男性成年人代謝因子及吸菸與大腸直腸腺瘤之相關性

Associations of Metabolic Factors and Cigarette Smoking with Colorectal Adenoma Risk in Taiwanese Men

目的：本回溯性研究目的在探討男性國人其代謝因子及吸菸與大腸直腸腺瘤之相關性。方法：我們分析了從2005年1月至2006年4月於本院接受自費健康檢查包含成功完成大腸鏡檢查之男性個案，共1,542位納入分析。其中檢查出有大腸直腸腺瘤之個案為研究組，其餘為對照組。代謝症候群採用2005年美國 National Cholesterol Education Program adult treatment panel III及2007年台灣修正版本的診斷標準，納入分析之變項包含：代謝危險因子、身體質量指數、吸菸及代謝症候群，希望能找出與大腸直腸腺瘤獨立相關之危險因子。此外在病例組中，代謝症候群及吸菸與大腸直腸腺瘤的大小及病理特徵之關聯性亦納入分析。結果：共有279位（18.1%）經由病理切片診斷為大腸直腸腺瘤。代謝症候群在病例組及對照組之盛行率分別為36.2%及21.6%。多變項邏輯回歸分析顯示：男性之大腸直腸腺瘤與年齡≥50歲、中央型肥胖、及有吸菸習慣呈顯著相關。代謝症候群也會增加男性罹患大腸直腸腺瘤之危險性，如果再加上吸菸其危險性會較有代謝症候群但未吸菸者更高（OR=1.69，95% CI：1.01-2.84）；此外吸菸者若合併有代謝症候群，其罹患大腸直腸腺瘤之危險性會較有吸菸但無代謝症候群者明顯增加（p= 0.049）。而且代謝症候群在病例組中也會增加罹患直徑大於1公分的大腸直腸腺瘤之危險性（p= 0.01）。結論：有中央型肥胖、代謝症候群或吸菸之男性成年人罹患大腸直腸腺瘤之危險性較高，而且此危險性在有吸菸且合併代謝症候群之男性呈現更明顯增加。因此應加強推廣菸害防治、減少中央型肥胖及代謝症候群盛行率，以降低男性國人得到大腸直腸腺瘤之危險性。

Purpose: The purpose of this study was to determine the associations of metabolic risk factors and cigarette smoking with colorectal adenoma risk among Taiwanese men. Methods: A retrospective case-control study was conducted on Taiwanese men who visited our institution for health examination. From January 2005 to April 2006, 1,542 male subjects who underwent complete colonoscopy during health examinations were enrolled. Metabolic syndrome was defined according to the modified National Cholesterol Education Program adult treatment panel III definition for South Asian and Chinese populations. Metabolic risk factors, body mass index, cigarette smoking habit, and the frequency of metabolic syndrome were compared between individuals with and without colorectal adenoma. Multivariate logistic regression was used to analyze the association between independent risk factors and colorectal adenoma. The effects of metabolic syndrome and cigarette smoking on pathological features and size of colorectal adenoma were also examined. Results: There were 279 (18.1%) subjects with pathologically proven colorectal adenoma. The prevalence rate of metabolic syndrome in men was 36.2% in the adenoma group and 21.6% in the control group. In multivariate analysis, old age ( ≥50 years), central obesity, current smoking habit, and metabolic syndrome were associated with an increased risk of colorectal adenoma in men. Male subjects with metabolic syndrome who were current smokers were more likely to develop colorectal adenoma than nonsmokers (OR = 1.69, 95% CI: 1.01-2.84). Furthermore, current smokers with metabolic syndrome had a significantly increased risk of colorectal adenoma compared to the risk of current smokers without metabolic syndrome (p= 0.049). Metabolic syndrome was also associated with an increased risk of colorectal adenoma larger than 1 cm in diameter in the adenoma group (p= 0.01). Conclusion: Male subjects with central obesity, metabolic syndrome, or a current smoking habit have an increased risk of developing colorectal adenoma, and the risk is significantly increased in current smokers with metabolic syndrome. We recommend that an increased emphasis on smoking prevention and reducing the prevalence of central obesity and metabolic syndrome will reduce the risk of colorectal adenoma among Taiwanese men.