背景:2020年,非酒精性脂肪性肝病(NAFLD)更名为代谢相关脂肪性肝病(MAFLD).NAFLD已被证实为结直肠肿瘤的危险因素,MAFLD与结直肠肿瘤的关系则尚存争议.目的:探讨MAFLD与结直肠腺瘤和早癌的相关性.方法:回顾性纳入2021年1月—2021年8月在武汉大学人民医院住院且符合条件的无高级别上皮内瘤变结直肠腺瘤患者274例(腺瘤组),结直肠早癌(高级别上皮内瘤变、黏膜内癌和黏膜下癌)患者21例(早癌组),同期结肠镜检查正常或非腺瘤性息肉患者406例作为对照组.比较3组患者的基线资料和MAFLD患病率;以Logistic回归模型分析MAFLD与结直肠腺瘤和早癌的相关性、此相关性是否存在性别差异,以及MAFLD与结直肠腺瘤临床病理特征的关系.结果:在调整混杂因素(性别、年龄、吸烟史、饮酒史、糖尿病史、高血压病史、肌酐)后,MAFLD与结直肠腺瘤(OR=1.83,95%CI:1.04~3.22,P=0.037)和早癌(OR=3.91,95%CI:1.14~13.42,P=0.031)显著相关.根据性别分层分析,仅女性MAFLD与结直肠腺瘤显著相关(OR=4.04,95%CI:1.56~10.47,P=0.004).未发现MAFLD与结直肠腺瘤的部位、大小、数目以及是否为进展期腺瘤相关(P均>0.05).结论:MAFLD是结直肠腺瘤和早癌的独立危险因素.女性MAFLD与结直肠腺瘤密切相关,男性中此相关性不明显.
Background:The terminology of nonalcoholic fatty liver disease(NAFLD)was changed to metabolic dysfunction-associated fatty liver disease(MAFLD)in 2020.NAFLD has been confirmed to be a risk factor for colorectal neoplasms,but the association between MAFLD and colorectal neoplasms is conflicting.Aims:To investigate the correlation of MAFLD with colorectal adenoma and early colorectal cancer.Methods:The clinical information of 701 patients who met the criteria and were admitted to Renmin Hospital of Wuhan University from January 2021 to August 2021 was collected retrospectively.Among them,274 colorectal adenoma patients with low-grade intraepithelial neoplasia or without intraepithelial neoplasia were classified as adenoma group,21 patients with high-grade intraepithelial neoplasia,intramucosal carcinoma,and submucosal carcinoma were classified as early cancer group,and 406 patients with normal colonoscopy or non-adenomatous polyps were served as control group.The general information and prevalence of MAFLD between these groups were compared.Furthermore,the correlation of MAFLD with colorectal adenoma and early colorectal cancer,and the gender difference of these correlations were analyzed by Logistic regression models.Subgroup analysis was performed based on the clinicopathological characteristics of colorectal adenoma.Results:When adjusting the confounding variables including gender,age,smoking,alcohol drinking,diabetes,hypertension,and serum creatinine,MAFLD was significantly associated with the prevalence of colorectal adenoma(OR=1.83,95%CI:1.04-3.22,P=0.037)and early colorectal cancer(OR=3.91,95%CI:1.14-13.42,P=0.031).When stratified as gender,the significant association remained in females(OR=4.04,95%CI:1.56-10.47,P=0.004),but not in males.In addition,no correlation was found between MAFLD and the location,size,number,and advanced histology of colorectal adenoma(all P>0.05).Conclusions:MAFLD is an independent risk factor for colorectal adenoma and early colorectal cancer.MAFLD is specifically associated with increased risk of colorectal adenoma in females but not in males.