切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2026, Vol. 15 ›› Issue (04) : 331 -339. doi: 10.3877/cma.j.issn.2095-3224.2026.04.006

论著

结直肠息肉生长速率预测模型建立及其在结直肠腺瘤性息肉筛查中的应用价值
董雯1, 张小春2, 金黑鹰2,(), 金超2,()   
  1. 1 210017 南京中医药大学第二附属医院内镜中心
    2 210017 南京中医药大学第二附属医院肛肠科
  • 收稿日期:2026-02-05 出版日期:2026-08-25
  • 通信作者: 金黑鹰, 金超
  • 基金资助:
    江苏省社会发展项目(BE2023786); 江苏省中医药科技发展计划项目(ZD202421); 江苏省高水平中医药重点学科建设项目(中西医结合肠道微生态学)

Establishment of a prediction model for colorectal polyp growth rate and its value in colorectal polyp screening

Wen Dong1, Xiaochun Zhang2, Heiying Jin2,(), Chao Jin2,()   

  1. 1 Endoscopy Center, the Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210017, China
    2 Department of Colorectal Surgery, the Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210017, China
  • Received:2026-02-05 Published:2026-08-25
  • Corresponding author: Heiying Jin, Chao Jin
引用本文:

董雯, 张小春, 金黑鹰, 金超. 结直肠息肉生长速率预测模型建立及其在结直肠腺瘤性息肉筛查中的应用价值[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(04): 331-339.

Wen Dong, Xiaochun Zhang, Heiying Jin, Chao Jin. Establishment of a prediction model for colorectal polyp growth rate and its value in colorectal polyp screening[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2026, 15(04): 331-339.

目的

基于结直肠腺瘤性息肉临床血脂指标与内镜特征,建立多变量模型,并验证其在预测息肉复发风险和量化生长速率方面的临床价值。

方法

采用回顾性观察性研究,纳入南京中医药大学第二附属医院既往行腺瘤性息肉切除并至少完成一次随访结肠镜检查的患者。收集基线临床资料、直肠与升结肠的基线与复查内镜数据(息肉数量、累积体积、最大径及复查间隔)。以内镜中心收治的795例作为测试组,肛肠中心收治的476例作为验证组,采用单因素与多因素Logistic回归分析筛选息肉复发的独立预测因素并构建列线图模型,通过受试者工作特征(ROC)曲线,计算曲线下面积(AUC)评估模型的判别效能。采用多元线性回归、稳健回归及对数模型分析各因素对复查息肉数量、累积体积及最大径的影响。

结果

共纳入1 271例患者,其中复发组1 005例,非复发组266例。多因素Logistic回归显示,总胆固醇升高(OR=2.51,95%CI:1.53~4.11)、复查间隔时间延长(OR=1.08,95%CI:1.04~1.12)、基线息肉数量多(OR=1.15,95%CI:1.06~1.25)是息肉复发的独立危险因素,高密度脂蛋白降低(OR=0.51,95%CI:0.27~0.95)是息肉复发的保护因素。基于此构建的列线图模型在测试集与验证集中的AUC分别为0.736和0.710。多元线性回归分析进一步证实,复查间隔时间是预测复查息肉数量(β=0.13,P<0.001)、累积体积(β=2.94,P<0.001)及最大径(β=0.23,P<0.001)的稳定因素。模型预测息肉最大径生长至10.0 mm的中位时间为25.08个月。亚组分析显示,直肠组与升结肠组的复发率分别为80.60%与77.39%,差异无统计学意义(P=0.182);部位不是息肉复发的独立预测因素(OR=0.82,95%CI:0.61~1.08,P=0.160)。

结论

结合血脂指标与内镜特征构建的多变量预测模型可作为息肉术后复发风险评估的辅助工具,为个体化随访间隔的制定提供初步量化参考。

Objective

To develop a multivariable model incorporating lipid profiles and endoscopic features of colorectal adenomatous polyps, and to validate its performance in predicting polyp recurrence risk and estimating polyp growth rate based on the surveillance interval.

