消蕈化浊方对肠息肉伴代谢综合征的临床疗效及影响因素分析

杨燕青; 芮蓉; 武鹏涛; 李瑛; 郑庆虎; 李达; 陶莹; 吴天芯; 周利红

doi:10.16766/j.cnki.issn.1674-4152.002958

消蕈化浊方对肠息肉伴代谢综合征的临床疗效及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002958

杨燕青¹,
芮蓉¹,
武鹏涛¹,
李瑛¹,
郑庆虎¹,
李达¹,
陶莹¹,
吴天芯¹,
周利红^{2, 3, ,}

1.
上海市浦东新区浦兴社区卫生服务中心中医科，上海 200129
2.
上海中医药大学附属曙光医院肿瘤科，上海 201203
3.
上海中医药大学附属曙光医院肿瘤研究所

基金项目:

国家自然科学基金面上项目 81973651

国家自然科学基金面上项目 82174145

上海市浦东新区卫生系统社区名中医人才培养项目 PWRzs-2020-02

上海市浦东新区科技发展基金项目 PKJ-Y56

详细信息

通讯作者:
周利红，E-mail：zlhtcm@hotmail.com

中图分类号: R574 R289.51
计量
- 文章访问数: 174
- HTML全文浏览量: 34
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-10-09
- 网络出版日期: 2023-05-31

Clinical effect of Xiaoxun Huazhuo Recipe on colorectal polyps with metabolic syndrome and influencing factors

1.
Department of Traditional Chinese Medicine, Shanghai Puxing Community Health Center, Pudong New District, Shanghai 200129, China

摘要

摘要: 目的评价消蕈化浊方对脾虚痰湿型肠息肉伴代谢综合征的临床疗效，并对肠息肉复发的影响因素进行分析。方法选取2020年1月—2021年6月于浦兴社区卫生服务中心就诊的76例肠息肉伴代谢综合征患者，按随机数字法分为治疗组和对照组各38例。对照组予以对症治疗及健康教育，治疗组予以消蕈化浊方煎剂，2组均连续治疗3个月。比较2组治疗后12个月肠息肉复发率和血清TC、TG、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、体重、BMI、腰围(WC)、腰臀比(WHR)变化，并通过logistic回归模型分析复发的影响因素。结果最终治疗组37例、对照组38例纳入研究。治疗组治疗后12个月复发率为10.8%(4/37)，对照组为31.6%(12/38)，差异有统计学意义(χ²=4.818，P=0.028)。2组间代谢指标和形体指数(HbA1c、SBP、WHR、FPG、LDL-C)治疗前后差值比较，差异有统计学意义(均P < 0.05)。多因素分析显示，治疗与否、红肉饮食、家族史、原息肉直径、BMI与复发有关。结论消蕈化浊方可降低肠息肉术后12个月的复发率，应综合饮食控制、运动锻炼、调节代谢异常以及积极治疗相关疾病作为干预策略。
- 结直肠息肉 /
- 代谢综合征 /
- 脾虚痰湿证 /
- 消蕈化浊方 /
- 影响因素
Abstract: Objective To evaluate the clinical effect of Xiaoxun Huazhuo Recipe on colorectal polyps with metabolic syndrome of spleen deficiency and phlegm dampness type, and to analyse the influence factors of colorectal polyps recurrence. Methods A total of 76 patients with intestinal polyps accompanied by metabolic syndrome were selected from Puxing Community Health Center from January 2020 to June 2021, the patients were randomly divided into treatment group and control group by random number method, with 38 cases in each group. The control group was given symptomatic treatment and health education, while the treatment group was given Xiaoxun Huazhuo Decoction. Both groups were treated continuously for 3 months. The recurrence rate of colorectal polyps and the changes of serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG), glycosylated haemoglobin (HbA1c), body weight, BMI, waist circumference (WC) and waist hip ratio (WHR) were compared between the two groups 12 months after the treatment. The influencing factors of recurrence were analysed by logistic regression model. Results The actual numbers of cases included were 37 in the treatment group and 38 in the control group. The recurrence rates of the two groups 12 months after the treatment were 10.8% (4/37) in the treatment group and 31.6% (12/38) in the control group, with a statistically significant difference (χ²=4.818, P=0.028). The differences in metabolic indices and body mass index (HbA1c, SBP, WHR, FPG, LDL-C) between the two groups before and after treatment were compared and found to be statistically significant (all P < 0.05). Multivariate analysis showed that treatment or not, red meat diet, family history, primary polyp size, BMI were related to recurrence. Conclusion Xiaoxun Huazhuo Recipe can reduce the recurrence rate of colorectal polyps 12 months after operation. Comprehensive diet control, exercise, regulation of metabolic abnormalities and active treatment of related diseases should be used as intervention strategies.
- Colorectal polyps /
- Metabolic syndrome /
- Spleen deficiency and phlegm dampness syndrome /
- Xiaoxun Huazhuo Recipe /
- Influence factors

