Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2021 May;36(3):557-567. doi: 10.3904/kjim.2019.360. Epub 2020 Jul 7.
BACKGROUND/AIMS: Metabolic syndrome has been reported to be a risk factor for metachronous colorectal neoplasia (CRN). However, the impact of nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome, on the development of metachronous CRN after polypectomy has been rarely examined. We evaluated the association between NAFLD and the development of metachronous CRN after polypectomy.
Asymptomatic subjects who underwent abdominal ultrasonography and endoscopic removal of ≥ 1 adenomas at the index colonoscopy between 2010 and 2014, and had a follow-up surveillance colonoscopy until 2017 were analyzed.
Of 6,182 participants, 2,642 (42.7%) had NAFLD at the time of the index colonoscopy. Patients with NAFLD had significantly higher cumulative incidence rates of metachronous overall CRN than those without NAFLD in both men (19.4% vs. 18.2% at 3 years and 49.2% vs. 44.0% at 5 years; p = 0.001) and women (18.7% vs. 10.5% at 3 years and 56.1% vs. 29.8% at 5 years; p < 0.001). Even after adjusting for confounders, NAFLD remained independently associated with an increased risk of metachronous overall CRN in both men (adjusted hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.06 to 1.29) and women (adjusted HR, 1.63; 95% CI, 1.27 to 2.07). Additionally, NAFLD was an independent risk factor for metachronous advanced CRN (ACRN) in women (adjusted HR, 2.61; 95% CI, 1.27 to 5.37).
NAFLD is related to an increased risk of metachronous CRN after polypectomy. Especially, women with NAFLD are at an increased risk of developing metachronous ACRN. Our results indicate a possible effect of NAFLD on the pathogenesis of CRN.
背景/目的：代谢综合征已被报道为结直肠腺瘤复发（CRN）的危险因素。然而，代谢综合征的肝脏表现——非酒精性脂肪性肝病（NAFLD）对息肉切除术后发生异时性 CRN 的影响很少被研究。我们评估了 NAFLD 与息肉切除术后异时性 CRN 发展之间的关系。
分析了 2010 年至 2014 年间在指数结肠镜检查中接受腹部超声和内镜下切除≥1 个腺瘤且在 2017 年之前进行随访结肠镜检查的无症状受试者。
在 6182 名参与者中，2642 名（42.7%）在指数结肠镜检查时患有 NAFLD。在男性（3 年时为 19.4%比 18.2%，5 年时为 49.2%比 44.0%；p = 0.001）和女性（3 年时为 18.7%比 10.5%，5 年时为 56.1%比 29.8%；p < 0.001）中，患有 NAFLD 的患者异时性总体 CRN 的累积发生率明显高于不患有 NAFLD 的患者。即使在调整混杂因素后，NAFLD 仍然与男性（调整后的危险比[HR]，1.17；95%置信区间[CI]，1.06 至 1.29）和女性（调整后的 HR，1.63；95%CI，1.27 至 2.07）中异时性总体 CRN 的风险增加独立相关。此外，NAFLD 是女性异时性高级 CRN（ACRN）的独立危险因素（调整后的 HR，2.61；95%CI，1.27 至 5.37）。
NAFLD 与息肉切除术后异时性 CRN 的风险增加有关。特别是，患有 NAFLD 的女性发生异时性 ACRN 的风险增加。我们的结果表明，NAFLD 可能对 CRN 的发病机制有影响。
