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中华实验和临床感染病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (01) : 54 -64. doi: 10.3877/cma.j.issn.1674-1358.2026.01.009

论著

胃息肉合并结肠息肉患者临床特征及其与不同亚型幽门螺杆菌感染的关系
戚红霞(), 张李娜, 王璐璐, 黄夕夏, 刘锋华   
  1. 200435 上海,上海市静安区市北医院消化内科
  • 收稿日期:2025-05-14 出版日期:2026-02-15
  • 通信作者: 戚红霞

Clinical characteristics analysis of gastric polyp complicated with colonic polyp and its relationship with different subtypes of Helicobacter pylori infection

Hongxia Qi(), Lina Zhang, Lulu Wang, Xixia Huang, Fenghua Liu   

  1. Department of Gastroenterology, Shibei Hospital, Jing’an District, Shanghai 200435, China
  • Received:2025-05-14 Published:2026-02-15
  • Corresponding author: Hongxia Qi
引用本文:

戚红霞, 张李娜, 王璐璐, 黄夕夏, 刘锋华. 胃息肉合并结肠息肉患者临床特征及其与不同亚型幽门螺杆菌感染的关系[J/OL]. 中华实验和临床感染病杂志(电子版), 2026, 20(01): 54-64.

Hongxia Qi, Lina Zhang, Lulu Wang, Xixia Huang, Fenghua Liu. Clinical characteristics analysis of gastric polyp complicated with colonic polyp and its relationship with different subtypes of Helicobacter pylori infection[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2026, 20(01): 54-64.

目的

探究胃息肉合并结肠息肉患者临床特征及其与不同亚型幽门螺杆菌(Hp)感染的关系。

方法

选择2018年10月至2023年10月于上海市静安区市北医院消化内科接受胃肠镜检查的300例患者为研究对象,根据胃肠镜检查结果分为胃息肉合并结肠息肉组(92例)、单纯胃息肉组(106例)和单纯结肠息肉组(102例)。比较3组患者的临床资料、胃肠镜检查结果、Hp感染率及亚型分布。采用多因素Logistic回归分析不同病理类型胃息肉合并结肠息肉以及该类患者Hp感染的独立影响因素;采用非条件Logistic回归模型分析各临床因素与Hp感染在胃息肉合并结肠息肉中的相乘交互作用,采用交互作用计算表分析其相加交互作用。

结果

3组患者性别(χ2=7.133、P=0.028)、年龄(F=65.696、P=0.015)、身体质量指数(BMI)(F=27.501、P=0.036)、吸烟史(χ2=6.765、P=0.034)、饮酒史(χ2=7.797、P=0.020)、Hp感染(χ2=10.460、P=0.005)、脂肪肝(χ2=6.031、P=0.049)、糖尿病(χ2=6.427、P=0.040)、白细胞介素-6(IL-6)(F=12.675、P=0.023)和转化生长因子-α(TGF-α)(F=33.368、P=0.030)差异均具有统计学意义。多因素Logistic回归分析结果显示,年龄(OR=2.503、95%CI:2.121~3.689、P=0.023)、饮酒史(OR=3.553、95%CI:2.868~4.712、P=0.009)、Hp感染(OR=3.217、95%CI:2.614~4.386、P=0.014)、脂肪肝(OR=1.631、95%CI:1.328~2.512、P=0.036)和糖尿病(OR=2.612、95%CI:2.181~3.711、P=0.021)均为发生不同病理类型胃肠息肉的独立影响因素。3组患者Hp亚型分布差异有统计学意义(χ2=14.700、P=0.001),较单纯胃息肉组和单纯结肠息肉组患者(41.03%和30.95%),胃息肉合并结肠息肉组患者Ⅰ型Hp阳性感染率(68.52%)显著升高(χ2=6.983、P=0.008,χ2=13.359、P=0.001)。Logistic回归分析显示,年龄(OR=2.411、95%CI:1.866~3.598、P=0.012)、饮酒史(OR=2.315、95%CI:1.645~3.487、P=0.016)、脂肪肝(OR=2.132、95%CI:1.431~3.065、P=0.031)和糖尿病(OR=2.268,95%CI:1.513~3.251、P=0.024)均为胃息肉合并结肠息肉患者Hp感染的独立危险因素。交互作用分析结果显示,年龄(OR相乘=5.136、95%CI相乘:1.358~15.842、P相乘=0.007;OR相加=8.624、95%CI相加:3.499~13.652、P相加=0.003)、饮酒史(OR相乘=4.954、95%CI相乘:1.006~12.834、P相乘=0.008;OR相加=8.239、95%CI相加:3.289~15.421、P相加=0.004)、脂肪肝(OR相乘=4.536、95%CI相乘:1.123~10.348、P相乘=0.009;OR相加=8.892、95%CI相加:1.869~17.212、P相加=0.002)、糖尿病(OR相乘=5.360、95%CI相乘:1.286~16.532、P相乘=0.006;OR相加=8.627,95%CI相加:1.217~15.964、P相加=0.003)和Ⅰ型Hp感染均在胃息肉合并结肠息肉中存在相乘及相加交互作用。

