【作者】 李锦；

【导师】 孔令斌；

【作者基本信息】 山东大学 ， 内科学（消化系病）， 2016， 硕士

【摘要】 目的通过病例对照研究比较不同病理类型的大肠腺瘤性息肉的危险因素发生率,探讨腺瘤性息肉癌变的危险因素,为结肠镜筛查提供依据。方法收集2014年5月-2015年9月期间因大肠腺瘤性息肉于我院消化内科及胃肠外科住院治疗的患者信息,主要包括患者年龄、性别、身高、体重、既往糖尿病病史、高血压病史、胃息肉病史、子宫内膜息肉病史、冠心病病史、既往父母肿瘤病史等基本病例特点,收集患者空腹测得的甘油三酯、总胆固醇数值,收集内镜下息肉部位、大小、数目等特点,收集病理诊断结果,对样本资料进行统计分析。结果1.大便带血症状在高危腺瘤组的比例为33.3%(18/54),高于低危腺瘤组比例11.3%(21/186),差异有统计学意义(X2=14.94,P=0.00)。2.高危腺瘤组既往存在糖尿病病史比例18.52%(10/54),高于低危腺瘤组比例8.60%(16/186),差异有统计学意义(X2=4.260,P=0.039)3.高危腺瘤组BMI平均值为25.02±3.61kg／m2,高于低危腺瘤组BMI平均值为23.92±3.50kg/m2,差异有统计学意义(t=1.997,P<0.05)。高危腺瘤组的甘油三酯平均值为1.88±1.19mmol/L,高于低危腺瘤组甘油三酯平均值为1.52±1.04mmol/L,差异存在统计学意义(t=2.199,P<0.05)。4.高危腺瘤组存在肿瘤家族史者比例为31.48%(17/54),高于低危腺瘤组比例18.82%(35/186),(X2=3.955,P=0.047)。5. Logistic回归分析结果高危腺瘤发生的危险因素为大便带血(P=0.034)、甘油三酯>5.85mmol/L(P=0.015)、BMI≥24.8kg/m2 (P=0.048)、父母肿瘤史(P=0.023)；各危险因素按照OR值由大自小依次为大便带血(OR=2.589,95%CI:1.0 74-6.244)、父母肿瘤病史(OR=2.437,95%CI:1.134-5.238)、甘油三酯>5.85mmol/L (OR=2.26,95%CI:1.171-4.362)、BMI≥24.8kg/m2 (OR=1.963,95%CI:1. 006-3.831)。结论大便带血、甘油三酯>5.85mmol/L及BMI≥24.8kg/m2、父母肿瘤史是高危腺瘤发生的危险因素。目的通过比较不同病理类型CAP组织、大肠癌组织、正常大肠组织中白介素6(Interleukin6, IL6)和白介素10 (Interleukin 10, IL10)在相应组织中的阳性表达率和IL6 mRNA、IL10 mRNA、表达量,探讨炎症介质在CAP癌变中的作用,为临床诊治提供指导。方法在2014年5月-2014年11月期间于济宁医学院附属医院收集不同病变类型的大肠组织标本共169例,应用荧光定量PCR及免疫组化法比较正常大肠组织、不同类型的大肠息肉组织、大肠癌组织中IL6和ILI0阳性表达率和IL6 mRNA、 IL10 mRNA、表达量。结果1. IL6 mRNA在腺癌中的相对表达量为2.951±0.474,高于绒毛状腺瘤组织(1.763±0.143)、管状绒毛状腺瘤(1.660±0.119)、管状腺瘤(1.603±0.136)和正常组织(1.000±0.000)(F=27.309,P<0.05),并且相对表达量逐渐降低。2.IL6蛋白在腺癌组织阳性表达率为72.41%,高于腺瘤性息肉及正常大肠组织阳性率(43.24%、10.34%)(X2=22.916,P<0.05)。3. IL10mRNA在腺癌组织中的相对表达量为3.516±0.337,高于绒毛状腺瘤(1.577±0.160)、管绒毛状腺瘤(1.538±0.077)、管状腺瘤(1.473±0.134)、正常组织(1.000±0.000),(F=89.919,P<0.05)。4.ILI0蛋白在腺癌组织阳性表达率82.76%,高于腺瘤性息肉及正常组织(44.59%、13.79%)(X2=27.923,P<0.05)。结论IL6、IL10可能作用于正常组织-腺瘤性息肉-腺癌的癌变过程,但在正常组织-增生性息肉-锯齿状腺瘤癌变过程中无明显作用。更多还原

