Construction of a multiple risk factor prediction model for colorectal adenoma in patients with type 2 diabetes mellitus

doi:10.11958/20220636

Abstract

Abstract:

Objective To investigate independent influencing factors of colorectal adenomas (CRA) in patients with type 2 diabetes mellitus (T2DM) and to establish the risk prediction model. Methods Patients with T2DM undergoing colonoscopy were divided into the adenoma group (n=145, pathologically diagnosed as CRA) and the control group (n=174, without abnormal colorectal mucosa). Age, sex, body mass index (BMI) and diabetes course, history of hypertension, diabetic peripheral neuropathy, fatty liver, gastrointestinal symptoms, metformin and insulin use in recent 5 years, Helicobacter pylori (Hp) infection, smoking history, drinking history and fecal occult blood were compared between the two groups. Laboratory data were also compared between the two groups, including tumor abnormal protein (TAP), glycosylated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), uric acid (UA) and vitamin D₃ levels. Multivariate Logistic regression was used to determine the independent risk factors for CRA in T2DM patients, and a new combined predictor was constructed (L_combined). The combined prediction value of L_combined was evaluated by ROC curve, and the fit degree was evaluated by Hosmer-Lemeshow test. Results In the adenoma group, age, BMI, male, history of hypertension, history of smoking, history of drinking, positive proportion of Hp, positive proportion of stool occult blood, HbA1c, TG, TAP and HOMA-IR were significantly higher than those in the control group. The proportion of metformin use and vitamin D₃ levels were lower in the adenoma group than those in the control group (P<0.05). Multivariate Logistic regression showed that the increased age, BMI, TAP, TG, smoking history, positive Hp and positive occult blood were independent risk factors for CRA in T2DM patients, while metformin was an independent protective factor (P<0.05). ROC curve showed that the AUC of L_combined was 0.815 (95%CI: 0.768-0.862, P<0.01), and Hosmer-Lemeshow test showed a good fit of the risk model (χ²=10.249, P=0.248). Conclusion The combined predictors of age, BMI, TAP, TG, smoking history, Hp infection, fecal occult blood and metformin use are effective in predicting the risk of colorectal adenoma in patients with T2DM.

Key words: diabetes mellitus, type 2, adenoma, colorectal neoplasms, metformin, risk factor, combined predictor

CLC Number:

R735

Figures/Tables 5

References 32

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组别	n			年龄（岁）			男性			BMI （kg/m²）					糖尿病病程（年）
对照组	174			50.52±8.51			100（57.47）			24.08（22.85，26.20）					4（2，9）
腺瘤组	145			53.16±9.48			101（69.66）			25.71（23.84，27.24）					5（2，10）
t、χ²或Z				2.621^＊＊			5.037^＊			4.075^＊＊					1.246
组别		高血压史			周围神经病变			胃肠道症状			脂肪肝		应用二甲双胍
对照组		56（32.18）			62（35.63）			46（26.43）			120（68.97）		127（72.99）
腺瘤组		65（44.83）			65（44.83）			51（35.17）			110（75.86）		89（61.38）
t、χ²或Z		5.370^＊			2.791			2.852			1.870		4.876^＊
组别			应用胰岛素			Hp阳性			吸烟史			饮酒史		大便隐血阳性
对照组			63（36.21）			39（22.41）			32（18.39）			38（21.84）		10（5.75）
腺瘤组			66（45.52）			66（45.52）			61（42.07）			63（43.45）		33（22.76）
t、χ²或Z			2.846			19.119^＊＊			21.469^＊＊			17.069^＊＊		19.625^＊＊

