建立乙型肝炎病毒感染与结肠直肠腺瘤之间的联系。
Establishing the link between hepatitis B virus infection and colorectal adenoma.
作者信息
Patel Brijesh B, Lipka Seth, Shen Huafeng, Davis-Yadley Ashley H, Viswanathan Prakash
机构信息
1 Department of Internal Medicine, 2 Department of Gastroenterology, Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA ; 3 Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA.
出版信息
J Gastrointest Oncol. 2015 Oct;6(5):492-7. doi: 10.3978/j.issn.2078-6891.2015.049.
BACKGROUND
Chronic hepatitis B (CHB) infection has been associated with malignancy, most notably hepatocellular carcinoma. Previous research has shown that hepatitis C is associated with increased colorectal adenomas and neoplasia. Currently, there are no studies on the association of CHB and colorectal adenomas. We aimed to identify a possible link between CHB and colorectal adenoma.
METHODS
A retrospective chart review was performed on 588 consecutive patients undergoing screening or diagnostic colonoscopy that were previously screened or diagnosed with hepatitis B. Comparisons between categorical variables were analyzed with Chi Square test and t-test for continuous variables. Unconditional logistic regression was used to generate age-, gender-and race-adjusted odds ratios and their 95% confidence intervals (CI) comparing medication users with non-users. Statistical analyses were performed with SAS 9.3 software.
RESULTS
A total of 487 patients were analyzed in the control group vs. 71 in the hepatitis B group. The adenoma detection rate was 23.9% in hepatitis B vs. 15.9% in the non-hepatitis B group for all cause colonoscopy; however this did not reach statistical significance. There was a significantly higher number of adenomas present in the distal colon compared to control (OR =2.16; 95% CI, 1.06-4.43; P=0.04). There were no significant findings between hepatitis B infection with size, multiplicity or presence of proximal adenomas. There was a significant difference noted in regards to smoking history, BMI and age between two groups.
CONCLUSIONS
Although the adenoma detection rate was higher in hepatitis B population vs. the non-hepatitis B group this did not reach statistical significance. However, we did find an association between CHB infection and the presence of distal colorectal adenomas. Larger prospective studies are needed to strengthen our findings along with future studies examining hepatitis B virus (HBV) and mechanisms inducing colorectal carcinogenesis.
背景
慢性乙型肝炎（CHB）感染与恶性肿瘤相关，最显著的是肝细胞癌。先前的研究表明，丙型肝炎与结直肠腺瘤和肿瘤形成增加有关。目前，尚无关于CHB与结直肠腺瘤关联的研究。我们旨在确定CHB与结直肠腺瘤之间可能存在的联系。
方法
对588例先前接受过乙型肝炎筛查或诊断的连续接受筛查或诊断性结肠镜检查的患者进行回顾性病历审查。分类变量之间的比较采用卡方检验，连续变量采用t检验。使用无条件逻辑回归生成年龄、性别和种族调整后的优势比及其95%置信区间（CI），比较用药者与非用药者。使用SAS 9.3软件进行统计分析。
结果
对照组共分析了487例患者，乙型肝炎组71例。在所有原因导致的结肠镜检查中，乙型肝炎组的腺瘤检出率为23.9%，非乙型肝炎组为15.9%；然而，这未达到统计学显著性。与对照组相比，远端结肠中的腺瘤数量显著更多（OR = 2.16；95% CI，1.06 - 4.43；P = 0.04）。乙型肝炎感染与近端腺瘤的大小、多发性或存在情况之间无显著发现。两组在吸烟史、体重指数和年龄方面存在显著差异。
结论
虽然乙型肝炎人群的腺瘤检出率高于非乙型肝炎组，但未达到统计学显著性。然而，我们确实发现CHB感染与远端结直肠腺瘤的存在之间存在关联。需要更大规模的前瞻性研究来加强我们的发现，以及未来研究乙型肝炎病毒（HBV）和诱导结直肠癌发生的机制。
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