Study On The Distribution Of TCM Syndrome Factors In Colorectal Adenomatous Polyps And Their Correlation With Abnormal Glucose And Lipid Metabolis

Research objectives:To summarize the distribution pattern of TCM syndrome elements of colorectal adenomatous polyps and to analyze the correlation between adenomatous polyps and abnormal glucose metabolism,abnormal lipid metabolism and TCM syndrome elements,and provide more references for clinical identification and treatment of colorectal adenomatous polyps.Research methods:The study was a cross-sectional study,with reference to relevant literature and combined with "Syndrome Identification" and expert opinions to develop a questionnaire for patients with colorectal adenomatous polyps,collect information on patients’ general information,disease history,laboratory indicators related to blood glucose and lipid metabolism,clinical symptoms,endoscopic manifestations and pathological histological diagnosis,establish a database,and use SPSS 25.0 software for Statistical analysis was performed.The distribution of TCM syndrome elements,polyp characteristics(number,size,location,pathological classification,risk stratification,etc.)and abnormal glucose and lipid metabolism in patients with colorectal adenomatous polyps were described and analyzed,and the distribution of abnormal glucose and lipid metabolism and TCM syndrome elements in patients with different adenomatous polyp groups were compared,and the correlation between the above factors was analyzed.Research results:A total of 322 patients with colorectal adenomatous polyps were included in this study.1.General data:(1)Gender and age:171 cases in males and 151 cases in females,with an average age of 61.39±10.09 years.(2)Blood type:52 cases(16.15%)of type A,89 cases(27.64%)of type B,96 cases(29.81%)of type O and 25 cases(7.76%)of type AB;(3)Residence status:252 cases(78.26%)of those who usually lived in urban areas and 70 cases(21.74%)of those who usually lived in rural areas.2.Disease-related factors:(1)Family history:25 cases(7.76%)with a family history of colorectal cancer,26 cases(8.07%)with a family history of other tumours of the gastrointestinal tract and 26 cases(8.07%)with a family history of tumours of other systems.(2)History of smoking and alcohol consumption:117 cases(36.34%)with a history of smoking,119 cases(36.96%)with a history of alcohol consumption,90 cases(27.95%)with both smoking and alcohol consumption.(3)Combined diseases:Combined with other diseases of the digestive system in the following order:gastro-oesophageal reflux disease in 121 cases(37.58%),chronic atrophic gastritis in 114 cases(35.40%),fatty liver in 110 cases(34.16%),with intestinal hyperplasia in 96 cases(29.81%),gastric polyps in 72 cases(22.36%),Helicobacter pylori infection in 67 cases(20.81%),haemorrhoids 57 cases(17.70%),bile reflux 34 cases(10.56%)and cholelithiasis 34 cases(10.56%).The lower order of comorbid extra-digestive diseases were pulmonary nodules in 227 cases(70.50%),hyperlipidaemia in 217 cases(67.39%),hypertension in 131 cases(40.68%),thyroid lesions in 115 cases(35.71%),emphysema in 72 cases(22.36%),diabetes mellitus in 62 cases(19.25%)and hyperuricaemia in 58 cases(18.01%).3.Distribution of clinical symptoms:Abdominal symptoms were mainly abdominal distension and pain,other symptoms included acid reflux,heartburn,.dry mouth,bitter mouth,difficulty in sleeping,easy to wake up,tiredness and fatigue,irritability,etc.The most frequent bowel movements were 1-2 times a day in 212 cases(65.84%),followed by 3-5 times a day(48 cases,14.91%)and the least frequent 2-3 times a day(40 cases,12.42%).4.Distribution pattern of TCM syndrome elements:(1)Distribution of TCM syndrome elements:the frequency of disease location syndrome elements,in descending order,were liver 192 cases(59.63%),spleen 152 cases(47.20%),large Intestine 118 cases(36.65%),stomach 100 cases(31.06%),kidney 52 cases(16.15%);the frequency of disease nature syndrome elements,in descending order,were dampness 186 cases(58.07%),hot 124 cases(38.68%),Yin deficiency 102 cases(31.68%),Qi stagnation 88 cases(27.33%),Qi deficiency 81 cases(25.16%),Yang deficiency 57 cases(17.70%),Phlegm 24 cases(7.45%),Blood stasis 15 cases(4.66%)and Cold 13 cases(4.04%).(2)Distribution of TCM syndrome element combinations:the most cases were 50(15.58%)for spleen+liver,followed by 45(14.02%)for stomach+liver,32(9.97%)for spleen+large Intestine,31(9.66%)for large Intestine,31(9.66%)for liver+large Intestine,20(6.23)for spleen+kidney,and 19(5.92%)for liver;nature syndrome element combinations dampness was present in 47 cases(15.46%),followed by Yin deficiency in 24 cases(7.89%),Qi deficiency+dampness in 22 cases(7.24%),dampness+Qi stagnation in 21 cases(6.91%),Yin deficiency+dampness in 21 cases(6.91%),Qi stagnation in 19 cases(6.25%),and Yang deficiency+dampness in 17 cases(5.59%).5.Colonoscopy and pathological diagnosis:(1)Number of polyps:936 polyps were found in 322 patients,65 patients with single polyps(20.19%)and 257 patients with multiple polyps(79.81%).(2)Polyp site:406(43.38%)polyps were located in the left hemicolon and 530(56.62%)in the right hemicolon;(3)Polyp size:600(64.10%)micro polyps(≤5 mm),299(31.94%)small polyps(6-10 mm)and 37(3.95%)large polyps(>10 mm).(4)Polyp morphology:841 polyps without a tip(89.85%),79 polyps with a subtip(8.44%)and 16 polyps with a long tip(1.71%).