结论

年龄、饮酒史、脂肪肝和糖尿病均是胃息肉合并结肠息肉患者Hp感染的独立影响因素,且上述因素与Ⅰ型Hp感染存在协同交互作用。临床对于此类胃息肉患者,建议行结肠镜检查以早期发现并干预可能并存的结肠病变。

Objective

To investigate the clinical characteristics of patients with concurrent gastric and colonic polyps and their relationship with different subtypes of Helicobacter pylori (Hp) infection.

Methods

Total of 300 patients who underwent gastroscopy and colonoscopy in the Department of Gastroenterology, Shanghai Shibei Hospital from October 2018 to October 2023 were enrolled. According to the results of gastrointestinal endoscopy, the patients were divided into concurrent gastric and colonic polyp group (92 cases), isolated gastric polyp group (106 cases) and isolated colonic polyp group (102 cases). The clinical data, gastrointestinal endoscopy findings, Hp infection rate and subtype distribution were compared among the three groups. The independent influencing factors for gastric polyps combined with colorectal polyps of different pathological types, as well as for Hp infection in these patients were analyzed by multivariate Logistic regression analysis. The multiplicative interaction between clinical factors and Hp infection in patients with concurrent gastric and colonic polyps were analyzed by an unconditional Logistic regression model, and additive interaction was analyzed by an interaction calculation table.

Results

Gender (χ2=7.133, P=0.028), age (F=65.696, P=0.015), body mass index (BMI) (F=27.501, P=0.036), smoking history (χ2=6.765, P=0.034), drinking history (χ2=7.797, P=0.020), Hp infection (χ2=10.460, P=0.005), fatty liver (χ2=6.031, P=0.049), diabetes mellitus (χ2=6.427, P=0.040), interleukin-6 (IL-6) (F=12.675, P=0.023) and transforming growth factor-α (TGF-α) (F=33.368, P=0.030) among the three groups were all with significant differences. Results of multivariate Logistic regression analysis showed that age (OR=2.503, 95%CI: 2.121-3.689, P=0.023), drinking history (OR=3.553, 95%CI: 2.868-4.712, P=0.009), Hp infection (OR=3.217, 95%CI: 2.614-4.386, P=0.014), fatty liver (OR=1.631, 95%CI: 1.328-2.512, P=0.036) and diabetes mellitus (OR=2.612, 95%CI: 2.181-3.711, P=0.021) were independent influencing factors for different pathological types of gastrointestinal polyps. The distribution of Hp subtypes was significantly different among the three groups (χ2=14.700, P=0.001). The infection rate of type Ⅰ Hp was significantly higher in concurrent gastric and colonic polyp group (68.52%) than that of isolated gastric polyp group (41.03%) and isolated colonic polyp group (30.95%) (χ2=6.983, P=0.008; χ2=13.359, P=0.001). Results of Logistic regression analysis revealed that age (OR=2.411, 95%CI: 1.866-3.598, P=0.012), drinking history (OR=2.315, 95%CI: 1.645-3.487, P=0.016), fatty liver (OR=2.132, 95%CI: 1.431-3.065, P=0.031) and diabetes mellitus (OR=2.268, 95%CI: 1.513-3.251, P=0.024) were all independent risk factors for Hp infection in patients with concurrent gastric and colonic polyps. Interaction analysis indicated that age (ORmultiplicative=5.136, 95%CImultiplicative: 1.358-15.842, Pmultiplicative=0.007; ORadditive=8.624, 95%CIadditive: 3.499-13.652, Padditive=0.003), drinking history (ORmultiplicative=4.954, 95%CImultiplicative: 1.006-12.834, Pmultiplicative=0.008; ORadditive=8.239, 95%CIadditive: 3.289-15.421, Padditive=0.004), fatty liver (ORmultiplicative=4.536, 95%CImultiplicative: 1.123-10.348, Pmultiplicative=0.009; ORadditive=8.892, 95%Cadditive : 1.869-17.212, Padditive=0.002), diabetes mellitus (ORmultiplicative=5.360, 95%CImultiplicative: 1.286-16.532, Pmultiplicative=0.006; ORadditive=8.627, 95%CIadditive: 1.217-15.964, Padditive=0.003) and type Ⅰ Hp infection exhibited multiplicative and additive interactions in the development of concurrent gastric and colonic polyp.