Methods

A retrospective observational study was conducted, enrolling adult patients who had undergone adenomatous polypectomy and at least one follow-up colonoscopy at the Second Affiliated Hospital of Nanjing University of Chinese Medicine. Baseline and follow-up endoscopic data (polyp number, cumulative volume, maximum diameter, and surveillance interval) from the rectum and ascending colon were collected. Patients from the endoscopy center (n=795) and the colorectal surgery center (n=476) were assigned to the test group and validation group, respectively. Univariate and multivariate logistic regression were used to screen for independent predictors of recurrence and to construct a nomogram model. The discriminatory performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC). Multiple linear regression, robust regression, and log-transformation models were employed to analyze the impact of various factors on the number, cumulative volume, and maximum diameter of polyps detected during follow-up.

Results

A total of 1 271 patients were included (1 005 in the recurrence group and 266 in the non-recurrence group). Multivariate logistic regression showed that elevated total cholesterol (OR=2.51, 95% CI: 1.53~4.11), prolonged surveillance interval (OR=1.08, 95%CI: 1.04~1.12), and higher baseline polyp count (OR=1.15, 95%CI: 1.06~1.25) were independent risk factors for polyp recurrence, while decreased high-density lipoprotein cholesterol (OR=0.51, 95%CI: 0.27~0.95) was a protective factor. The nomogram model constructed based on these factors achieved AUCs of 0.736 and 0.710 in the training and validation sets, respectively. Multiple linear regression analysis further confirmed that the surveillance interval was a stable factor for predicting the number (β=0.13, P<0.001), cumulative volume (β=2.94, P<0.001), and maximum diameter (β=0.23, P<0.001) of polyps at follow-up. The model predicted a median time of 25.08 months for the maximum polyp diameter to reach 10.0 mm. Subgroup analysis showed that the recurrence rates in the rectal group and the ascending colon group were 80.60% and 77.39%, respectively, with no statistically significant difference (P = 0.182). Polyp location was not identified as an independent predictor of recurrence (OR = 0.82, 95% CI: 0.61~1.08, P = 0.160).

Conclusion

The multivariable model prediction model, integrating lipid parameters with endoscopic features, has the potential to serve as an adjunctive tool for post-polypectomy recurrence risk assessment, providing a preliminary quantitative reference for individualizing surveillance intervals.