HTML全文

表 1 2组肠息肉伴代谢综合征患者入组时基线资料比较

Table 1. Comparison of baseline data of intestinal polyps with metabolic syndrome in 2 groups

组别	例数	性别(例)		年龄 (x±s, 岁)	身高(x±s, cm)		体重(x±s, kg)			腰围(x±s, cm)
组别	例数	男性	女性	年龄 (x±s, 岁)	男性	女性	男性	女性		男性	女性
治疗组	37	16	21	65.97±5.96	168.63±4.99	158.57±4.98	75.84±11.80	64.86±11.87		90.19±8.12	86.62±8.59
对照组	38	16	22	64.66±5.10	167.44±5.49	157.50±5.07	70.51±9.11	64.51±10.60		92.25±10.24	87.91±9.51
统计量		0.010^a		1.028^b	0.640^b	0.699^b	1.431^b	0.100^b		0.631^b	0.466^b
P值		0.921		0.307	0.527	0.488	0.163	0.921		0.533	0.644

组别	例数	臀围(x±s, cm)			BMI(x±s)		WHR(x±s)			息肉部位(例)
组别	例数	男性	女性		男性	女性	男性	女性		左半结肠	右半结肠
治疗组	37	96.69±6.09	93.76±7.84		26.61±3.73	25.68±3.96	0.93±0.04	0.92±0.04		21	16
对照组	38	97.13±7.58	96.05±9.42		25.17±3.19	25.92±3.54	0.95±0.05	0.92±0.04		20	18
统计量		0.180^b	0.862^b		1.175^b	0.207^b	1.024^b	0.621^b		0.129^a
P值		0.858	0.394		0.249	0.837	0.314	0.538		0.720

组别	例数	息肉数目(例)			息肉直径(例)		病理分型(例)					伴瘤变(例)
组别	例数	< 3个	≥3个		< 10 mm	≥10 mm	管状腺瘤	管-绒腺瘤	锯齿状腺瘤	增生性	炎症性	有	无
治疗组	37	27	10		28	9	22	2	2	9	2	12	25
对照组	38	26	12		28	10	23	3	2	8	2	10	28
统计量		0.187^a			0.039^a		0.268^a					0.712^a
P值		0.665			0.843		0.992					0.399
注：^a为χ²值, ^b为t值。

下载: 导出CSV

表 2 2组肠息肉伴代谢综合征患者治疗前后代谢相关指标差值比较(x±s)

Table 2. Comparison of metabolism-related indexes between the two groups of patients with intestinal polyps and metabolic syndrome before and after treatment(x±s)

组别	例数	TC (mmol/L)	TG (mmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	FPG (mmol/L)	HbA1c (mmol/L)	SBP (mmHg)	DBP (mmHg)	BMI	WHR
治疗组	37	0.63±0.77	0.16±0.29	0.55±0.61	-0.05±0.13	0.68±1.11	0.43±0.68	7.14±9.70	2.11±8.50	0.26±1.61	0.03±0.03
对照组	38	0.31±0.65	-0.04±0.60	0.17±0.48	-0.01±0.14	0.10±0.52	0.04±0.61	2.08±7.13	2.79±9.04	0.24±1.14	0.01±0.03
t值		1.978	1.834	3.030	1.425	2.850	2.603	2.568	0.336	0.418	2.332
P值		0.052	0.071	0.003	0.158	0.006	0.011	0.013	0.575	0.677	0.022

下载: 导出CSV

表 3 肠息肉复发影响因素的单因素logistic回归分析

Table 3. Single-factor logistic regression analysisof influencing factors of recurrence afterremoval of intestinal polyps

