Relationship Between Non-alcoholic Fatty Liver Disease And Colorectal Adenomatous Polyp According To The Degree Of Liver Fibrosis

Objective Through the study of the relationship between non-alcoholic fatty liver disease and the severity of liver fibrosis and colorectal adenomatous polyps,we further clarify the common risk factors of colorectal adenomatous polyps,so as to identify high-risk groups of colorectal adenomas early.We recommend screening colonoscopy in advance and removing colon adenomas early,thus reducing the incidence rate of colorectal cancer.Methods A total of 538 eligible colorectal adenomatous polyp patients admitted to the Department of Gastroenterology,the Third Affiliated Hospital of Anhui Medical University from April 2018 to April 2021 were selected as the adenoma group,of which165 were high-risk adenomas.A total of 495 patients with normal colonoscopy were selected as the control group.Firstly,by comparing the general data and the number of patients with nonalcoholic fatty liver between adenoma group,high-risk adenoma group and control group,it is clear whether non-alcoholic fatty liver is a risk factor of adenomatous polyps and high-risk adenoma through multivariate regression analysis.Secondly,patients with nonalcoholic fatty liver were stratified by three noninvasive liver fibrosis scoring systems: APRI,FIB-4 and NFS,The patients were divided into advanced liver fibrosis group（APRI≥0.5;FIB-4≥1.30;NFS≥-1.455）and nonadvanced liver fibrosis group（APRI<0.5;FIB-4<1.30;NFS<-1.455）to compare the risk of adenomatous polyps and high-risk adenomas in different fibrosis groups,so as to explore the relationship between the severity of liver fibrosis and colorectal adenomatous polyp and high-risk adenomatous polyp in patients with nonalcoholic fatty liver disease.This study uses spss22 software to process and analyze the data.Results Compared with the control group,there were differences in age,sex,smoking history,BMI,AST,HDL and non-alcoholic fatty liver between adenomatous polyps and high-risk adenomatous polyp.Nonalcoholic fatty liver disease was an independent risk factor for colorectal adenomatous polyp and high-risk adenomatous polyp（OR were1.632 and 1.714,95% confidence interval（CI）were 1.145-2.324 and 1.054-2.785,P <0.05）.After further stratification of liver fibrosis severity,adjusted for age,gender and BMI,Among the three noninvasive fibrosis scores,the risk of colorectal adenoma and high-risk adenoma in patients with advanced fibrosis was significantly higher than that in nonadvanced liver fibrosis group and non fatty liver group.Advanced liver fibrosis was an independent risk factor for colorectal adenomas and high-risk adenomas.The OR and 95% confidence interval in APRI score were 2.272（1.031-5.005）and 5.271（2.112-13.158）;The OR and 95% confidence interval in FIB-4 score were 3.160（1.702-5.867）and 6.490（3.137-13.424）The OR and 95% confidence interval in NFS score were 5.384（2.997-9.674）and 8.921（4.445-17.902）.However,there was no significant difference in the risk of colorectal adenomas and high-risk adenomas between the non-advanced liver fibrosis group and the non fatty liver group.Conclusion（1）The incidence of CRA is closely related to NAFLD and the severity of NAFLD liver fibrosis.（2）NAFLD in advanced liver fibrosis is an independent risk factor for CRA and high-risk adenoma,while NAFLD in non advanced fibrosis is not an independent risk factor for CRA and high-risk adenoma.There is no significant difference in the prevalence of CRA and high-risk adenoma between NAFLD patients in nonadvanced fibrosis and patients without NAFLD.（3）With the increase of the severity of liver fibrosis,the prevalence of CRA and high-risk adenoma increased gradually.