| BackgroundThe incidence of colorectal cancer is the second highest among malignant tumors in China.A lot of colorectal cancer is derived from the malignant transformation of colorectal adenoma(CRA).At present,there is no standard for the etiology,pathogenesis,diagnosis and treatment of CRA in traditional Chinese Medicine(TCM).Through exploring the TCM tongue characteristics and TCM constitution distribution of CRA,it can provide a basis for syndrome differentiation of TCM and classification of CRA,which is helpful for the standardized diagnosis and treatment of TCM.In addition,the diet-related risk factors and the characteristics of bowel sounds of CRA population are still unclear.The semi-quantitative food frequency questionnaire survey method is helpful to understand the relationship between CRA and diet.The 24-hour monitoring of bowel sounds can more clearly understand the intestinal motility characteristics of CRA,and provide new ideas and strategies for the prevention,diagnosis and treatment of CRA.Objective1.To explore the constitution distribution of CRA patients and the difference of tongue image characteristics between CRA patients and controls.2.To explore the differences and time distribution of bowel sounds between CRA patients and controls by 24-hour continuous bowel sound recording and analyzing,and to understand the intestinal dynamic characteristics of CRA.3.To study the impact of diet and lifestyle on CRA,and to explore the risk factors of CRA.Methods1.CRA patients were consecutively recruited from the outpatient department,ward and endoscopy center of a tertiary hospital in Beijing,and healthy volunteers were recruited from the outpatient department and physical examination center.Through questionnaire survey and examination report,the general information,colonoscopy report and pathological report of the subjects were collected to screen the subjects for inclusion.According to the "Classification and Determination of Constitution of Traditional Chinese Medicine" issued by the China Association of Traditional Chinese Medicine,the constitution types were determined,including nine constitution types:balanced constitution,Qi-deficiency constitution,yang-deficiency constitution,yin-deficiency constitution,phlegm dampness constitution,damp-heat constitution,blood stasis constitution,qi-stagnation constitution,and special constitution constitution.Photos of tongue images were collected through the automatic photography system,and the main features included tongue texture(tooth marks,cracks,prurients,petechiae,ecchymosis,fat and thin),tongue color(pale,light red,red,crimson,dark red,and purple),tongue coating texture(thin,greasy,peeling,moisturizing),and tongue coating color(white moss,yellow moss,dark yellow moss,and scorched yellow moss).Chi-square test was used to compare the differences in tongue image and constitution between CRA group and control group.2.Complete 24-hour monitoring of bowel sounds was conducted on subjects who met the inclusion criteria.The monitoring indicators mainly included the basic acoustic characteristics of bowel sounds,including Bowel sound rate(BSR),Bowel sound duration(BSD),Bowel sound interval(BSI),Bowel sound amplitude(BSA),and Bowel sound frequency(BSF).Other monitoring indicators include Rate of bowel sound with a duration greater than 2s(BSD-2),Rate of bowel sound with an amplitude greater than 60dB(BSA-60),and No duration of bowel sounds(NBSD);Compare the twelve hour distribution characteristics of bowel sounds and explore the impact of defecation on bowel sounds.Statistical comparisons were conducted using t-tests,chi square tests,and non parametric tests.3.1:1 matched case-control study was conducted to investigate the dietary patterns of the subjects using a semi-quantitative food frequency questionnaire.The data were converted into the amount consumed per time,frequency of consumption per week,and total amount consumed per week for each kind of food.At the same time,the dietary habits and lifestyle of the subjects were investigated.Paired samples t-test,paired chi-square test,or Wilcoxon signed rank sum test for paired samples were used for analysis.Then,smoking,drinking,BMI,waistto-hip ratio and other covariates were used as covariates,and multivariate logistic regression analysis was used to adjust other confounding factors to screen out independent risk factors for CRA.The receiver operating characteristic(ROC)curve of the diet variables screened after multiple adjustments for predicting CRA was drawn,and the area under the ROC curve(AUC),specificity,sensitivity,maximum Youden index and corresponding critical value were calculated.Results1.Comparison of basic information,clinical data,TCM constitution and tongue image of subjects in each group①Comparison of basic information:272 subjects were finally included in the study,including 163 in CRA group and 109 in control group.The proportion of males,family history of intestinal polyps or colorectal cancer,hypertension,hyperlipidemia,type 2 diabetes and waist-to-hip ratio in CRA group were significantly higher than those in control group(P<0.05).