胃息肉：大腸息肉之一危險因子

Gastric Polyps: A Risk Factor for Colonic Polyps

目的：臨床上時常見到大腸息肉患者身上合併發生胃息肉，國外的研究發現胃息肉會增加大腸息肉的風險，然而國內缺少相關的研究報告，本研究目的旨在探討國內胃息肉與大腸息肉的相關性。方法：這是以北部某大型醫院健康檢查中心為樣本所作的回溯性橫斷式分析。以2008年1月至2009年12月期間曾至醫院健檢時同時接受胃鏡及大腸鏡檢查之7,896位民眾為樣本，分析胃息肉與大腸息肉之盛行率以及兩者之間的關連性；此外，我們同時也分析了其他因子，如年齡、性別、血糖、血脂肪與大腸息肉的相關。本研究採用羅吉斯迴歸（logistic regression）分析胃息肉及其他因子與大腸息肉之關聯性。結果：本次研究總共包含7,896位受檢者，男性佔4,216人（53.4%），女性佔3,680人（46.6%），平均年齡48.3±11.1歲；788（10%）人之胃鏡檢查有發現胃息肉，其中男性有286人，女性有502人。大腸息肉的比率在有胃息肉的人身上比沒有胃息肉的人要高。在單變項迴歸分析中，發現胃息肉、老年人、男性、體重過重、血糖偏高、高膽固醇、高三酸甘油酯、低HDL、高LDL較易發生大腸息肉，勝算比（OR）分別為1.18（1.01-1.37)、2.02（1.70-2.40）、1.95（1.77-2.14）、1.53（1.39-1.69）、1.61（1.43-1.82）、1.23（1.12-1.35）、1.63（1.47-1.81）、1.31（1.19-1.44）、1.28（1.71-1.41）；進一步以複迴歸模式校正後顯示，胃息肉、老年人、男性、體重過重、空腹血糖偏高、高膽固醇、高三酸甘油酯及較低的高密度脂蛋白膽固醇有較高的機會發生大腸息肉，OR分別為1.34（1.14-1.56）、1.88（1.58-2.24）、1.80（1.63-2.00）、1.14（1.02-1.27）、1.28（1.13-1.45）、1.19（1.08-1.32）、1.22（1.08-1.37）、1.18（1.06-1.32），但高的低密度脂蛋白膽固醇則無顯著相關。結論：本研究顯示胃息肉為大腸息肉的獨立危險因子，臨床上遇到胃息肉的病患，如果同時合併有其他大腸癌相關危險因子的話（如家族大腸癌史，體重過重，高油脂飲食習慣等），則可以考慮大腸鏡檢查。

Background: Patients with colonic polyps often have gastric polyps. Previous studies have shown that the risk for colonic polyps increases in patients with gastric polyps; however, no such study has been done in Taiwan. Our aim was to determine if there was an association between gastric polyps and colonic polyps in the Taiwanese population. Methods: This was a cross-sectional study in a health screening center in a hospital in northern Taiwan. We collected data from January 2008 to December 2009. A total of 7896 persons received both panendoscopy and colonfibroscopy. We analyzed the prevalence of gastric polyps and colonic polyps in our study population and the association between the two. We also explored the associations between colonic polyps and different factors (e.g., age, gender, blood glucose and lipid levels). Logistic regression was performed for the analysis. Results: This study contained a total of 7,896 subjects of whom 4,216 were men (53.4%) and 3,680 were women (46.6%). Their mean age was 48.3 ± 11.1 years; 788 subjects (10%) had gastric polyps, of these, 286 were male and 502 were female. The prevalence of colonic polyps was higher in subjects with gastric polyps than in those without them. On univariate logistic regression analysis, we found that those with gastric polyps, age greater than 65 years, male, overweight, high fasting glucose, high total-cholesterol, high triglycerides, low high-density lipoprotein cholesterol (HDL-C) and high low-density lipoprotein cholesterol (LDL-C) were more prone to colonic polyps, the odds ratios (ORs) were 1.18 (1.01-1.37), 2.02 (1.70-2.40), 1.95 (1.77-2.14), 1.53 (1.39-1.69), 1.61 (1.43-1.82), 1.23 (1.12-1.35), 1.63 (1.47-1.81), 1.31 (1.19-1.44), and 1.28 (1.71-1.41) respectively. Multiple logistic regression analysis showed that those with gastric polyps, age greater than 65 years, male, overweight, high fasting glucose, high total cholesterol, high triglycerides and low HDL-C were at a higher risk for colonic polyps. ORs were 1.34 (1.14-1.56), 1.88 (1.58-2.24), 1.80 (1.63-2.00), 1.14 (1.02-1.27), 1.28 (1.13-1.45), 1.19 (1.08-1.32), 1.22 (1.08- 1.37) and 1.18 (1.06-1.32) respectively. High LDL-C had no significant correlation. Conclusions: This study shows that gastric polyps are an independent risk factor for colonic polyps. If subjects have gastric polyps, unhealthy dietary habits, a past medical history or family history of colonic polyps, then colonfibroscopy should be considered.