Study On The Microscopic Features, Pathological Types And TCM Syndrome Types Of Colorectal Adenoma Intraepithelial Neoplasia

BackgroundColorectal adenoma(CRA)is a common disease of the digestive system.As a precancerous lesion of colorectal cancer(CRC),it has the characteristics of high incidence,easy diagnosis,and easy recurrence.Colorectaladenomas,after pathological immunohistochemical analysis,are further graded into low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN),of which HGIN has a higher degree of dysplasiaand malignant transformation.HGIN is an important factor affecting the treatment plan and prognosis of colorectal adenoma.Treatment options of HGIN,which is an advanced adenomas differ from such of low-grade intraepithelial neoplasia.Existing assessment methods rely heavily on the pathological results,and treatment plans are susceptible to incomplete adenoma resection or insufficient detection.It is particularly important to evaluate the degree of intraepithelial neoplasia before performing colorectal adenoma operations,but there is quite limited researches in this orientation at present.At present,existing treatment of colorectal adenoma is mainly limited to resection of the neoplasia or enteroscope re-check after surgery.Western medicine intervention methods to prevent postoperative recurrence have considerable side effects and no clinical promotion.A large number of studies in recent years have shown that the use of traditional Chinese medicine(TCM)to prevent recurrence of colorectal adenoma is safe and effective.Syndrome differentiation and treatment is the basic principle of using TCM to treat diseases.Accurate syndrome differentiation is the fundamental to ensure clinical efficacy.TCM syndrome differentiation relies on the judgment of the practitioners by combing the four diagnosis methods,which is often subjective and lacking objective assessment criteria.ObjectiveThis study probes into the endoscopic features,pathological classification,and TCM syndrome types of HGIN cases,resulting in a preliminary judgment over the progression of the colorectal intraepithelial neoplasia according to their characteristics,and providing a reference for the clinical selection of reasonable examination,treatment and colonoscopy review programs.In this study,the correlation between the TCM syndrome types of patients with colorectal adenomas and the endoscopic manifestations and pathological classification has been analyzed,so as to provide the objective evaluation indicators for the TCM syndrome differentiation,and improve the accuracy of the TCM syndrome differentiation.MethodIn accordance with the inclusion and exclusion criteria,this study has selected patients aged 50 years old and above who were diagnosed with confirmed colorectal adenoma accompanied with HGIN or LGIN by electronic colonoscopy in Beijing Rectum Hospital(Beijing Er Long Lu Hospital)from May 2017 to August 2018.Such patients were divided into the HGIN group and the LGIN group by using the results of immunohistochemistry as the basis for division.If the patient had multiple adenomas and both HGIN and LGIN,he or she was included in the HGIN group.The author has collected information in relation to patients’gender,age,location of the disease,congestion of adenoma,incidence of multiple polyps,status of pedicles,pathological types of the adenomas and the TCM syndrome types.The correlation between gender,location of the disease,congestion,pathological type,multiple polyps,pedicles,TCM syndromes,etc.and HGIN has been analyzed.In addition,the correlation between TCM syndrome type and the location of the disease,congestion,presence or absence of multiple polyps,and incidence of pedicles has also been analyzed.Results1.Research data overviewA total of 325 patients with colorectal adenoma were enrolled.The patients’ ages ranged from 50 to 82 years,with an average age of 60.04 ± 6.80 years;there were 211 males and 114 females with a male to female gender ratio of 1.85:1.Among them,158 cases(48.6%)were in the high-level group and 167 cases(51.4%)in the low-level group.Among all patients,the distribution of the disease location:152 cases in rectum(46.8%)>87 cases in sigmoid colon(26.8%)>57 cases in descending colon(17.5%)>5 cases in ascending colon(1.5%)>21 cases in transverse colon(6.5%)>3 cases in the ileocecus(0.9%);status of adenoma congestion:258 cases(79.4%)in non-congested state>67 cases(20.6%)in congested state;presence of multiple polyps:207 cases with multiple polyps(63.7%)>118 cases with single polyps(36.3%);presence of pedicles in polyps:289 cases(88.9%)without pedicles>36 cases(11.1%)with pedicles;pathological type