变量	B	SE	Wald χ²	P值	OR值	95% CI
组别	-0.958	0.599	2.557	0.010	0.384	0.118~1.241
红肉饮食	2.380	0.684	12.085	0.001	10.800	2.824~41.310
缺乏运动	2.878	1.065	7.298	0.007	17.778	2.203~143.449
家族史	2.430	0.663	13.434	< 0.001	11.357	3.097~41.646
胆囊疾病	1.533	0.607	6.376	0.012	4.632	1.409~15.222
非酒精性脂肪肝	1.568	0.692	5.142	0.023	4.798	1.237~18.607
BMI	-0.192	0.091	4.455	0.035	0.826	0.691~0.986
息肉直径	1.473	0.601	6.000	0.014	4.364	1.342~14.184

下载: 导出CSV

表 4 肠息肉复发影响因素的多因素logistic逐步回归模型分析

Table 4. Multivariate logistic stepwise regression model analysis of the influencing factors of intestinal polyp recurrence

变量	B	SE	Wald χ²	P值	OR值	95% CI
组别	2.732	1.289	4.449	0.035	15.251	1.214~191.808
红肉饮食	1.833	0.905	4.028	0.045	6.216	1.037~37.009
家族史	3.607	1.275	8.272	0.004	38.592	3.204~465.201
BMI	-0.342	0.158	4.697	0.030	0.710	0.521~0.968
息肉直径	1.879	0.923	4.130	0.042	6.537	1.064~39.963

下载: 导出CSV

参考文献(23)