(6)Type of polyp pathology:691 tubular adenomas(73.82%),7 villous adenomas(0.75%),62 villous tubular adenomas(6.62%),4 serrated lesions(0.43%),96 inflammatory polyps(10.26%)and 76 hyperplastic polyps(8.12%).6.Correlation between adenomatous polyps and abnormal glucose metabolism:191 patients with glucose metabolism related indicators,FBG level(P=0.002)and HbA1C level(P=0.016)were higher in the multiple polyp group than in the single polyp group,the difference was statistically significant;overall glucose abnormalities(P=0.004),high fasting glucose(P=0.012)and high glycated haemoglobin(P=0.016)were more frequent than in the single polyp group,and the differences were statistically significant.No statistically significant differences were seen in the distribution of FBG levels,HbA1C levels,and overall glucose abnormalities between groups for adenomatous polyp size,pathological type,risk stratification,and location(all P>0.05).7.Correlation between adenomatous polyps and abnormal lipid metabolism:237 patients with lipid metabolism-related indices,with higher TG levels in the multiple polyp group than in the single polyp group,with a statistically significant difference(P=0.004<0.05);more patients with hypertriglyceridaemia in the multiple polyp group than in the single polyp group,with a statistically significant difference(P=0.002<0.05);and more patients with hypertriglyceridaemia in the villous tubular and villous adenoma groups than in the single polyp group,with a borderline significant difference(P=0.002<0.05).more patients with triglycerides than in the tubular adenoma group,with the difference reaching borderline significant levels(P=0.063).There were no statistically significant differences in TC levels,TG levels,HDL-C levels,LDL-C levels,or overall dyslipidaemia distribution between groups for adenomatous polyp size,risk stratification,and location(all P>0.05).8.Correlation between adenomatous polyps and symptoms:there were statistically significant differences in the proportions of patients with abdominal pain(P=0.014)and decreased appetite(P=0.011)in the progressive adenoma and non-progressive adenoma groups;there were statistically significant differences in the proportions of patients with diarrhoea(P=0.042)and acid reflux(P=0.048)in the left and right hemicolectomatous adenoma groups,and borderline significant differences in the proportions of GERD symptom clusters(P=0.050).There were no significant differences in the number of polyps,size of adenomatous polyps or type of pathology between the groups(all P>0.05).9.Correlation between adenomatous polyps and TCM evidence:(1)Number of polyps:the proportion of Qi deficiency syndrome elements was higher in patients with single polyps than in patients with multiple polyps,with a statistically significant difference(P=0.033<0.05).(2)Adenoma size:The proportion of Qi stagnation syndrome elements was higher in patients with≥10 mm adenoma(P=0.045)than in patients with ≥10 mm adenoma,and the proportion of dampness syndrome elements(P=0.001)and hot syndrome elements(P=0.029)was lower than in patients with<10 mm adenoma,with a statistically significant difference.(3)Adenoma pathological types:The differences in the distribution of adenoma pathological types among the TCM syndrome elements were not statistically significant(all P>0.05).(4)Different risk stratification of adenoma:The proportions of dampness syndrome elements(P=0.043)and hot syndrome elements(P=0.036)were higher in patients with nonprogressive adenoma than in patients with progressive adenoma,with a statistically significant difference.(6)Adenoma location:The differences in the distribution of adenoma location in each TCM syndrome elements were not statistically significant(all P>0.05).10.Correlation between glucose and lipid metabolism and TCM syndrome elements:The proportion of Yin deficiency syndrome elements was higher in patients with dysglycemia than in those without dysglycemia,with a statistically significant difference(P=0.032<0.05);the proportion of dampness syndrome elements was higher in patients with dyslipidemia than in those without dyslipidemia,with a borderline significant difference(P=0.059);the difference in the distribution of whether both dysglycemia and dyslipidemia were abnormal in each TCM evidence element was not statistically significant(all P>0.05).Research findings:1.Abnormal glucose and lipid metabolism correlated with the number of polyps and the type of adenoma pathology,with a higher proportion of multiple colorectal polyps in patients with high fasting glucose,high glycosylated haemoglobin and hypertriglyceridaemia,as well as a higher proportion of villous tubular and villous adenomas in patients with hypertriglyceridaemia.2.There was a correlation between the location of the adenoma and the symptoms,with a higher proportion of diarrhoea symptoms in patients with a left hemicolectomy and a higher proportion of acid reflux symptoms and GERD symptoms in patients with a right hemicolectomy.3.The distribution of disease location syndrome elements of colorectal adenomatous polyposis is dominated by the liver,spleen and large intestine,with the most cases of double pathology;The distribution of disease nature syndrome elements is dominated by the dampness,hot and Yin deficiency,with the most cases of mixed pathology between deficiency and reality;single polyps are closely related to Qi deficiency syndrome elements;adenomas<10 mm and non-progressive adenomas are closely related to dampness and hot syndrome elements;adenomas ≥10 mm are closely related to Qi stagnation syndrome elements;blood glucose abnormalities are closely related to yin deficiency elements,and lipid abnormalities are closely related to damp elements.