背景:关于儿童大肠息肉危险因素的证据很少。本研究探讨了临床表现,形态学和病理学特征,和儿童大肠息肉的危险因素。
方法:这项回顾性病例对照研究包括接受结肠镜检查的儿童,根据结肠镜检查结果分为结直肠息肉组和正常对照组。采用logistic回归分析儿童大肠息肉的危险因素。
结果:息肉患儿的平均年龄为6.77±3.44岁。息肉主要在男性中检测到(72.9%);便血是主要的临床表现(80.25%)。大多数息肉为幼年性(88.9%)和单发性(87.7%);50.6%位于直肠乙状结肠区。单因素分析显示性别(P=0.037),年龄(P<0.001),家庭聚集(P<0.001),特异性免疫球蛋白E(sIgE)(P<0.001),血小板计数(P=0.001),天冬氨酸转氨酶(AST)(P=0.016),肉类摄入量(P=0.010),和蔬菜摄入量(P<0.001)与结直肠息肉显著相关。年龄≤6岁(3-6岁:OR:26.601,95%CI:3.761-160.910;<3岁:OR:22.678,95%CI:1.873-274.535),正家庭聚集(OR:3.540,95%CI:1.177-10.643),sIgE阳性(OR:2.263,95%CI:1.076-4.761),在Logistic回归分析中,较高的肉类摄入量(OR:1.046,95%CI:1.029-1.063)是小儿结直肠息肉的危险因素。较高的蔬菜摄入量(OR:0.993,95%CI:0.986-1.000)是儿童大肠息肉的保护因素。受试者工作特征(ROC)曲线分析预测结直肠息肉的肉摄入量曲线下面积(AUC)为0.607,最佳临界值为92.14g/d(P=0.010,95%CI:0.527~0.687)。肉类和蔬菜摄入量联合预测小儿结直肠息肉的AUC为0.781(P<0.001,95%CI:0.718-0.845)。
结论:青少年,孤独,位于直肠乙状结肠区的息肉最常见于儿童。便血是主要的临床表现。大多数息肉是,但也检测到多发性和近端息肉。年龄≤6岁,尤其是3-6年,积极的家庭聚集,sIgE阳性,和较高的肉类摄入量是儿童大肠息肉的危险因素。较高的蔬菜摄入量是一个保护因素。
Scarce evidence exists on pediatric colorectal polyp risk factors. This study explored the clinical manifestations, morphological and pathological
characteristics of, and risk factors for pediatric colorectal polyps.
This retrospective
case-control study included children who received colonoscopy, divided into a colorectal polyp group and a normal control group based on colonoscopy results. The risk factors for colorectal polyps in children were analyzed through logistic regression analysis.
The mean age of children with polyps was 6.77 ± 3.44 years. Polyps were detected predominantly in males (72.9%); hematochezia was the primary clinical manifestation (80.25%). Most polyps were juvenile (88.9%) and solitary (87.7%); 50.6% were located in the rectosigmoid area. Univariate analysis showed that gender (P = 0.037), age (P < 0.001), family aggregation (P < 0.001), specific immunoglobulin E (sIgE) (P < 0.001), platelet count (P = 0.001), aspartate aminotransferase (AST) (P = 0.016), meat intake (P = 0.010), and vegetable intake (P < 0.001) were significantly associated with colorectal polyps. Age ≤ 6 years (3-6 years: OR: 26.601, 95% CI: 3.761-160.910; < 3 years: OR: 22.678, 95% CI: 1.873-274.535), positive family aggregation (OR: 3.540, 95% CI: 1.177-10.643), positive sIgE (OR:2.263, 95% CI: 1.076-4.761), and higher meat intake (OR:1.046, 95% CI: 1.029-1.063) were risk factors for pediatric colorectal polyps in logistic regression analysis. Higher vegetable intake (OR: 0.993, 95% CI: 0.986-1.000) was a protective factor against pediatric colorectal polyps. The area under the curve (AUC) of meat intake in the receiver operating characteristic (ROC) curve analysis for predicting colorectal polyps was 0.607; the best cut-off value was 92.14 g/d (P = 0.010, 95% CI: 0.527-0.687). The meat and vegetable intake combination AUC in predicting pediatric colorectal polyps was 0.781 (P < 0.001, 95% CI: 0.718-0.845).
Juvenile, solitary, and located in the rectosigmoid region polyps are most common in children. Hematochezia is the main clinical manifestation. Most polyps were, but multiple and proximally located polyps were also detected. Age ≤ 6 years, especially 3-6 years, positive family aggregation, positive sIgE, and higher meat intake are risk factors for pediatric colorectal polyps. A higher vegetable intake is a protective factor.