[1]	DEKKER E, TANIS P J, VLEUGELS J, et al. Colorectal cancer[J]. Lancet, 2019, 394(10207): 1467-1480. doi: 10.1016/S0140-6736(19)32319-0
[2]	YU Y, WU J S. Presence of metabolic syndrome and thyroid nodules in subjects with colorectal polyps[J]. Med Sci Monit, 2021, 27: e927935. DOI: 10.12659/MSM.927935.
[3]	YAO F, BO Y C, ZHAO L Y, et al. Prevalence and influencing factors of metabolic syndrome among adults in China from 2015 to 2017[J]. Nutrients, 2021, 13(12): 4475. doi: 10.3390/nu13124475
[4]	WU H R, TIAN J X, DAI D, et al. Efficacy and safety assessment of traditional Chinese medicine for metabolic syndrome[J]. BMJ Open Diabetes Res Care, 2020, 8(1): e001181. DOI: 10.1136/bmjdrc-2020-001181.
[5]	吴肇汉, 秦新裕, 丁强, 等. 实用外科学[M]. 4版. 北京: 人民卫生出版社, 2017: 369-370. WU Z H, QIN X Y, DING Q, et al. Practic of surgery[M]. 4th edition. Beijing: People's Medical Publishing House, 2017: 369-370.
[6]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 国际内分泌代谢杂志, 2021, 41(5): 482-548. doi: 10.3760/cma.j.cn121383-20210825-08063 Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. International Journal of Endocrinology and Metabolism, 2021, 41(5): 482-548. doi: 10.3760/cma.j.cn121383-20210825-08063
[7]	郑筱萸. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 361-364. ZHENG X Y. Guiding principles of clinical research on new drugs of traditional Chinese medicine[M]. Beijing: China Medical Science Press, 2002: 361-364.
[8]	CAO W, CHEN H D, YU Y W, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J(Engl), 2021, 134(7): 783-791. http://doc.paperpass.com/journal/20210136zhcmj.html
[9]	NAGTEGAAL I D, ODZE R D, KLIMSTRA D, et al. The 2019 WHO classification of tumours of the digestive system[J]. Histopathology, 2020, 76(2): 182-188. doi: 10.1111/his.13975
[10]	TANAKA S, SAITOH Y, MATSUDA T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps[J]. J Gastroenterol, 2021, 56(4): 323-335. doi: 10.1007/s00535-021-01776-1
[11]	殷凯, 瞿建国, 陈吉祥, 等. 腹腔镜与结肠镜联合治疗早期结直肠肿瘤的临床效果分析[J]. 中华全科医学, 2018, 16(11): 1810-1812. doi: 10.16766/j.cnki.issn.1674-4152.000492 YIN K, QU J G, CHEN J X, et al. Clinical efficacy of laparoscopic surgery combined with colonoscopy procedure in the treatment of early colorectal tumo[J]. Chinese Journal of General Practice, 2018, 16(11): 1810-1812. doi: 10.16766/j.cnki.issn.1674-4152.000492
[12]	张志杰, 余静芳, 马高峰, 等. 大肠息肉病的中西医治疗进展[J]. 中医临床研究, 2019, 11(21): 3-5. doi: 10.3969/j.issn.1674-7860.2019.21.002 ZHANG Z J, YU J F, MA G F, et al. Advances in the treatment of colorectal polyposis with Chinese and western medicine[J]. Clinical Journal of Chinese Medicine Clinical Journal of Chinese Medicine, 2019, 11(21): 3-5. doi: 10.3969/j.issn.1674-7860.2019.21.002
[13]	SONG M Y, EMILSSON L, BOZORG S R, et al. Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study[J]. Lancet Gastroenterol, 2020, 5(6): 537-547. http://www.sciencedirect.com/science/article/pii/S2468125320300091
[14]	HAO Y Z, WANG Y N, QI M, et al. Risk factors for recurrent colorectal polyps[J]. Gut Liver, 2020, 14(4): 399-411.
[15]	CHI Z, LIN Y, HUANG J, et al. Risk factors for recurrence of colorectal conventional adenoma and serrated polyp[J]. Gastroenterol Rep(Oxf), 2021, 10: goab038. DOI: 10.1093/gastro/goab038.
[16]	COLUSSI D, FABBRI M, ZAGARI R M, et al. Lifestyle factors and risk for colorectal polyps and cancer at index colonoscopy in a FIT-positive screening population[J]. United European Gastroenterol J, 2018, 6(6): 935-942. doi: 10.1177/2050640618764711
[17]	WU Y, ZHANG Y, JIAO J. The relationship between n-3 polyunsaturated fatty acids and telomere: a review on proposed nutritional treatment against metabolic syndrome and potential signaling pathways[J]. Crit Rev Food Sci Nutr, 2022: 1-20. DOI: 10.1080/10408398.2022.2142196.
[18]	MILANO A, BIANCO M A, BURI L, et al. Metabolic syndrome is a risk factor for colorectal adenoma and cancer: a study in a White population using the harmonized criteria[J]. Therap Adv Gastroenterol, 2019, 12: 1756284819867839. DOI: 10.1177/1756284819867839.
[19]	郭克宁. 代谢综合征及其相关因素与结直肠息肉的相关性研究[D]. 石家庄: 河北医科大学, 2019. GUO K N. The correlation between metabolic syndrome and colorectal polyps[D]. Shijiazhuang: Hebei Medical University, 2019.
[20]	KATONA B W, WEISS J M. Chemoprevention of colorectal cancer[J]. Gastroenterology, 2020, 158(2): 368-388. doi: 10.1056/nejm200006293422606
[21]	房静远, 李延青, 陈萦晅, 等. 中国结直肠肿瘤综合预防共识意见(2021年, 上海)[J]. 胃肠病学, 2021, 26(5): 279-311. https://www.cnki.com.cn/Article/CJFDTOTAL-WIEC202105005.htm FANG J Y, LI Y Q, CHEN Y Y, et al. Chinese consensus on prevention of colorectal neoplasia (2021, Shanghai)[J]. Chinese Journal of Gastroenterology, 2021, 26(5): 279-311. https://www.cnki.com.cn/Article/CJFDTOTAL-WIEC202105005.htm
[22]	于春月, 赵雪香, 王文婷, 等. 大肠息肉的中医体质类型分布规律调查分析[J]. 中医学报, 2019, 34(12): 2665-2669. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201912040.htm YU C Y, ZHAO X X, WANG W T, et al. Investigation and Analysis on the Distribution Law of TCM Constitution Types of Colorectal Polyp[J]. Acta Chinese Medicine, 2019, 34(12): 2665-2669. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201912040.htm
[23]	边杨清, 郑昱, 郑培永, 等. 中医体质类型与结直肠息肉相关性的Meta分析[J]. 上海中医药杂志, 2021, 55(2): 24-32. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ202102008.htm BIAN Y Q, ZHENG Y, ZHENG P Y, et al. Meta-analysis of correlation between TCM constitution and colorectal polyps[J]. Shanghai Journal of Traditional Chinese Medicine, 2021, 55(2): 24-32. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ202102008.htm