【Abstract】 ObjectiveThrough case control study, comparing incidence rate of different risk factors among different pathological types pathological types,finding the risk factors in polyp canceration and providing the basis for screening colonoscopy.MethodsPatients who suffering from colon polyps between May 2014 and September 2015 and at the department of Gastroenterology and Gastrointestinal Surgery,Affilitated Hospital of Jining Medical University,were anlyzed.the information including age, sex,height, weight,body mass index,history of diabetes、 hypertension、gastric polyps、endometrial polyps, coronary artery disease, Family history of cancer,triglycerides and total cholesterol value,collect endoscopic polyp location, size,number and pathology,anlyze the sample data.Results1.The proportion of stool symptoms in advanced adenoma polyp group was 33.3% (18/54), higher than the proportion of non-adenoma pilyp group 11.3% (21/186), the difference was statistically significant (X2= 14.94, P= 0.00).2.Advanced adenoma polyp group with a history of diabetes was 18.52%(10/54), the proportion is higher than the proportion of non-advanced adenoma polyp group 8.60%(16/186), the difference was statistically significant (X2= 4.260, P= 0.039).3.Advanced adenoma polyp group mean BMI was 25.02±3.61kg/m2, higher than the non-advanced adenoma group mean BMI was 23.92 ± 3.50kg/m2, the difference was statistically significant (t=1.997,P<0.05). Triglycerides in advanced adenoma polyp group was 1.88±1.19mmol/L, higher than the non-advanced adenoma group of triglycerides with an average of 1.52±1.03mmol/L, the differences was statistically significant (t=2.199,P<0.05).4.The proportion of family history of cancer in advanced adenoma polyp group was 31.48%(17/54), higher than the proportion of non-advanced adenoma group was18.82%(35/186), (X2= 3.955, P= 0.047).5.The risk factors of advanced adenoma polyps are blood in stool(P=0.03 4), triglyceride>5.85mmol/L(P=0.015),BMI≥24.8kg/m2 (P=0.048),parental history of cancer (P=0.023);The risk factors are as follows:blood in stool(OR=2.589,9 5%CI:1.074-6.244),parental history of cancer (OR=2.437,95%CI:1.134-5.238),trigl yceride>5.85mmol/L (OR=2.26,95%CI:1.171-4.362),BMI≥24.8kg/m2 (OR=1.96 3,95%CI:1.006-3.831)ConclusionPatients with stool, triglycerides>5.85mmol/L,and BMI≥24.8kg/m2,family history of cancer are risk factors of advanced adenoma..ObjectiveComparing the positive expression rate and mRNA expression level of IL6,IL10 in different pathological types of s CAP,colorectal cancer, normal adjacent,to explore the role of inflammatory mediators in the carcinogenesis of cap and provide guidance for clinical diagnosis and treatment.MethodsTotal 169 patients with different pathology types of colorectal tissues were collected during May 2014 and November 2014 in Affiliated Hospital of Jining Medical University. IL6,IL 10 expression in tissues were detected using Real-Time Fluorescent Quantitative PCR and immunohistochemistry.Results l.the relative expression of IL6 mRNA in adenocarcinoma was 2.951 ±0.474,higher than villous adenomas(1.763 ±0.143), tubular villous adenoma s(1660± 0.119), tubular adenomas (1.603±0.136) and normal tissues (1.000±0.000) (F=27.309, P< 0.05), at the same time,the relative expression quantity decrease gradually. 2.The positive expression rate of IL6 protein in adenocarcinoma was 72.41%, which was higher than that in adenomatous polyps,normal colorectal tissues (43.24%, 10.34%) (X2=22.916, P＜0.05).3.The relative expression of IL10 mRNA in carcinoma was3.516±0.337, higher than vilous adenomas (1.577±0.160), tubular-villous adenomas(1.538±0.077), tubular adenomas(1.473±0.134) and normal tissues (1.000±0.000), (F=89.919, P< 0.05).4.The positive expression rate of IL10 protein in adenocarcinoma was 82.76%, which was higher than that in adenomatous polyp,normal tissues (44.59%,13.79%) (X2=27.923, P<0.05).ConclusionIL-6, IL-10 may play a role in the progress of normal tissue-adenoma polyp-adeno carcinoma, but in normal tissue-hyperplasia polyposis-serrated adenoma canceration progress was no obvious effect.更多还原