Kowalczyk Marek, Klepacki Łukasz, Zieliński Ewa, Kurpiewski Waldemar, Zinkiewicz Krzysztof, Dyśko Łukasz, Pesta Wiesław
Department of Psychology and Sociology of Health and Public Health, University of Warmia and Mazury, 10-082 Olsztyn, Poland.
Clinic of Oncological and General Surgery, University Clinical Hospital in Olsztyn, 10-082 Olsztyn, Poland.
J Clin Med. 2020 Dec 26;10(1):55. doi: 10.3390/jcm10010055.
The problem of smoking and its influence on the occurrence of precursors and advanced colorectal cancer is often discussed in the medical literature. Tobacco smoke can provide a non-nutritional source of polycyclic hydrocarbons and other substances which, when combined with an incorrect diet, may play a role in promoting carcinogenesis at the level of the genetic control mechanism. The aim of our study was to assess the effect of smoking on the frequency and type of aberrant crypt foci (ACF) in the rectum and polyps in the large intestine in people who smoke more than 20 cigarettes a day for more than 20 years.
A colonoscopy combined with rectal mucosa staining with 0.25% methylene blue was performed in 131 patients. Each of the study participants gave informed consent to participate in the study. Three bioptates were collected from the foci defined macroscopically as ACF; in cases where there were fewer foci, the number of collected foci was respectively lower. On the colonoscopy day, patients completed the questionnaire regarding epidemiological data used for analysis of factors affecting the occurrence of ACF in the study group. The number of ACF in the colon was divided into three groups: -ACF < 5, 5 < ACF < 10, ACF > 10. In the statistical analysis, numerical data were presented and real numbers, range of arrhythmic means, mean standard deviation, and results of probability distribution. The Student's test, U test, and chi2 were applied in order to determine the significance of differences of means and frequency of events in both groups. The level of significance was set at α = 0.05. Statistica 7.1 and Excel 2010 were used. Most smokers are in the age groups between 51-70 years. In the youngest (31-40 years), single ACF appear first (ACF <5) ACF in the number of 5-10 appear a little later (around 50 years of age) and dynamically increase, reaching a maximum at the age of 60-65.ACF in the number >10 appear at the latest age (55 years old) and their number gradually increases with age (linear growth). The probability of occurrence of ACF in all groups is greater in smokers, and the difference for the ACF group 5-10 and ACF >10 is statistically significant with a significance level of < 0.05. Apart from ACF normal, all types of ACF are more likely in this group than in non-smokers and these differences are statistically significant with < 0.05.
Smoking has a significant impact on the number and type of rectal ACF. Smokers have a greater number of ACFs in the rectum than non-smokers, and the most common type is hyperplastic ACF. Smokers are more likely to develop polyps in all sections of the colon compared to non-smokers.
医学文献中经常讨论吸烟问题及其对结直肠癌前体和进展期结直肠癌发生的影响。烟草烟雾可提供多环芳烃和其他物质的非营养来源，这些物质与不正确的饮食相结合，可能在基因控制机制层面促进致癌作用。我们研究的目的是评估吸烟对每天吸烟超过20支且烟龄超过20年的人群直肠中异常隐窝病灶（ACF）的频率和类型以及大肠息肉的影响。
对131例患者进行了结肠镜检查，并结合用0.25%亚甲蓝对直肠黏膜进行染色。每位研究参与者均签署知情同意书参与本研究。从宏观上定义为ACF的病灶处采集3块活检组织；若病灶较少，则采集的病灶数量相应减少。在结肠镜检查当天，患者完成了关于流行病学数据的问卷，用于分析研究组中影响ACF发生的因素。结肠中ACF的数量分为三组：-ACF＜5、5＜ACF＜10、ACF＞10。在统计分析中，呈现了数值数据以及实数、无节律均值范围、平均标准差和概率分布结果。应用了学生检验、U检验和卡方检验，以确定两组均值差异和事件频率的显著性。显著性水平设定为α = 0.05。使用了Statistica 7.1和Excel 2010软件。大多数吸烟者年龄在51 - 70岁之间。在最年轻的年龄段（31 - 40岁），首先出现单个ACF（ACF＜5），数量为5 - 10个的ACF出现稍晚（约50岁左右）且动态增加，在60 - 65岁时达到峰值。数量＞10个的ACF出现最晚（55岁），其数量随年龄逐渐增加（呈线性增长）。所有组中吸烟者发生ACF的概率更高，ACF数量为5 - 10个组和ACF＞10个组的差异具有统计学意义，显著性水平＜0.05。除正常ACF外，该组中所有类型的ACF比非吸烟者更易出现，且这些差异具有统计学意义，＜0.05。
吸烟对直肠ACF的数量和类型有显著影响。吸烟者直肠中的ACF数量多于非吸烟者，最常见的类型是增生性ACF。与非吸烟者相比，吸烟者在结肠各段更易发生息肉病变。
