Correlation Between Tongue Features And LTB4/BLT1 Axis In Risk Stratification Of Patients With Intestinal Adenomas

ObjectivesThe purpose of this study is to explore the tongue features,LTB4/BLT1 expression differences and their correlations in patients with different risks of colorectal adenomas(CRA),which may provide an objective basis for the application of tongue diagnosis and clarify the role of LTB4/BLT1 axis in the pathogenesis of intestinal adenoma.MethodsFrom March 2019 to January 2020,patients were recruited from the outpatient and ward of digestive department of a top three hospital in Beijing,and healthy control(HC)volunteers were recruited from the society as the control group.According to "Guidelines for colonoscopy surveillance after polypectomy:a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society",patients with intestinal adenoma were divided into low-risk adenoma group(LRA)and high-risk adenoma group(HRA).The general information,colonoscopy and pathological reports of the volunteers were collected through questionnaire survey and examination report to screen the enrolled subjects.The tongue pictures were collected by intelligent health mirror,and the serum samples and intestinal mucosa tissues were collected.The inflammatory factors and their receptors(LTB4/BLT1)were detected by enzyme linked immunosorbent assay(ELISA)and immunohistochemistry(IHC).SPSS 26.0 was used to analyze and compare the tongue features and the expression level of LTB4/BLT1 in different risk groups,and to further explore the possible relationship between them.Results1.Clinical data?Age and gender:150 cases were included in the tongue study,including 50 cases in HC,LRA and HRA groups respectively.The LTB4/BLT1 study included 75 participants,all from the tongue study,including 25 cases in HC,LRA and HRA groups respectively.There was no significant difference in gender and age among the three groups(P>0.05).?Obesity-related indicators:There was no significant difference in the distribution of body mass index and waist-to-hip ratio among the three groups(P>0.05).?History of intestinal adenoma detection:4 recurred cases were detected in HRA group and 1 case in LRA group.2.Endoscopic features?Number of polypsA total of 165 polyps were detected in 50 adenoma patients,40 polyps in LRA group and 125 polyps in HRA group.Among them,single polyps accounted for 26%,2-3 polyps accounted for 44%,and more than 3 polyps accounted for 30%.?Polyp sizeAccording to statistics of the polyps with the largest diameter in a single examination,micro polyps accounted for 8%,small polyps accounted for 48%,medium-sized polyps accounted for 32%,and large polyps accounted for 12%.In LRA group,there were 3 cases of micropolyps(12%),22 cases of small polyps(8 8%).In HRA group,there were 1 case of micropolyps(4%),2 cases of small polyps(8%),16 cases of medium-sized polyps(64%)and 6 cases of large polyps(24%).?Polyp morphologyFrom the overall distribution,there were 14 cases(28%)of Yamada type ?,17 cases(34%)of Yamada type ?,8 cases(16%)of Yamada type ? and 11 cases(22%)of Yamada type ?.In LRA group,there were 8 cases(32%)of type I,9 cases(36%)of type ?,4 cases(16%)of type? and 4 cases(16%)of type ?.In HRA group,there were 6 cases(24%)of type ?,8 cases(32%)of type ?,4 cases(16%)of type ? and 7 cases(28%)of type ?.There was no significant difference in the distribution of morphological manifestations among the groups(P>0.05).?Polyp positionThere was no statistical difference in the location distribution of polyps in different risk groups(P=0.92>0.05).But the detection rate of HRA in the sigmoid colon was higher than LRA(60%VS 48%).3.Pathological resultsAccording to Shinya grading,tubular adenoma was found in 39 cases(78%),tubulo-villous adenoma in 10 cases(20%)and villous adenoma in 1 case(2%).According to Morson classification,17 cases(34%)were mild atypical hyperplasia,30 cases(60%)were moderate atypical hyperplasia,and 3 cases(6%)were severe atypical hyperplasia.4.Tongue picture?Tongue color:the detection rate of red tongue in adenoma group was higher than that in control group(40%vs 22%,P<0.05);?Tongue shape:the detection rate of thin tongue in adenoma group was lower than that in control group(5%vs 20%,P<0.05);?Special tongue:the detection rate of tongue pricking in adenoma group was higher than that in control group(21%vs 8%,P<0.05);?Coating color:the detection rate of yellow coating in adenoma group was higher than that in control group(66%vs 26%,P<0.01)and the detection rate of yellow coating in HRA group was higher than that in LRA group(80%vs 52%,P<0.01).However,there was no significant difference in depth of yellow among groups.?Thick and thin tongue fur:the detection rate of thick fur in adenoma group was higher than that in control group(58%vs 18%,P<0.01),and the detection rate of thick fur in HRA group was higher than that in LRA group(72%vs 44%,P<0.01).5.The expression level of LTB4/BLT1?Serum LTB4 concentration:the serum LTB4 concentration of HRA group was higher than that of control group(P<0.01).?The expression level of BLT1 in intestinal mucosa:as risk level of adenoma increases,the positive expression rate(average optical density)of BLT1 in intestinal mucosa tissue increases(P?0.01).The main expression sites of the receptors were in the epithelium,glands and stroma of intestinal mucosa.?Correlation:there was a positive correlation between LTB4 and BLT1,but the correlation was weak(p=0.28,P<0.05).6.Correlation between differential tongue features and LTB4/BLT1 expressionThe expression levels of LTB4 and BLT1 in the thick-coated population were higher than those in the thin-coated population(P<0.01).Conclusion1.Red tongue,fat tongue,pricking tongue and yellow thick fur are related to CRA,among which yellow thick fur is closely associated with HRA.2.LTB4/BLT1 axis may be involved in the pathogenesis of CRA,and serum LTB4 may have predictive significance.3.Thick moss is related to the level of inflammation in body of patients with CRA,and its mechanism remains to be further studied.