②Clinical symptoms of CRA:the top five gastrointestinal symptoms in 163 CRA patients were as follows:91 cases(55.83%)had difficulty in defecation,80 cases(49.08%)had abdominal distension,75 cases(46.01%)had sticky stool,58 cases(35.58%)had straining,and 53 cases(32.52%)had loose stool.③Endoscopic features:CRA mainly occurs in the rectum and sigmoid colon,with multiple polyps.The endoscopic morphology is mainly Yamada type I and Yamada type II.The diameter of villous adenoma was significantly larger than that of other adenomas(P<0.05).The diameter of moderate and high dysplasia adenoma was significantly larger than that of low dysplasia adenoma(P<0.05).④Constitution distribution:the most common TCM constitution type of CRA patients was damp-heat constitution,and other abnormal constitutions were mainly blood-stasis constitution and phlegm dampness constitution.the most common TCM constitution type of control group was balanced constitution,and there was a statistically significant difference in the distribution types of constitution between the two groups(P<0.001).⑤Tongue features:the incidence of dark red tongue,purple tongue,yellow moss,thick moss,greasy moss,rot moss,fat tongue,cracked tongue,petechial and ecchymosis tongue in CRA group was significantly higher than that in control group(P<0.05).The occurrence rate of dark red tongue and purple tongue in high-risk adenoma group was significantly higher than that in low-risk adenoma group(P<0.05).The incidence of thin tongue in the recurrent polyps group was significantly higher than that in the first detected polyps group(P<0.05).2.Comparison of 24-hour bowel sounds among groups①The BSR and BSA-60 in CRA group were significantly higher than those in control group(P<0.05).Compared with the control group,the CRA group had a significantly shorter interval when no bowel sounds were detected(P<0.05).②The BSR one hour before defecation in the CRA group was significantly higher than that one hour after defecation(P<0.05).There was no significant difference in BSR before and after defecation in the control group(P>0.05).③The correlation analysis of the basic acoustic characteristics of bowel sounds showed that BSR was positively correlated with BSD(r=0.660,P<0.001),and BSR was negatively correlated with BSI(r=-0.737,P<0.001),but there was no linear correlation between BSR and BSA,BSR and BSF(P>0.05).④The BSR of subjects in both groups increased from 21:00 to 07:00 and decreased at other times.Except for BSF,the remaining basic acoustic signature parameters of bowel sounds showed similar rhythmic fluctuations over time during the 24-hour gut sounding monitoring in both groups.3.Comparison of diet and lifestyle among groups①The proportion of drinking and smoking in CRA group was significantly higher than that in control group(P<0.05).After adjusting for multiple confounding factors,multivariate logistic regression analysis showed that:Preference for salty food(OR=3.24,95%CI:1.17-9.00),over-eating(OR=9.53,95%CI:3.06-29.65),onion,ginger and garlic intake per time(OR=1.09,95%CI:1.02-1.18),hot vegetables intake per time(OR=1.01,95%CI:1.02-1.18),95%CI:1.001.02),weekly total intake of onion,ginger and garlic(OR=1.02,95%CI:1.01-1.03),weekly total intake of beef and lamb(OR=1.00,95%CI:1.00-1.01),weekly total intake of eggs(OR=1.00,95%CI:1.00-1.01),and weekly total intake of eggs(OR=1.00,95%CI:1.00-1.01).95%CI:1.00-1.01),barbecue intake(OR=4.70,95%CI:1.48-14.91)were positively associated with CRA.Light diet(OR=0.25,95%CI:0.08-0.77),boiled cooking(OR=0.22,95%CI:0.060.81)and green tea intake per time(OR=0.99,95%CI:0.98-1.00)were negatively associated with CRA.②The AUCs of weekly intake of onion,ginger and garlic,weekly intake of beef and mutton,weekly intake of eggs were 0.68[95%CI(0.59,0.77)],0.69[95%CI(0.61,0.78)],0.71.[95%CI(0.62,0.80)],respectively,and the onion,ginger and garlic intake for the critical value of CRA was 87.50 g per week.The critical value of beef and mutton intake was 187.50 g per week.The critical value of egg intake was 507.50 g per week.Conclusion1.High waist-to-hip ratio,family history of intestinal polyps or colorectal cancer,hypertension,hyperlipidemia,and type 2 diabetes mellitus are risk factors for CRA.Metabolic diseases such as hypertension,hyperlipidemia,and type 2 diabetes mellitus are often coexisting with CRA.The most common TCM constitution type of CRA patients is damp-heat constitution,and other abnormal constitutions are mainly blood-stasis constitution and phlegm dampness constitution.2.The tongue features of CRA patients with damp-heat syndrome or damp-heat combined with stasis syndrome are dominant,and the "stasis" tongue appearance is closely related to highrisk adenoma.3.CRA patients had a higher bowel sound rate,a shorter interval between undetectable bowel sounds,more occurrences of high DB amplitude,and strong relation to bowel movement events than those without polyps.In addition,the bowel rate showed a slow movement during the day and fast movement at night.4.Smoking,drinking,over-salty food preference,over-eating,barbecue,spice,beef and mutton and eggs intake are risk factors for CRA.vegetarian diet,boiled cooking,and green tea are protective factors for CRA. |
PDF Full Text Request