目的 观察慢性肾脏病(CKD)患者结直肠病变的发生情况,分析CKD患者发生结直肠病变的危险因素.方法 收集行结肠镜检查的CKD患者719例和非CKD患者404例的临床资料,比较两组患者结直肠病变的发生情况.按结肠镜检查的结果将CKD患者分为结肠镜检查阳性组和阴性组,分析两组临床生物化学指标,计量资料采用t检验和秩和检验比较,率的比较采用卡方检验.采用Logistic回归分析评估CKD患者发生结直肠病变的危险因素.结果 CKD患者结肠镜检查阳性率为21.28％(153/719),高于非CKD组的12.62％(51/404,x2=13.036,P＜0.01),其中1期CKD患者结肠镜检查阳性率为17.50％(56/320),2～3期患者为22.68％(66/291),4～5期患者为28.70％(31/108),各组间差异有统计学意义(x2 =6.623,P＜0.05).结直肠癌的发生率在CKD组患者中为3.89％(28/719),高于非CKD组的1.73％(7/404,x2=4.003,P＜0.05);结直肠息肉的发生率在CKD组中为8.34％(60/719),高于非CKD组的5.20％(21/404,x2=3.827,P＜0.05);IBD的发生率在CKD组患者中为9.04％(65/719),高于非CKD组的5.69％(23/404,x2=4.013,P＜0.05).其中结直肠癌和结直肠息肉的发生率在1期CKD患者中为2.50％(8/320)和6.25％(20/320),2～3期CKD患者为3.78％(11/291)和8.59％(25/291),4～5期CKD患者为8.33％(9/108)和13.89％(15/108),各组间差异均有统计学意义(x2 =7.359和6.199,P均＜0.05).结肠镜检查阳性组的CKD患者较阴性组年龄大(t=-3.821,P＜0.01)、Hb低(t=3.541,P＜0.01)、ESR和CRP明显升高(Z=-4.996和-7.493,P均＜0.01)、胆固醇和低密度脂蛋白升高(t=-2.659和-3.248,P均＜0.01)、血肌酐升高(Z=-3.683,P＜0.01)、肾小球滤过率估计值(eGFR)明显降低(Z=-6.227,P＜0.01),差异均有统计学意义.Logistic回归分析显示年龄(β=0.981,95％CI 0.965～0.998,P=0.032)、血肌酐(β=1.006,95％CI 1.002～1.009,P=0.001)、ESR(β=1.029,95％CI1.018～1.040,P＜0.01)是影响CKD患者发生结直肠病变的危险因素.结论 CKD患者结直肠病变发生率高,且随着eGFR的下降,其发生率上升.CKD患者发生结直肠病变可能与高龄、贫血、脂质代谢、炎性反应和肾功能减退有关.
目的 觀察慢性腎髒病(CKD)患者結直腸病變的髮生情況,分析CKD患者髮生結直腸病變的危險因素.方法 收集行結腸鏡檢查的CKD患者719例和非CKD患者404例的臨床資料,比較兩組患者結直腸病變的髮生情況.按結腸鏡檢查的結果將CKD患者分為結腸鏡檢查暘性組和陰性組,分析兩組臨床生物化學指標,計量資料採用t檢驗和秩和檢驗比較,率的比較採用卡方檢驗.採用Logistic迴歸分析評估CKD患者髮生結直腸病變的危險因素.結果 CKD患者結腸鏡檢查暘性率為21.28％(153/719),高于非CKD組的12.62％(51/404,x2=13.036,P＜0.01),其中1期CKD患者結腸鏡檢查暘性率為17.50％(56/320),2～3期患者為22.68％(66/291),4～5期患者為28.70％(31/108),各組間差異有統計學意義(x2 =6.623,P＜0.05).結直腸癌的髮生率在CKD組患者中為3.89％(28/719),高于非CKD組的1.73％(7/404,x2=4.003,P＜0.05);結直腸息肉的髮生率在CKD組中為8.34％(60/719),高于非CKD組的5.20％(21/404,x2=3.827,P＜0.05);IBD的髮生率在CKD組患者中為9.04％(65/719),高于非CKD組的5.69％(23/404,x2=4.013,P＜0.05).其中結直腸癌和結直腸息肉的髮生率在1期CKD患者中為2.50％(8/320)和6.25％(20/320),2～3期CKD患者為3.78％(11/291)和8.59％(25/291),4～5期CKD患者為8.33％(9/108)和13.89％(15/108),各組間差異均有統計學意義(x2 =7.359和6.199,P均＜0.05).結腸鏡檢查暘性組的CKD患者較陰性組年齡大(t=-3.821,P＜0.01)、Hb低(t=3.541,P＜0.01)、ESR和CRP明顯升高(Z=-4.996和-7.493,P均＜0.01)、膽固醇和低密度脂蛋白升高(t=-2.659和-3.248,P均＜0.01)、血肌酐升高(Z=-3.683,P＜0.01)、腎小毬濾過率估計值(eGFR)明顯降低(Z=-6.227,P＜0.01),差異均有統計學意義.Logistic迴歸分析顯示年齡(β=0.981,95％CI 0.965～0.998,P=0.032)、血肌酐(β=1.006,95％CI 1.002～1.009,P=0.001)、ESR(β=1.029,95％CI1.018～1.040,P＜0.01)是影響CKD患者髮生結直腸病變的危險因素.結論 CKD患者結直腸病變髮生率高,且隨著eGFR的下降,其髮生率上升.CKD患者髮生結直腸病變可能與高齡、貧血、脂質代謝、炎性反應和腎功能減退有關.
