摘要
Abstract
Objective To analyze the influencing factors of colorectal adenoma recurrence in endoscopic post-polypectomy type 2 diabetic patients treated with different glucose-lowering therapies,providing an evidence-based reference for clinical identification of such cases with recurrence risks.Methods A total of 273 type 2 diabetic patients with colorectal adenoma who were diagnosed and treated by endoscopic resection of colorectal adenoma in Shenzhen Shekou People's Hospital during January 2006 to June 2016 were included in the cohort and divided into untreated group(n=50),sulfonylureas-treated group (n=94),thiazole-treated group(n=52),metformin-treated group(n=45) and insulin-treated group(n=32) based on the treatment regimen.We obtained the patients' follow-up data. The follow-up period was about 5 years,and the patients who were followed up for less than 5 years were followed up for July 2016. Blood sugar control,hypoglycemic drugs usage,status of aspirin and statins use were recorded.Results Kaplan-meier curve analysis showed that untreated group,sulfonylureas-treated group,thiazole-treated group and insulin-treated group demonstrated higher colorectal adenoma recurrence rate compared with metformin-treated group(χ2=15.14,18.34,46.83,34.29,P<0.01).Multivariate Cox regression analysis further demonstrated that history of hypertension〔HR=2.96,95%CI(1.40,6.24)〕,suffering from diabetes for 48 months or longer 〔HR=2.84,95%CI(1.03,7.81)〕,poor glycemic control(fasting plasma glucose>6.1 mmol/L)〔HR=4.97,95%CI(1.74, 14.22)〕,more than 20% of the largest adenoma volume was villous adenoma 〔HR=5.73,95%CI(1.86,17.61)〕 and use of sulfonylureas〔HR=3.19,95%CI(1.42,7.14)〕,use of insulin〔HR=3.48,95%CI(1.70,7.13)〕 were risk factors for recurrence of colorectal adenoma,whereas use of metformin could significantly reduce the recurrence〔HR=0.25,95%CI (0.09,0.73),P<0.05〕.Conclusion Sulfonylureas,metformin and insulin could significantly influence colorectal adenoma recurrence in post-polypectomy type 2 diabetic patients.In view of this,glucose-lowering drugs that can cause lower risk for adenoma recurrence should be used for subsequent treatment as much as possible.关键词
糖尿病,2型/降糖药物/结直肠肿瘤/复发/队列研究Key words
Diabetes mellitus,type 2/Antidiabetic drugs/Colorectal neoplasms/Recurrence/Cohort studies分类
医药卫生
