非酒精性脂肪性肝病与结直肠息肉发病风险的相关性研究

Association between Non-Alcoholic Fatty Liver Disease and the Risk of Colorectal Polyp

摘要: 背景与目的：非酒精性脂肪性肝病(Non-alcoholic fatty liver disease, NAFLD)与结直肠息肉发生风险的关系尚不明确。本研究主要分析了NAFLD与结直肠息肉发病风险的相关性。方法：我们选取了2019年1月~2022年2月在青岛市市立医院消化内二科住院的患者共1003例，所有患者均接受瞬时弹性成像(FibroScan)及结肠镜检查。根据受控衰减参数(controlled attenuation parameter, CAP)将患者分为NAFLD组与非NAFLD组。比较两组患者的一般资料、生化指标及结直肠息肉特征，利用多变量logistic回归分析NAFLD与结直肠息肉风险的相关性。统计学分析利用SPSS 26.0软件进行。结果：与非NAFLD组患者相比，NAFLD患者发生结直肠息肉的患病率显著增加，包括腺瘤性息肉与增生性息肉(P均<0.001)。多变量logistic回归分析结果显示无论在模型1 (校正了性别、年龄、吸烟史、BMI)、模型2 (进一步校正了糖尿病、高血压病、代谢综合征、血脂异常)或模型3 (进一步校正了ALB, TBIL, ALT, AST, ALP, GGT, UA) 中，NAFLD始终是结直肠息肉(模型1：OR = 1.968, 95% CI: 1.474~2.627, P < 0.001；模型2：OR = 1.792, 95% CI: 1.332~2.413, P < 0.001；模型3：OR = 1.769, 95% CI: 1.302~2.403, P < 0.001)的独立危险因素，其中包括腺瘤性息肉(模型1：OR = 1.612, 95% CI: 1.177~2.209, P = 0.003；模型2：OR = 1.497, 95% CI: 1.083~2.069, P = 0.014；模型3：OR = 1.576, 95% CI: 1.129~2.199, P = 0.008)与增生性息肉(模型1：OR = 1.672, 95% CI: 1.213~2.304, P = 0.002；模型2：OR = 1.555, 95% CI: 1.118~2.163, P = 0.009；模型3：OR = 1.491, 95% CI: 1.060~2.097, P = 0.022)。结论：NAFLD显著增加了结直肠息肉的患病率。同时也是结直肠息肉、腺瘤性息肉、增生性息肉的主要危险因素。

Abstract: Background and Objectives: The association between non-alcoholic fatty liver disease (NAFLD) and the risk of colorectal polyp remains unclear. This study was conducted to analyze the association between NAFLD and the risk of colorectal polyp. Methods: A total of 1003 hospitalized patients were selected from the department of Gastroenterology, Qingdao Municipal Hospital from January 2019 to February 2022. All patients were underwent the transient elastography (FibroScan) and colonoscopy. Patients were divided into the NAFLD group and non-NAFLD group according to the controlled attenuation parameter. The characteristics of general data, biochemical indexes and colorectal polyps between the two groups were compared. Multivariate logistic regression was used to analyze the association between NAFLD and the risk of colorectal polyps. Statistical analysis was performed using SPSS 26.0 software. Results: Compared with non-NAFLD patients, the prevalence of colorectal polyp in NAFLD patients was significantly increased, including adenomatous polyp and hyperplastic polyp (all P < 0.001). Multivariate logistic regression analysis showed that NAFLD was always an independent risk factor for colorectal polyp (Model 1: OR = 1.968, 95% CI: 1.474~2.627, P < 0.001; Model 2: OR = 1.792, 95% CI: 1.332~2.413, P < 0.001; Model 3: OR = 1.769, 95% CI: 1.302~2.403, P < 0.001) in Model 1 (adjusted for sex, age, smoking history, BMI), Model 2 (further adjusted for diabetes mellitus, hypertension, metabolic syndrome, dyslipidemia) and Model 3 (further corrected for ALB, TBIL, ALT, AST, ALP, GGT, UA), including adenomatous polyp (Model 1: OR = 1.612, 95% CI: 1.177~2.209, P = 0.003; Model 2: OR = 1.497, 95% CI: 1.083~2.069, P = 0.014; Model 3: OR = 1.576, 95% CI: 1.129~2.199, P = 0.008) and hyperplastic polyp (Model 1: OR = 1.672, 95% CI: 1.213~2.304, P = 0.002; Model 2: OR = 1.555, 95% CI: 1.118~2.163, P = 0.009; Model 3: OR = 1.491, 95% CI: 1.060~2.097, P = 0.022). Conclusion: NAFLD significantly increases the prevalence of colorectal polyp. It is also a major risk factor for colorectal polyp, adenomatous polyp, and hyperplastic polyp.