목적 관찰만성신장병(CKD)환자결직장병변적발생정황,분석CKD환자발생결직장병변적위험인소.방법 수집행결장경검사적CKD환자719례화비CKD환자404례적림상자료,비교량조환자결직장병변적발생정황.안결장경검사적결과장CKD환자분위결장경검사양성조화음성조,분석량조림상생물화학지표,계량자료채용t검험화질화검험비교,솔적비교채용잡방검험.채용Logistic회귀분석평고CKD환자발생결직장병변적위험인소.결과 CKD환자결장경검사양성솔위21.28％(153/719),고우비CKD조적12.62％(51/404,x2=13.036,P＜0.01),기중1기CKD환자결장경검사양성솔위17.50％(56/320),2～3기환자위22.68％(66/291),4～5기환자위28.70％(31/108),각조간차이유통계학의의(x2 =6.623,P＜0.05).결직장암적발생솔재CKD조환자중위3.89％(28/719),고우비CKD조적1.73％(7/404,x2=4.003,P＜0.05);결직장식육적발생솔재CKD조중위8.34％(60/719),고우비CKD조적5.20％(21/404,x2=3.827,P＜0.05);IBD적발생솔재CKD조환자중위9.04％(65/719),고우비CKD조적5.69％(23/404,x2=4.013,P＜0.05).기중결직장암화결직장식육적발생솔재1기CKD환자중위2.50％(8/320)화6.25％(20/320),2～3기CKD환자위3.78％(11/291)화8.59％(25/291),4～5기CKD환자위8.33％(9/108)화13.89％(15/108),각조간차이균유통계학의의(x2 =7.359화6.199,P균＜0.05).결장경검사양성조적CKD환자교음성조년령대(t=-3.821,P＜0.01)、Hb저(t=3.541,P＜0.01)、ESR화CRP명현승고(Z=-4.996화-7.493,P균＜0.01)、담고순화저밀도지단백승고(t=-2.659화-3.248,P균＜0.01)、혈기항승고(Z=-3.683,P＜0.01)、신소구려과솔고계치(eGFR)명현강저(Z=-6.227,P＜0.01),차이균유통계학의의.Logistic회귀분석현시년령(β=0.981,95％CI 0.965～0.998,P=0.032)、혈기항(β=1.006,95％CI 1.002～1.009,P=0.001)、ESR(β=1.029,95％CI1.018～1.040,P＜0.01)시영향CKD환자발생결직장병변적위험인소.결론 CKD환자결직장병변발생솔고,차수착eGFR적하강,기발생솔상승.CKD환자발생결직장병변가능여고령、빈혈、지질대사、염성반응화신공능감퇴유관.
Objective To investigate the incidence of colorectal disease in patients with chronic kidney disease (CKD) and analyze the risk factor of colorectal disease in patients with CKD.Methods The clinical data of 719 patients with CKD underwent colonoscopy examination and 404 patients without CKD underwent colonoscopy examination were collected.The incidence of colorectal disease was compared between patients of the two groups.According to the results of colonoscopy examination,the patients with CKD were divided into colonoscopy positive group and negative group,and clinical biochemical indexes of the two groups were analyzed.The rank-sum test or t-test was used to compare the measurement data.Rates were compared by Chi-square test.The risk factors of colorectal disease in patients with CKD were evaluated by logistic regression.Results The positive rate of colonoscopy examination in 719 patients with CKD was 21.28％ (153/719),which was higher than that of patients without CKD (12.62 ％,51/404; x2 =13.036,P＜0.01).The positive rate of colonoscopy in patients with CKD at stage 1 was 17.50％ (56/320),at stage 2 or 3 was 22.68％(66/291),at stage 4 or 5 was 28.70％ (31/108).There were significant differences among the three groups (x2-6.623,P＜0.05).The incidence of colorectal cancer in patients with CKD was 3.89 ％ (28/719),which was higher than that of patients without CKD (1.73％,7/404; x2 =4.003,P＜0.05).The incidence of colorectal polyps in CKD group was 8.34％(60/719),which was higher than that of non-CKD group (5.20％,21/404; x2 =3.827,P＜0.05).The incidence of inflammatory bowel disease in CKD group was 9.04％(65/719),which was higher than that of non-CKD group (5.69 ％,23/404; x2 =4.013,P＜0.05).The incidence of colorectal cancer and colorectal polyps in patients with CKD at stage Ⅰ was 2.50％(8/320) and 6.25％(20/320),at stage 2 or 3 was 3.78％(11/291) and 8.59％(25/291),at stage 4 or 5 was 8.33％(9/108) and 13.89％ (15/108).There were significant differences among the three groups (x2-7.359 and 6.199,both P＜ 0.05).The age of colonoscopy positive group was older than that of colonoscopy negative group (t=-3.821,P＜0.01); there were lower hemoglobin (t=3.541,P＜0.01),increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (Z=-4.996 and-7.493,both P＜0.01),higher cholesterol and low density lipoprotein (t=-2.659 and-3.248,both P＜0.01),increased serum creatinine (Z=-3.683,P＜0.01) and declined glomerular filtration rate (Z=-6.227,P＜0.01) in colonoscopy positive group than in colonoscopy negative group; the differences were statistically significant.Logistic regression analysis indicated that age (β=0.981,95％ CI 0.965 to 0.998,P =0.032),serum creatinine (β=1.006,95％CI 1.002 to 1.009,P=0.001) and ESR (β=1.029,95％CI 1.018 to 1.040,P＜0.01) were risk factors of colorectal disease in patients with CKD.Conclusions The incidence of colorectal disease in patients with CKD is high,and it increases along with the declined glomerular filtration rate.The colorectal disease in patients with CKD patients may be associated with age,anemia,lipid metabolism,inflammation and impaired renal function.
