血脂异常患者结直肠早期癌发病的危险因素分析

Risk factors for early colorectal cancer in patients with dyslipidemia

摘要:

探讨血脂异常患者结直肠早期癌发病的危险因素，以及他汀类药物在其中可能发挥的作用。回顾性分析2018年2月—2021年2月北京友谊医院消化科行内镜治疗合并血脂异常的结直肠肿物患者资料。根据结肠镜及病理结果将266例患者分为结直肠腺瘤组（n=174）和结直肠早期癌组（n=92）。分析两组患者临床资料的差异，采用Logistic回归分析血脂异常患者结直肠早期癌发病的危险因素。结果发现，与结直肠腺瘤组相比，结直肠早期癌组患者的男性比例（64.1%比25.9%）、吸烟比例（41.3%比14.4%）和饮酒比例（37.0% 比17.2%）更高，同时低密度脂蛋白胆固醇［（3.06±0.81） mmol/L比（2.60±0.74） mmol/L］和总胆固醇值更高［（5.27±1.22） mmol/L 比（4.61±1.06） mmol/L］，而他汀用药占比更低（27.2% 比52.9%），差异均有统计学意义（P均<0.05）。多因素Logistic回归分析显示，男性（OR=3.641， 95%CI：1.694~7.826）、吸烟（OR=2.920， 95%CI：1.159~7.356）以及较高的低密度脂蛋白胆固醇（OR=2.203，95%CI：1.481~3.277）、较高的总胆固醇水平（OR=1.744，95%CI：1.329~2.289）是血脂异常患者结直肠早期癌发生的危险因素，而他汀用药史（OR=0.469，95%CI：0.236~0.932）对避免血脂异常患者结直肠早期癌的发生具有保护作用。应对血脂异常患者进行戒烟宣教，监测低密度脂蛋白胆固醇、总胆固醇水平，必要时使用他汀类药物促进血脂达标，同时积极进行结直肠癌的早期筛查。

Abstract:

To investigate the risk factors for early colorectal cancer in patients with dyslipidemia and the possible role of statins, data of 266 patients with colorectal mass and dyslipidemia who received endoscopic treatment in Beijing Friendship Hospital from February 2018 to February 2021 were collected. The patients were divided into the colorectal adenoma group (n=174) and the early colorectal cancer group (n=92) according to colonoscopic and pathological results. Clinical data of the two groups were analyzed. Logistic regression analysis was used to evaluate the risk factors for early colorectal cancer in patients with dyslipidemia. The results showed compared with the colorectal adenoma group, the early colorectal cancer group had a higher proportion of males (64.1% VS 25.9%), smoking (41.3% VS 14.4%) and drinking (37.0% VS 17.2%) and higher low density lipoprotein cholesterol (LDL-C) (3.06±0.81 mmol/L VS 2.60±0.74 mmol/L) and total cholesterol (TC) values (5.27±1.22 mmol/L VS 4.61±1.06 mmol/L), while the proportion of statin use was lower (27.2% VS 52.9%). There were significant differences in the above indices (all P<0.05). Multivariate logistic regression analysis showed that male (OR=3.641, 95%CI:1.694-7.826), smoking (OR=2.920, 95%CI:1.159-7.356), higher LDL-C (OR=2.203,95%CI:1.481-3.277) and higher TC level (OR=1.744,95%CI:1.329-2.289) were risk factors for early colorectal cancer in patients with hyperlipidemia, while the history of statin use (OR =0.469, 95%CI: 0.236-0.932) had a protective effect. Smoking cessation education, early screening of LDL-C, TC level, statin use if necessary to reach the standard lipids and screening of early colorectal cancer should be actively carried out in patients with dyslipidemia.