表1 复发与非复发患者的基线临床资料及首次内镜检查结果[
±s,例(%),MQ1Q3)]
表2 单因素和多因素分析息肉复发的影响因素
图1 息肉复发影响因素的列线图
图2 息肉复发影响因素的模型验证。2A:测试组的ROC曲线;2B:验证组的ROC曲线
表3 复查间隔时间、血脂及基线息肉数与复查息肉数量、累积体积及最大径的关联分析
变量 OLS 稳健回归 对数模型
β,95%CI P β,95%CI P β,95%CI P
复查息肉数 截距 0.72(0.12,1.32) 0.019 0.65(0.23,1.53) 0.009 0.76(0.63,0.88) <0.001
复查间隔时间 0.13(0.10,0.17) <0.001 0.14(0.10,0.18) <0.001 0.03(0.02,0.04) <0.001
TC 0.16(−0.23,0.54) 0.422 0.10(−0.16,0.36) 0.539 0.03(−0.05,0.11) 0.472
基线息肉数 0.24(0.18,0.29) <0.001 0.18(0.13,0.22) <0.001 0.04(0.03,0.06) <0.001
HDL-C 0.97(0.24,1.69) 0.009 0.66(0.06,1.26) 0.030 0.16(0.01,0.31) 0.040
复查息肉累积体积 截距 24.07(0.25,47.89) 0.048 23.25(13.69,32.81) <0.001 2.99(2.69,3.30) <0.001
复查间隔时间 2.94(1.52,4.36) <0.001 1.19(0.62,1.76) <0.001 0.04(0.02,0.05) <0.001
TC −4.94(−20.27,10.38) 0.527 −0.78(−6.93,5.37) 0.803 0.04(−0.16,0.23) 0.703
基线息肉数 −1.04(−3.30,1.22) 0.368 0.35(−0.56,1.26) 0.452 0.01(−0.02,0.04) 0.593
HDL-C 40.22(11.35,69.09) 0.007 14.32(2.74,25.91) 0.015 0.35(−0.02,0.71) 0.066
复查息肉最大径 截距 3.96(3.11,4.81) <0.001 3.40(2.62,4.18) <0.001 1.55(1.44,1.66) <0.001
复查间隔时间 0.23(0.18,0.28) <0.001 0.25(0.21,0.30) <0.001 0.03(0.02,0.04) <0.001
TC −0.36(−0.91,0.19) 0.200 −0.36(−0.86,0.14) 0.157 −0.04(−0.23,0.18) 0.227
基线息肉数 0.13(0.05,0.21) 0.002 0.14(0.07,0.21) <0.001 0.02(0.01,0.03) <0.001
HDL-C 0.39(−0.64,1.42) 0.454 0.61(−0.33,1.56) 0.204 0.04(−0.09,0.18) 0.510
图3 观测值与模型预测的复查息肉数目(3A)、复查息肉体积(3B)以及复查息肉最大径(3C)随复查间隔的变化关系。散点(灰色)为样本实际观测值;实线(蓝色)为基于原始尺度最小二乘法(OLS)模型预测值,虚线(红色)为对数变换模型[log(y+1)]预测值经反变换后的回归曲线
表4 直肠组与升结肠组息肉复发及生长相关指标比较
表5 按部位分层的结直肠息肉复发影响因素的多因素Logistic回归分析
[1]
张兴龙, 蔡林, 朱称心, 等. 内镜检查在结直肠癌防治中的应用及研究进展[J]. 肿瘤学杂志, 2024, 30(10): 825-832.
[2]
Knudsen AB, Rutter CM, Peterse EFP, et al. Colorectal cancer screening: an updated modeling study for the US preventive services task force[J]. JAMA, 2021, 325(19): 1998-2011.
[3]
Gupta S, Lieberman D, Anderson J C, et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US multi-society task force on colorectal cancer[J]. Am J Gastroenterol, 2020, 115(3): 415-434.
[4]
上海国家消化系统疾病临床医学研究中心(上海), 中华医学会消化内镜学分会, 中国抗癌协会肿瘤内镜专业委员会, 等. 中国结直肠癌癌前病变和癌前状态处理策略专家共识[J]. 中华消化内镜杂志, 2022, 39(1): 1-18.
[5]
Sint Nicolaas J, de Jonge V, van Baalen O, et al. Optimal resource allocation in colonoscopy: timing of follow-up colonoscopies in relation to adenoma detection rates[J]. Endoscopy, 2013, 45(7): 545-552.
[6]
Song M, Garrett WS, Chan AT. Nutrients, foods, and colorectal cancer prevention[J]. Gastroenterology, 2015, 148(6): 1244-1260.
[7]
Ma Z, Zou S, Liu R, et al. Socioeconomic development index (SDI) gradients and high BMI-Driven pan-cancer burden: a global burden of disease study on mortality, disability, and health inequities (2015-2021)[J]. BMC Public Health, 2025, 25(1): 3295.