Conclusions

Age, drinking history, fatty liver and diabetes mellitus are independent influencing factors of Hp infection in patients with gastric polyp and colonic polyp, and there is a synergistic interaction between the above factors and type Ⅰ Hp infection in the occurrence of the disease. In clinical practice, colonoscopy is recommended for patients with such gastric polyp to early detect and intervene possible coexisting colonic lesions.

表1 三组患者的临床资料
临床资料 胃息肉合并结肠息肉组(92例) 单纯胃息肉组(106组) 单纯结肠息肉组(102组) 统计量 P
性别 [例(%)] χ2=7.133 0.028a
男性 63(68.48) 55(51.89) 53(51.96)
女性 29(31.52) 51(48.11) 49(48.04)
年龄(
±s,岁)
67.18±5.41 59.13±5.16 60.34±5.12 F=65.696 0.015
BMI(
± s,kg/m2
27.24±3.45 24.15±3.28 24.19±3.15 F=27.501 0.036
DBP(
± s,mmHg)
75.94±7.12 75.85±7.61 74.29±7.53 F=1.550 0.475
SBP(
± s,mmHg)
135.91±13.92 132.48±13.84 135.19±12.97 F=1.782 0.429
呼吸(
± s,次/min)
20.89±3.52 20.56±3.94 21.03±3.61 F=0.437 0.897
心率(
± s,次/min)
36.03±2.36 36.51±2.47 36.43±2.41 F=1.079 0.603
吸烟史 [例(%)] 62(67.39) 56(52.83) 51(50.00) χ2=6.765 0.034a
饮酒史 [例(%)] 71(77.17) 64(60.38) 62(60.78) χ2=7.797 0.020a
Hp感染 [例(%)] 54(58.70) 39(36.79) 42(41.18) χ2=10.460 0.005
Ⅰ型Hp+ 37(68.52) 16(41.03) 13(30.95) χ2=14.700 0.001
Ⅱ型Hp+ 17(31.48) 23(58.97) 29(69.05)
十二指肠息肉 [例(%)] 49(53.26) 51(48.11) 54(52.94) χ2=0.682 0.711a
Barrett食管 [例(%)] 59(64.13) 58(54.72) 61(59.80) χ2=1.823 0.402a
脂肪肝 [例(%)] 68(73.91) 63(59.43) 60(58.82) χ2=6.031 0.049a
糖尿病 [例(%)] 72(78.26) 67(63.21) 65(63.73) χ2=6.427 0.040a
TC(
±s,mmol/L)
4.15±1.14 4.17±1.01 4.02±1.12 F=0.565 0.828
TG(
± s,mmol/L)
1.96±0.64 1.85±0.62 1.81±0.59 F=1.505 0.485
HDL(
± s,mmol/L)
1.12±0.19 1.28±0.26 1.25±0.21 F=13.807 0.070
LDL(
± s,mmol/L)
2.23±0.38 2.26±0.41 2.19±0.43 F=0.761 0.730
β2-MG(
± s,mg/L)
8.92±3.16 8.76±3.53 8.81±3.31 F=0.058 1.000
Hb(
± s,mg/L)
93.29±28.54 87.29±27.31 88.94±26.57 F=1.222 0.558
ALB(
± s,mg/L)
36.29±8.46 35.26±8.17 35.19±8.29 F=0.521 0.852
SCr(
± s,μmol/L)
74.38±10.31 73.59±10.16 74.26±10.23 F=0.175 0.996
TBil(
± s,μmol/L)
11.34±4.21 11.05±4.13 11.16±4.06 F=0.121 1.000
FIB(
± s,mmol/L)
3.51±0.51 3.43±0.56 3.39±0.52 F=1.255 0.548
FBG(
± s,mmol/L)
4.71±1.39 4.62±1.26 4.68±1.24 F=0.124 1.000
GSP(
± s,μmol/L)
