg since age 18 were 1.76 times as likely as those who gained <5 kg to report polyps (95% CI = 1.33–2.33). The IRR comparing the highest (≥0.87) to lowest (<0.71) quintiles of WHR was 1.26 (95% CI = 1.04–1.54), after adjustment for covariates including BMI. BMI at age 18, adult height, and waist circumference (BMI‐adjusted) were not materially associated with risk. Results were similar among women with a recent endoscopy. Discussion: Weight gain and obesity in adulthood may increase the risk of colorectal polyps in African‐American women.     

Germline susceptibility to colorectal cancer due to base-excision repair gene defects

DNA repair is a key process in the maintenance of genome integrity. Here, we present a large, systematically collected population-based association study (2,239 cases; 1,845 controls) that explores the contribution to colorectal cancer incidence of inherited defects in base-excision repair (BER) genes. We show that biallelic MUTYH defects impart a 93-fold (95% CI 42-213) excess risk of colorectal cancer, which accounts for 0.8% of cases aged <55 years and 0.54% of the entire cohort. Penetrance for homozygous carriers was almost complete by age 60 years. Significantly more biallelic carriers had coexisting adenomatous polyps. However, notably, 36% of biallelic carriers had no polyps. Three patients with heterozygous MUTYH defects carried monoallelic mutations in other BER genes (OGG1 and MTH1). Recessive inheritance accounted for the elevated risk for those aged <55 years. However, there was also a 1.68-fold (95% CI 1.07-2.95) excess risk for heterozygous carriers aged >55 years, with a population attributable risk in this age group of 0.93% (95% CI 0%-2.0%). These data provide the strongest evidence to date for a causative role of BER defects in colorectal cancer etiology and show, to our knowledge for the first time, that heterozygous MUTYH mutations predispose to colorectal cancer later in life. These findings have clinical relevance for BER gene testing for patients with colorectal cancer and for genetic counseling of their relatives.     

西妥昔单抗和贝伐珠单抗治疗晚期结直肠癌的有效性和安全性比较

目的:比较西妥昔单抗和贝伐珠单抗治疗晚期结直肠癌的有效性和安全性。方法:选取2014年1月～2017年8月我院收治的晚期结直肠癌患者100例,根据患者入院先后顺序随机分为两组,所有患者均给予FOLFIRI方案进行化疗,A组在化疗的基础上给予贝伐珠单抗进行治疗,B组在化疗的基础上给予西妥昔单抗进行治疗。比较两组患者临床治疗的缓解率、控制率及不良反应的发生情况,对所有患者随访1年,记录并比较两组患者的无进展生存期。结果:两组患者的缓解率、控制率、恶心呕吐、头晕、延迟性腹泻、肝肾损伤、白细胞减少、血小板减少和尿蛋白的发生率相比均无统计学差异(P0.05),但B组患者骨髓抑制和皮疹的发生率显著高于A组(P0.05);两组患者的无进展生存期相比无统计学差异(P0.05)。结论:西妥昔单抗和贝伐珠单抗治疗晚期结直肠癌的临床效果相当,且不良反应较轻,以Ⅰ～Ⅱ度为主,患者均可耐受,对症治疗后均有所缓解。西妥昔单抗易引发骨髓抑制和皮疹,在临床应用过程中需注意并进行有效预防和积极处理。     

直肠癌组织中PTEN和Notch1的表达及其与临床病理参数的关系

目的:探究直肠癌组织中PTEN和Notch1的表达及其与临床病理参数的关系。方法:收集2014年1月~2015年4月,我院肿瘤外科确诊48例直肠癌病理组织标本与20例直肠癌患者癌旁正常组织标本为研究对象,应用免疫组化链霉菌抗生物素蛋白-过氧化物酶连结法(S-P法)分析PTEN和Notch1蛋白在直肠癌病理组织和正常组织中的表达情况。结果:PTEN和Notch1主要表达于直肠癌组织细胞质中,呈现棕黄色;Notch1在直肠癌病理组织中表达率显著高于正常组织(P0.05);PTEN在正常组织表达率显著高于在直肠癌组织(P0.05);Notch1在淋巴转移、中底分化及分期为C期患者病理组织中表达率较高(P0.05);PTEN在无淋巴转移、中底分化程度及A+B期患者病理组织表达率较高(P0.05);相关性分析显示,Notch1和PTEN在直肠癌病理组织中表达呈现负相关关系(r=-0.534,P=0.000)。结论:Notch1和PTEN表达失调在直肠癌的发生、发展和淋巴结转移中有重要作用;PTEN表达可能对直肠癌的发生、发展具有抑制作用,Notch1表达可能对直肠癌的发生、发展具有促进作用。     

Augmentation of regulatory T cells (CD4+CD25+Foxp3+) correlates with tumor stage in patients with colorectal cancer

Recent evidence suggests that decline of regulatory T cells (Tregs) play a critical role in the prevalence of autoimmune diseases inhibiting the maintenance of peripheral self tolerance, while its augmentation leads to insufficient antitumor response, accompanied with poor prognosis in various malignancies. Increased number of Tregs (CD4+CD25+FoxP3+) were noticed in peripheral blood mononuclear cells (PBMCs), tumor-infiltrating lymphocytes (TILs) and/or regional lymph nodes lymphocytes (LNLs) of patients with gastrointestinal tumors. The aim of our study was to investigate the correlation between the percentage of Tregs in peripheral blood of patients with colorectal carcinoma, using flow cytometric technique and tumor stages, classified as Dukes' A, B, C or D and by stage of differentiation. Peripheral blood venous samples were obtained from 92 patients with colorectal cancer and from 30 healthy adult volunteers. Statistical analysis: Linear regression equations were generated using a least-squares method and analyzed for differences of covariance. Statistical significance was calculated by Mann Whitney U-test. Our data has shown that 15% patients with colorectal cancer were classified as Dukes' A, 41% were Dukes' B, 35% were Dukes' C and 9% were Dukes' D. 54% patients with CRC were well differentiated, 11% were poorly differentiated, 20 were moderately differentiated, tage, 4% were mucinous carcinoma and rest of 11% were partly good differentiated with mucinous components. The increased percentage of Tregs in colorectal cancer patients correlates with tumor stage. These results indicate a possible involvement of regulatory T cells in disease progression. New strategies using inhibition or depletion of Tregs are necessary to elucidate the complexity of defective tumor immunity.