distribution:220 cases of tubular adenoma(67.7%)>90 cases of tubular-villous adenoma in(27.7%)>15 cases of villous adenoma(4.6%);distribution of TCM syndromes:123 cases with syndrome of dampness-heat diffusing downward(37.8%)>112 cases with syndrome of spleen deficiency(34.5%)>90 cases with syndrome of qi stagnation and blood stasis(27.7%).2.Statistical results of correlation factors of intraepithelial neoplasia in colorectal adenomaThere was no statistical difference in age and gender distribution between the two groups with different levels of intraepithelial neoplasia(all P>0.05).The results of single factor analysis showed that the incidence rates of disease locations,adenoma congestion,pathological type of adenoma,presence of multiple polyps and TCM syndrome types in the HGIN group and the LGIN group were different and the differences are statistically significant(all P<0.05).The results of multi-factor analysis showed that the presence or absence of multiple polyps in colorectal adenoma was not a factor affecting the incidence of intraepithelial neoplasia in colorectal adenoma(P>0.05).Location of incidence,adenoma congestion,pathological type of adenoma,and TCM syndrome type were all independent risk factors for intraepithelial neoplasia(all P<0.05).The data of rectum,sigmoid colon,descending colon and transverse colon were statistically different in the location group(all P<0.05),and the OR value of rectum(1.000)>sigmoid colon(0.356)>transverse colon(0.270)>descending colon(0.129)after comparison.There was no statistical difference between the data of rectum,ascending colon and ileocecus(all P>0.05),and in terms of the OR value comparison,ascending colon(1.336)>rectum(1.000)>ileocecus(0.641).In the pathological type of adenoma group,the difference between villous adenoma and tubular-villous adenoma was statistically significant(P<0.05),and the comparison of OR values showed a result of tubular-villous adenoma(3.730)>villous adenoma(1.000).There was no statistical difference between villous adenoma and tubular adenoma(P>0.05),and the comparison of the OR values showed a result of villous adenoma(1.000)>tubular adenoma(0.568).In the TCM syndrome type group,there was no statistical difference in the data of hot and humid betting,stagnation of qi and blood stasis,and deficiency of spleen-qi(all P>0.05),and the comparison of the OR values showed a result of syndrome of dampness-heat diffusing downward(1.000)>syndrome of spleen deficiency(0.457)>syndrome of qi stagnation and blood stasis(0.449).3.Statistical results of correlation factors of TCM syndrome types of colorectal adenomaThere was no significant difference between different TCM syndromes and the location of adenoma,incidence of multiple polyps,and presence or absence of pedicles(all P>0.05).There was statistical differences between TCM syndromes and the state of congestion in the adenomas and pathological types(all P<0.05),and the number of cases with congestion in the syndrome of dampness-heat diffusing downward group were significantly more than those in the syndrome of qi stagnation and blood stasis group and the syndrome of spleen deficiency group.In addition,the number of villous adenoma cases and tubular-villous adenoma cases in the syndrome of dampness-heat diffusing downward group was more than the other TCM syndrome groups.Conclusion1.Overall data analysis conclusionThis study finds that the incidence rate of colorectal adenoma among males is higher than that among females.There are more cases of tubular adenoma,non-congested adenoma,multiple polyps,and polyps without pedicles than their other counterparts.Colorectal adenoma occurs most frequently in the rectum.The number of colorectal adenoma cases with the TCM syndrome of dampness-heat diffusing downward is higher than that of other TCM syndrome types.2.Conclusion of correlation factor analysis of colorectal adenoma intraepithelial neoplasiaHGIN is associated with factors such as the location of the disease,adenoma congestion,pathological classification,and TCM syndromes.Among them,the incidence in the rectum or ascending colon,adenoma congestion,villous adenoma or tubular-villous adenoma,and TCM syndrome of dampness-heat diffusing downward are all independent risk factors for HGIN.3.Conclusion of correlation factor analysis between TCM syndrome types and colorectal adenomaDistribution ofTCM syndrome types for colorectal adenoma cases are different among cases with different congestion state and pathological classifications.Among them,the congested state,villous adenoma,or tubular-villous adenoma are most common in the TCM syndrome of dampness-heat diffusing downward group.