324.10±46.37 313.49±45.29 316.29±46.21 F=1.372 0.517
HbAlc(
± s,%)
9.84±1.23 9.63±1.16 9.72±1.17 F=0.767 0.727
IL-6(
± s,pg/ml)
136.38±18.23 113.41±18.56 118.25±17.52 F=12.675 0.023
TNF-α(
± s,ng/ml)
253.48±21.29 243.85±18.61 239.61±17.26 F=13.212 0.073
TGF-α(
± s,pg/ml)
2.59±0.47 2.13±0.31 2.23±0.44 F=33.368 0.030
VEGF(
± s,pg/ml)
223.13±25.17 205.42±24.49 210.36±22.61 F=13.805 0.070
表2 三组患者胃肠镜检查结果 [例(%)]
表3 92例胃息肉合并结肠息肉患者病理类型影响因素的多因素Logistic回归分析
影响因素 胃息肉病理类型 结肠息肉病理类型
胃底腺息肉 腺瘤性息肉 增生性息肉 炎性息肉 腺瘤性息肉 增生性息肉 炎性息肉
性别
OR 1.271 1.412 1.457 1.319 2.948 1.294 1.385
95%CI 1.022~1.673 1.105~1.904 1.142~1.968 1.078~1.716 2.403~4.115 1.047~1.682 1.091~1.897
P 0.186 0.089 0.064 0.128 0.017 0.130 0.085
年龄
OR 1.318 1.881 1.342 1.307 2.915 1.876 1.335
95%CI 1.059~1.726 1.517~2.947 1.077~1.757 1.050~1.712 2.396~4.021 1.512~2.912 1.071~1.748
P 0.077 0.031 0.106 0.059 0.017 0.031 0.063
BMI
OR 1.275 1.192 1.233 1.256 2.455 1.348 1.241
95%CI 1.038~1.659 0.954~1.546 1.002~1.598 1.021~1.629 2.089~3.607 1.211~1.933 1.008~1.609
P 0.085 0.164 0.105 0.061 0.023 0.042 0.082
吸烟史
OR 1.182 1.396 1.157 1.193 1.204 1.143 1.214
95%CI 0.951~1.519 1.276~2.054 0.929~1.482 0.960~1.534 0.969~1.549 0.917~1.464 0.977~1.563
P 0.123 0.041 0.108 0.083 0.071 0.134 0.067
饮酒史
OR 1.247 3.269 2.197 1.172 2.364 3.306 1.942
95%CI 1.011~1.600 2.658~4.412 1.854~3.367 0.942~1.498 1.978~3.418 2.699~4.487 1.631~3.152
P 0.061 0.014 0.025 0.096 0.024 0.012 0.027
Hp感染
OR 1.886 2.131 2.703 1.956 3.105 3.468 3.516
95%CI 1.522~3.061 1.812~3.305 2.255~3.804 1.728~3.218 2.593~4.315 2.764~4.598 2.814~4.634
P 0.031 0.026 0.021 0.027 0.016 0.011 0.009
脂肪肝
OR 1.269 1.798 3.358 1.253 2.654 2.841 1.282
95%CI 1.032~1.649 1.456~2.748 2.715~4.516 1.019~1.626 2.218~3.768 2.368~3.878 1.042~1.666
P 0.087 0.033 0.012 0.091 0.021 0.018 0.054
糖尿病
OR 1.272 1.863 1.237 2.371 3.062 1.225 1.261
95%CI 1.035~1.654 1.498~2.899 1.005~1.607 2.031~3.512 2.546~4.287 0.995~1.592 1.026~1.640
P 0.086 0.031 0.105 0.024 0.016 0.114 0.075
IL-6
OR 1.172 1.623 1.148 1.127 1.161 1.183 1.136
95%CI 0.942~1.504 1.312~2.499 0.921~1.471 0.903~1.443 0.933~1.490 0.951~1.518 0.910~1.455
P 0.123 0.036 0.092 0.164 0.137 0.120 0.152
TGF-α
OR 1.157 1.182 1.229 1.243 1.215 1.173 1.146