组别	n			年龄（岁）			男性			BMI （kg/m²）					糖尿病病程（年）
对照组	174			50.52±8.51			100（57.47）			24.08（22.85，26.20）					4（2，9）
腺瘤组	145			53.16±9.48			101（69.66）			25.71（23.84，27.24）					5（2，10）
t、χ²或Z				2.621^＊＊			5.037^＊			4.075^＊＊					1.246
组别		高血压史			周围神经病变			胃肠道症状			脂肪肝		应用二甲双胍
对照组		56（32.18）			62（35.63）			46（26.43）			120（68.97）		127（72.99）
腺瘤组		65（44.83）			65（44.83）			51（35.17）			110（75.86）		89（61.38）
t、χ²或Z		5.370^＊			2.791			2.852			1.870		4.876^＊
组别			应用胰岛素			Hp阳性			吸烟史			饮酒史		大便隐血阳性
对照组			63（36.21）			39（22.41）			32（18.39）			38（21.84）		10（5.75）
腺瘤组			66（45.52）			66（45.52）			61（42.07）			63（43.45）		33（22.76）
t、χ²或Z			2.846			19.119^＊＊			21.469^＊＊			17.069^＊＊		19.625^＊＊

组别	n		HbA1c（%）		TC（mmol/L）			TG（mmol/L）
对照组	174		6.9（6.5，8.4）		4.38（3.66，5.03）			1.52（0.99，2.05）
腺瘤组	145		7.7（6.8，9.7）		4.45（3.55，5.29）			1.60（1.16，3.01）
Z			3.414^＊＊		0.621			2.378^＊＊
组别	LDL-C（mmol/L）			UA（μmol/L）			维生素D₃（μg/L）
对照组	2.82（2.05，3.22）			295（242，332）			18.67（14.84，22.11）
腺瘤组	2.60（1.91，3.28）			290（252，355）			17.71（13.09，20.93）
Z	1.353			0.438			2.137^＊
组别		TAP凝聚物面积（μm²）				HOMA-IR
对照组		93.35（89.14，100.74）				1.67（1.12，3.05）
腺瘤组		99.90（91.30，108.20）				2.02（1.46，3.03）
Z		4.669^＊＊				2.540^＊

组别	n		HbA1c（%）		TC（mmol/L）			TG（mmol/L）
对照组	174		6.9（6.5，8.4）		4.38（3.66，5.03）			1.52（0.99，2.05）
腺瘤组	145		7.7（6.8，9.7）		4.45（3.55，5.29）			1.60（1.16，3.01）
Z			3.414^＊＊		0.621			2.378^＊＊
组别	LDL-C（mmol/L）			UA（μmol/L）			维生素D₃（μg/L）
对照组	2.82（2.05，3.22）			295（242，332）			18.67（14.84，22.11）
腺瘤组	2.60（1.91，3.28）			290（252，355）			17.71（13.09，20.93）
Z	1.353			0.438			2.137^＊
组别		TAP凝聚物面积（μm²）				HOMA-IR
对照组		93.35（89.14，100.74）				1.67（1.12，3.05）
腺瘤组		99.90（91.30，108.20）				2.02（1.46，3.03）
Z		4.669^＊＊				2.540^＊

项目	B	SE	Wald χ²	P	OR	OR 95%CI
性别	0.319	0.353	0.813	0.367	1.375	0.688~2.749
年龄	0.075	0.018	17.140	<0.001	1.078	1.040~1.117
BMI	0.104	0.052	3.932	0.047	1.109	1.001~1.229
高血压	0.397	0.299	1.768	0.184	1.488	0.828~2.672
吸烟史	0.782	0.349	5.019	0.025	2.187	1.103~4.335
饮酒史	0.341	0.350	0.947	0.331	1.406	0.708~2.793
应用二甲双胍	-0.760	0.303	6.285	0.012	0.468	0.258~0.847
Hp感染	0.775	0.293	7.007	0.008	2.171	1.223~3.855
大便隐血	1.045	0.461	5.143	0.023	2.844	1.152~7.020
TAP凝聚物面积	0.041	0.013	9.880	0.002	1.042	1.016~1.069
HbA1c	0.071	0.074	0.923	0.337	1.074	0.929~1.241
TG	0.271	0.125	4.666	0.031	1.311	1.025~1.675
维生素D₃	-0.023	0.024	0.889	0.346	0.978	0.933~1.025
HOMA-IR	-0.008	0.074	0.011	0.915	0.992	0.858~1.147
常数项	-11.942	2.248	28.216	<0.001	<0.001