[8]
Vahed IE, Esmaili Z, Mamaghani MP, et al. The association between serum lipid levels and colorectal cancer risk: a dose-response meta-analysis of 23 studies[J]. PloS One, 2025, 20(10): e0333907.
[9]
Zhou X, Sevilla-Gonzalez M, Phipps AI, et al. Diabetogenic processes for insulin resistance-linked hyperinsulinaemia are associated with colorectal cancer[J]. Diabetologia, 2026, 69(4): 942-952.
[10]
王树玲, 康争春, 赵胜兵, 等. 加强结肠镜检查规范培训, 提高结肠腺瘤检出率[J]. 海军军医大学学报, 2023, 44(3): 265-271.
[11]
何晋德, 王怀堂, 刘玉兰, 等. 常规电子结肠镜检查中结肠息肉漏诊分析[J]. 中华消化内镜杂志, 2007, 24(5): 354-356.
[12]
崔璐, 乔伟光, 朱博, 等. 内镜反转技术对右半结肠息肉检出率影响的研究[J]. 现代消化及介入诊疗, 2017, 22(2): 238-240.
[13]
中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录)[J]. 营养学报, 2004, (1): 1-4.
[14]
王增武, 刘静, 李建军, 等. 中国血脂管理指南(2023年)[J]. 中国循环杂志, 2023, 38(3): 237-271.
[15]
Tomayko MM, Reynolds CP. Determination of subcutaneous tumor size in athymic (nude) mice[J]. Cancer Chemotherapy and Pharmacology, 1989, 24(3): 148-154.
[16]
Liu Y, Cheng C, Li W, et al. Machine learning-based prediction of short-term recurrence of colorectal adenomatous polyps following EMR: model development and validation study[J]. Int J Med Inform, 2026, 206: 106165.
[17]
Stoian M, Becheanu G, Balescu I, et al. Recurrence and carcinogenetic rates of colorectal polyps[J]. Chirurgia (Bucur), 2024, 119(1): 21-35.
[18]
Kasugai K, Ogasawara N, Sasaki M. Colonoscopy surveillance after polypectomy[J]. Clin J Gastroenterol, 2011, 4(6): 355-363.
[19]
Du JY, Huang GY, Xie YC, et al. High levels of triglycerides, apolipoprotein B, and the number of colorectal polyps are risk factors for colorectal polyp recurrence after endoscopic resection: a retrospective study[J]. J Gastrointest Oncol, 2022, 13(4): 1753-1760.
[20]
Du M, Drew DA, Goncalves MD, et al. Early-onset colorectal cancer as an emerging disease of metabolic dysregulation[J]. Nature Reviews Endocrinology, 2025, 21(11): 686-702.
[21]
Du Q, Wang Q, Fan H, et al. Dietary cholesterol promotes AOM-induced colorectal cancer through activating the NLRP3 inflammasome[J]. Biochemical pharmacology, 2016, 105: 42-54.
[22]
Zhang L, Xiao G, Su D, et al. Diagnostic value of the combined detection of microbiota, multiple inflammation-related indicators, serum lipid indices, and tumour markers in colorectal polyps: a case-control study[J]. Int J Med Sci, 2025, 22(11): 2757-2770.
[23]
Tian Y, Wang K, Li J, et al. The association between serum lipids and colorectal neoplasm: a systemic review and meta-analysis[J]. Public Health Nutrition, 2015, 18(18): 3355-3370.
[24]