95%CI 0.927~1.500 0.947~1.531 0.984~1.594 0.996~1.612 1.131~1.879 0.939~1.519 0.918~1.477
P 0.132 0.102 0.067 0.053 0.046 0.084 0.134
表4 三组患者不同病理类型息肉Hp感染阳性率 [例(%)]
表5 三组不同病理类型息肉患者Hp亚型分布 [例(%)]
表6 胃息肉合并结肠息肉患者Hp感染影响因素的Logistic回归分析
表7 临床特征与Hp感染在胃息肉合并结肠息肉中的交互作用
因素1 因素2 胃息肉合并结肠息肉(否/是) OR值(95%CI OR值(95%CIa
年龄 Hp感染
<63岁b Hp-b 85/11 1.000 1.000
<63岁 Ⅱ型Hp+ 18/15 2.132(0.845~6.482) 1.974(0.798~5.187)
<63岁 Ⅰ型Hp+ 17/19 2.568(0.877~6.923) 2.285(0.852~6.721)
≥63岁 Hp- 52/17 4.595(0.816~9.846) 4.297(0.763~10.849)
≥63岁 Ⅱ型Hp+ 11/2 5.235(1.169~11.633) 4.982(1.025~10.528)
≥63岁c Ⅰ型Hp+c 25/28 8.971(3.684~14.659) 8.624(3.499~13.652)
交互作用 相加模型 RERI=2.357(95%CI:1.324~8.527)、P=0.014
AP=0.273(95%CI:0.179~0.431)、P=0.021
S=1.448(95%CI:1.125~18.623)、P=0.032
相乘模型 OR=5.136(95%CI:1.358~15.842)、P=0.008
饮酒史 Hp感染
b Hp-b 105/25 1.000 1.000
Ⅱ型Hp+ 11/22 1.864(0.638~6.135) 1.629(0.598~5.687)
Ⅰ型Hp+ 10/24 2.648(0.798~8.541) 2.241(0.726~8.052)
Hp- 31/4 2.946(0.849~9.032) 2.495(0.796~8.874)
Ⅱ型Hp+ 8/5 4.294(1.158~12.659) 3.853(1.032~12.018)
c Ⅰ型Hp+c 43/12 8.721(3.465~15.982) 8.239(3.289~15.421)
交互作用 相加模型 RERI=3.145(95%CI:1.653~10.618)、P=0.009
AP=0.382(95%CI:0.213~0.648)、P=0.015
S=1.768(95%CI:1.125~10.178)、P=0.028
相乘模型 OR=4.954(95%CI:1.006~12.834)、P=0.047
脂肪肝 Hp感染
b Hp-b 65/4 1.000 1.000
Ⅱ型Hp+ 11/8 2.682(0.669~6.485) 2.184(0.618~6.032)
Ⅰ型Hp+ 9/12 3.058(0.765~8.154) 2.733(0.716~7.845)
Hp- 72/24 3.486(0.923~11.063) 3.197(0.875~10.629)
Ⅱ型Hp+ 18/9 5.592(1.245~14.684) 5.154(1.032~13.847)
c Ⅰ型Hp+c 33/35 9.197(2.032~18.487) 8.892(1.869~17.212)
交互作用 相加模型 RERI=2.005(95%CI:1.285~11.294)、P=0.019
AP=0.225(95%CI:0.132~0.518)、P=0.026
S=1.341(95%CI:1.021~8.974)、P=0.041
相乘模型 OR=4.536(95%CI:1.123~10.348)、P=0.022
糖尿病 Hp感染
b Hp-b 58/5 1.000 1.000
Ⅱ型Hp+ 12/3 2.543(0.532~7.151) 2.184(0.509~6.547)
Ⅰ型Hp+ 6/12 3.651(0.699~8.987) 3.324(0.634~8.231)
Hp- 83/19 4.598(0.846~11.231) 4.294(0.805~10.684)
Ⅱ型Hp+ 15/16 5.032(0.978~13.276) 4.625(0.912~12.879)
c Ⅰ型Hp+c 34/37 8.978(1.321~16.877) 8.627(1.217~15.964)
交互作用 相加模型 RERI=1.678(95%CI:1.285~10.699)、P=0.024
AP=0.195(95%CI:0.089~0.521)、P=0.033
S=1.282(95%CI:1.063~9.653)、P=0.045
相乘模型 OR=5.360(95%CI:1.286~16.532)、P=0.011
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