Zhang Xin, Wang Ying, Zhu Tong, Ge Jian, Yuan Jun-Hua
Department of Geriatric Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China.
World J Gastrointest Oncol. 2024 Oct 15;16(10):4129-4137. doi: 10.4251/wjgo.v16.i10.4129.
According to the degree of intradermal neoplasia in the colorectal exhalation, it can be divided into two grades: Low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia (HGIN). Currently, it is difficult to accurately diagnose LGIN and HGIN through imaging, and clinical diagnosis depends on postoperative histopathological diagnosis. A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.
To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.
We selected 84 older patients diagnosed with HGIN as the HGIN group ( = 95 colonic polyps) and 112 older patients diagnosed with LGIN as the LGIN group ( = 132 colonic polyps) from Shandong Provincial Hospital Affiliated to Shandong First Medical University. The endoscopic features, demographic characteristics, and clinical manifestations of the two patient groups were compared, and a logistic regression model was used to analyze the risk factors for HGIN in these patients.
The HGIN group was older and had a higher number of sigmoid colon polyps, rectal polyps, pedunculated polyps, polyps ≥ 1.0 cm in size, polyps with surface congestion, polyps with surface depression, and polyps with villous/tubular adenomas, a higher proportion of patients with diabetes and a family history of colorectal cancer, patients who experienced rectal bleeding or occult blood, patients with elevated carcinoembryonic antigen (CEA) and cancer antigen 199 (CA199), and lower nutritional levels and higher frailty levels. The polyp location (in the sigmoid colon or rectum), polyp diameter (≥ 1.0 cm), pathological diagnosis of (villous/tubular adenoma), family history of colorectal cancer, rectal bleeding or occult blood, elevated serum CEA and CA199 levels, lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.
The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location, size, villous/tubular characteristics, family history, elevated levels of tumor markers, and lower nutritional levels and higher frailty levels.
根据结直肠呼气中皮内瘤变程度，可分为两级：低级别上皮内瘤变（LGIN）和高级别上皮内瘤变（HGIN）。目前，通过影像学难以准确诊断LGIN和HGIN，临床诊断依赖术后组织病理学诊断。在结直肠息肉的手术治疗和护理干预中，迫切需要一种术前评估HGIN的更准确方法。
探讨老年结直肠息肉患者HGIN的特征及危险因素。
我们从山东第一医科大学附属山东省立医院选取84例诊断为HGIN的老年患者作为HGIN组（结肠息肉95枚），112例诊断为LGIN的老年患者作为LGIN组（结肠息肉132枚）。比较两组患者的内镜特征、人口学特征及临床表现，并采用逻辑回归模型分析这些患者HGIN的危险因素。
HGIN组患者年龄较大，乙状结肠息肉、直肠息肉、带蒂息肉、直径≥1.0 cm的息肉、表面充血息肉、表面凹陷息肉、绒毛状/管状腺瘤息肉数量较多，糖尿病患者及有结直肠癌家族史患者比例较高，出现直肠出血或潜血的患者、癌胚抗原（CEA）和糖类抗原199（CA199）升高的患者，营养水平较低且衰弱程度较高。息肉位置（乙状结肠或直肠）、息肉直径（≥1.0 cm）、（绒毛状/管状腺瘤）病理诊断、结直肠癌家族史、直肠出血或潜血、血清CEA和CA199水平升高、营养水平较低及衰弱程度较高也是HGIN的独立危险因素。
结直肠息肉高级别瘤变的发生与其位置、大小、绒毛状/管状特征、家族史、肿瘤标志物水平升高以及营养水平较低和衰弱程度较高密切相关。