Zhang L, Feng Z, Li Y, et al. Salivary and fecal microbiota: potential new biomarkers for early screening of colorectal polyps[J]. Front Microbiol, 2023, 14: 1182346.
[25]
Ren Y, Zhuang Z, Xie Y, et al. BCAA-producing clostridium symbiosum promotes colorectal tumorigenesis through the modulation of host cholesterol metabolism[J]. Cell Host & Microbe, 2024, 32(9): 1519-1535.
[26]
Xie X, Wang W, Zhang H, et al. Cholesterol-induced colorectal cancer progression and its mitigation through gut microbiota remodeling and simvastatin treatment[J]. BMC Cancer, 2025, 25(1): 977.
[27]
Ben Q, An W, Jiang Y, et al. Body mass index increases risk for colorectal adenomas based on meta-analysis[J]. Gastroenterology, 2012, 142(4): 762-772.
[28]
Yam ST, Mclauchlan J, Mccombie A, et al. Colorectal polyp distribution in relation to age: meta-analysis[J]. BJS Open, 2025, 9(6): zraf132.
[29]
薛露露, 杨桢, 赵亚涛. 45~54岁无症状体检者结直肠镜筛查情况分析[J]. 肿瘤基础与临床, 2025, 38(4): 555-557.
[1] 陆玓, 高杨. 幽门螺杆菌感染亚型对结直肠息肉病理类型及炎症特征的影响[J/OL]. 中华实验和临床感染病杂志(电子版), 2025, 19(03): 165-174.
[2] 杨宁, 张立翱, 李仁君, 金水. 非遗传性结直肠息肉病患者的临床特征及息肉复发的影响因素分析[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(02): 168-174.
[3] 范阿强, 王勉, 柳金强, 武浩杰, 王健, 洪流. 连续横向结肠延长术治疗家族性腺瘤性息肉病合并直肠癌患者一例[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 85-89.
[4] 吕钗, 吴子坤, 朱文溥, 赵卫杰, 陈广龙, 艾慧晗, 杨行, 鲍邦和, 刘发强, 李智. 全结肠切除术治疗家族性腺瘤性息肉病相关结直肠癌的预后分析[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 45-57.
[5] 王健, 麻如欢, 苏宇, 田雨, 郭银燕. 不同BMI水平下结直肠息肉复发的影响因素研究[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(03): 259-265.
[6] 叶茂, 王晓兰, 黄何, 吕苏奇, 李晨, 李跃伟, 吕定超. 45岁及以上人群中载脂蛋白B与冠状动脉狭窄严重程度的相关性分析[J/OL]. 中华临床医师杂志(电子版), 2026, 20(03): 202-209.
[7] 赵灵芝, 石光英. 熊去氧胆酸联合瑞舒伐他汀治疗脂肪肝合并高脂血症患者的临床疗效研究[J/OL]. 中华临床医师杂志(电子版), 2025, 19(08): 589-593.
[8] 温欢, 苏博, 刘金波, 王宏宇. 北京市社区中老年人群非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值与抑郁风险的关联性[J/OL]. 中华临床医师杂志(电子版), 2025, 19(06): 414-419.
[9] 张琳茹, 刘恩悦, 王红侠, 邢兴, 刘倩, 杨伏猛. 基于六西格玛模式评价血脂项目的分析性能及其质量控制方案的设计[J/OL]. 中华临床实验室管理电子杂志, 2025, 13(04): 200-205.
[10] 彭辉, 王燕青. 2型糖尿病载脂蛋白E基因多态性与糖尿病视网膜病变及血脂水平相关研究[J/OL]. 中华诊断学电子杂志, 2025, 13(04): 270-274.
[11] 杜泽宇, 郭恒, 张向辉, 何佳, 木拉提别克·克尔曼, 马儒林, 郭淑霞. 新疆兵团农村居民血脂指标与心血管疾病发病关联的队列研究[J/OL]. 中华心脏与心律电子杂志, 2026, 14(01): 28-35.
[12] 李松琳, 刘奉, 金润浩, 刘晓玉, 于夕丽, 唐洪涛, 鞠华秀. 老年结直肠息肉切除日间手术患者围手术期管理方案的构建与应用[J/OL]. 中华胃肠内镜电子杂志, 2026, 13(01): 56-61.
[13] 唐佩, 王翊钊, 马连君. 结直肠息肉内镜下冷切除技术的治疗进展[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(01): 50-53.
[14] 侯莉明, 王晓明. 老年人群血脂异常的管理策略[J/OL]. 中华老年病研究电子杂志, 2026, 13(01): 1-6.
[15] 林小灵, 刘恬宁, 艾星星, 黄洁微, 袁香华, 赵宛鄂, 刘雪彦. 新诊断2型糖尿病患者颈动脉病变与血脂、脉压、肱踝指数的相关性的研究[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(04): 276-281.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?