結腸直腸息肉的相關危險因子探討

研究背景與目的：國人向來有相當高的B型肝炎病毒感染的盛行率， 文獻已確定B型肝炎病毒感染和肝癌、肝外癌與進行性結腸直腸腺瘤有顯著的相關性。因部分的結腸直腸息肉帶有癌變性，但國內並無B型肝炎病毒感染和結腸直腸息肉相關性的文獻，本研究是去探討國人結腸直腸息肉患者，B型肝炎病毒感染是否也有顯著較高的比例。研究方法：本回溯性研究，擷取健保資料庫2004年到2013年10年間的樣本，有無結腸直腸息肉患者分別各18363人，分析結腸直腸息肉患者與B型肝炎病毒感染的相關性。研究結果：本研究中，有無結腸直腸息肉樣本中帶有B型肝炎病毒感染的比例分別是6.8%和3.7%，p < 0.001。罹患息肉並且有B型肝炎病毒感染的校正後勝算比為Adj-ORb:1.79 (CI:1.63-21.98)。在20-39歲年齡層有息肉的案例組中，B型肝炎病毒感染比例有顯著高出沒有息肉的對照組。罹患息肉並且感染B型肝炎病毒的平均年齡比未受B型肝炎病毒感染者年輕。男性有較高的比例同時患結腸直腸息肉與受B型肝炎病毒感染。結論與應用：本研究依大數據研究分析的結果，發現結腸直腸息肉患者帶有B型肝炎病毒感染有正相關性，因部分的結腸直腸息肉帶有癌變性，未來可建議確定B型肝炎病毒感染者可追蹤大腸鏡檢查，以達結腸直腸息肉治療，甚或早期診斷出結腸直腸癌接受早期治療。

Background and Objective : Hepatitis B virus (HBV) infection is a common nation wide disease in Taiwan. Previous literatures confirmed that HBV infection may lead to hepatocellular carcinoma, and has a strong relationship among extra-hepatic cancers, including advanced colorectal adenoma. Part of colorectal polyps are carcinogenetic, however, there is lack of study focused on the relationship among colorectal polyp and HBV infection in our nation. The aim of our study is to determine whether patients having colorectal polyps have elevated prevalence of HBV infection.Method : This retrospective cohort study was approved by the National Health Insurance Administration and the Institutional Review Board of Chung Shan Medical University (Registration Number: CSMUH CS2-15100). The claims data, Longitudinal Health Insurance Database 2000 (LHID2000), were comprised one million patients randomly collected from the NHIRD registry. A total of 18363 patients with polyp were assessed. We further identified a control group without polyp history for the comparison cohort, frequency-matched (1:1 ratio) to the case with regard to sex and age.Results : In this study, the prevalence of HBV was 6.8% in the polyps group, which was significant higher than the prevalence of 3.7% found in the non-polyps group (p<0.001). The adjusted odds ratio, Adj-ORb:1.79 (CI:1.63-21.98), is still significant higher in the polyps group after adjustment for comorbidities. There is still higher correlation between polyps and HBV infection, especially in 20-39 age fraction. In the polyp cohort, the mean age of HBV infection was significantly younger. Men account for a higher proportion of groups that are simultaneously infected with HBV and suffer from colonic polyps.Conclusion : This study is based on retrospective cohort study design, and the results confirmed that HBV infection is positively related to colorectal polyps. We could conclude that reminding people with HBV infection to receive colonoscopy survey if polyps presence for cancer prevention as early diagnosis and treatment is an important issue in our country for adjusting health and welfare policy.