A Nested Case-control Study On Risk Factors For Recurrence Of Colonic Polyps

Purpose : This study analyzed and summarized the risk factors for recurrence of colonic polyps by following up the cases after colonic polypectomy,comparing the personal data of the recurring cases after colonic polypectomy,the baseline condition and the distribution characteristics of TCM disease position and disease.Provide ideas for the treatment of colon polyps.Methods: This study adopts a prospective nested case-control study method,and data collection comes from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,and the First Affiliated Hospital of Shandong First Medical University.The 503 patients who had undergone colon polypectomy from October 2016 to January2018 were included in the follow-up observation cohort,and follow-up was carried out regularly.Whenever a recurrent colon polyp appeared,the patient was included in the case group,and then according to the 1:2 matching principle,The patients who did not relapse at the end of follow-up were collected as the control group.Carry out T test or Chi-square test according to the characteristics of the variables,and describe the values by frequency and percentage.Carry out multivariate binary logistic regression analysis on the variables with statistical differences to obtain independent risk factors.Results:The study included 106 cases in the case group and 212 cases in the control group,a total of 318 cases.1.Among the individual factors of the patients,age,BMI index,TG level,history of hypertension,smoking history,and family history of cancer were statistically different (P<0.05).Multivariate binary logistic regression analysis showed that age ≥62 years old,BMI overweight,high TG level,history of hypertension,and family history of cancer were risk factors for recurrence of colonic polyps.The risk of recurrence increased by32% for every 3 units of TG increase(OR=3.32).For every unit increase in the BMI index,the risk of recurrence increases by 33.8%(OR=1.338).Patients with a history of smoking have a significantly higher risk of recurrence of colon polyps than those without a history of smoking(OR=29.844).The risk of colon polyps recurrence in patients with a family history of cancer was 4.446 times higher than those without a family history of cancer(OR=4.446).Gender,history of drinking,history of use of NSAIDs,and Helicobacter pylori infection were not significantly different in the recurrence of polyps(P>0.05),and they were not independent factors influencing polyps recurrence.2.Among polyp factors,polyps>1cm,number ≥ 3,and adenomatous polyps are independent risk factors for colonic polyp recurrence(P<0.05,OR>1);polyp diameter<0.5cm is a protective factor.The recurrence group was mainly distributed in the descending colon(81.3%)and sigmoid colon(73.8%),followed by the transverse colon(40.2%)and ascending colon(27.1%).Among the procedural factors,good bowel preparation(OR<1)is a protective factor.There was no significant relationship between endoscopic resection and colon polyp recurrence(P>0.05).3.In TCM syndromes,the main disease location is spleen,stomach,and large intestine;dampness,phlegm,and qi stagnation are important factors for polyp recurrence.In the spleen,dampness,phlegm,and qi deficiency are the main symptoms;in the stomach,dampness,phlegm,blood stasis,and qi deficiency are the main diseases;in the large intestine,blood stasis,dampness,fire,and qi stagnation are the main diseases.The liver is mainly qi stagnation and fire,and the kidney disease is mainly yang deficiency and qi deficiency.Conclusions: The results of this study can provide ideas and methods for clinical treatment of colon polyps.The number of polyps is ≥ 3 or ≥ 2.The diameter of polyps is >1cm,and adenomatous polyps are important indicators for predicting polyp recurrence.Patients ≥62 years of age,overweight BMI,high TG level,history of hypertension,smoking history,and family history of cancer should be reviewed regularly with electronic colonoscopy to improve their unhealthy lifestyle and avoid the risk of recurrence.The recurrence of colonic polyps occurs in the spleen and stomach,often in the large intestine,and is related to the liver and kidney.The disease is manifested as a mixture of deficiency and excess,original deficiency and standard excess,and more deficiency and less deficiency.Actually,phlegm dampness,qi stagnation,and blood stasis are the main factors;deficiency is mainly due to qi deficiency.