无症状中国人中晚期结肠息肉的患病率
Prevalence of advanced colonic polyps in asymptomatic Chinese.
作者信息
Liu Hui-Hsiung, Wu Meng-Chen, Peng Yeh, Wu Ming-Shiang
机构信息
Graduate Institute of Public Health, Taipei Medical University, Taipei, Taiwan, China.
出版信息
World J Gastroenterol. 2005 Aug 14;11(30):4731-4. doi: 10.3748/wjg.v11.i30.4731.
AIM
To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without polyps in the distal colon.
METHODS
Data were collected prospectively during colonoscopic examinations performed in 5 973 subjects as part of health evaluation at our unit from December 1997 to December 2003. Polyps were considered advanced, if they were larger than 10 mm or were tubovillous, villous or malignant. Proximal colon was defined as the splenic flexure and more proximal portions of the colon.
RESULTS
Colon polyps were detected in 971 (16.3%) subjects (613 males and 358 females) with their mean age being 56.6+/-10.7 years. Advanced polyps were noted in 199 (3.3%) individuals. Subjects were sub-classified according to the location of polyps into three groups: distal (569, 58.6%), proximal (284, 29.2%), and combined proximal and distal (118, 12.2%) groups. Subjects with advanced polyps in these three groups were 95 (9.8%), 56 (5.8%), and 48 (4.9%) respectively. In the 48 subjects with advanced combined polyps, 13 advanced polyps were distributed at the distal colon, 17 at the proximal colon, and 18 at both. Eighteen colon cancers including 12 at sigmoid and 6 at ascending colon were confirmed by final pathology. The relative risk for advanced proximal polyp according to distal findings was 3.1 (95%CI: 1.3-7.4) for hyperplastic polyp, 2.7 (95%CI: 1.4-5.3) for tubular polyp and 13.5 (95%CI: 5.1-35.4) for advanced polyp as compared to that for no polyp. However, 56 (28.2%) of 199 subjects with advanced polyps had no index polyps at the distal colon and might go undetected under sigmoidoscopic screening.
CONCLUSION
Although distal lesions can predict the risk of advanced proximal polyps, a substantial portion of Chinese with advanced proximal polyps is not associated with any distal sentinel lesions. These data have implications for screening policy of colon cancers in Taiwanese Chinese.
目的
调查无症状中国人中进展期息肉的患病率，并确定远端结肠有无息肉的受试者发生近端进展期结肠息肉的风险。
方法
1997年12月至2003年12月期间，对在本单位接受结肠镜检查作为健康评估一部分的5973名受试者进行前瞻性数据收集。息肉若大于10毫米或为管状绒毛状、绒毛状或恶性，则被视为进展期息肉。近端结肠定义为脾曲及结肠更靠近近端的部分。
结果
在971名（16.3%）受试者（613名男性和358名女性）中检测到结肠息肉，他们的平均年龄为56.6±10.7岁。199名（3.3%）个体发现有进展期息肉。受试者根据息肉位置分为三组：远端（569名，58.6%）、近端（284名，29.2%）和近端与远端合并（118名，12.2%）组。这三组中有进展期息肉的受试者分别为95名（9.8%）、56名（5.8%）和48名（4.9%）。在48名有进展期合并息肉的受试者中，13个进展期息肉分布在远端结肠，17个在近端结肠，18个在两者都有。最终病理确诊18例结肠癌，其中12例在乙状结肠，6例在升结肠。与无息肉者相比，根据远端检查结果，增生性息肉发生近端进展期息肉的相对风险为3.1（95%CI：1.3 - 7.4），管状息肉为2.7（95%CI：1.4 - 5.3），进展期息肉为13.5（95%CI：5.1 - 35.4）。然而，199名有进展期息肉的受试者中有56名（28.2%）在远端结肠没有指示性息肉，可能在乙状结肠镜筛查中未被发现。
结论
虽然远端病变可预测近端进展期息肉的风险，但相当一部分有近端进展期息肉的中国人与任何远端前哨病变无关。这些数据对台湾中国人结肠癌的筛查策略有启示意义。
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