Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Associations between Nonalcoholic Fatty Liver Disease and Colorectal Adenoma in Health Screen Examinees

건강검진 수진자에서 비알코올 지방간 질환과 대장 선종과의 연관성에 관한 연구

  • Choi, Won-Gyu (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Kim, Sang-Jung (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Myung, Seok-Jin (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Choi, Seung-Oh (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Kim, Jung-Hee (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Park, Sang-Woon (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Park, Sang-Jong (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Jang, Eun-Jeong (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Park, Ju-Sang (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Baik, Hyun W. (Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center) ;
  • Kim, Eun-Ran (Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Beom-Jin (Chung-Ang University College of Medicine)
  • 최원규 (분당제생병원 소화기내과) ;
  • 김상중 (분당제생병원 소화기내과) ;
  • 명석진 (분당제생병원 소화기내과) ;
  • 최승오 (분당제생병원 소화기내과) ;
  • 김정희 (분당제생병원 소화기내과) ;
  • 박상운 (분당제생병원 소화기내과) ;
  • 박상종 (분당제생병원 소화기내과) ;
  • 장은정 (분당제생병원 소화기내과) ;
  • 박주상 (분당제생병원 소화기내과) ;
  • 백현욱 (분당제생병원 소화기내과) ;
  • 김은란 (성균관대학교 의과대학 서울삼성병원 내과학교실) ;
  • 김범진 (중앙대학교 의과대학 내과학교실)
  • Received : 2010.06.16
  • Accepted : 2010.09.02
  • Published : 2010.10.30
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Abstract

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) and colorectal cancer share several risk factors. However the relationship between NAFLD and colorectal adenoma is unclear. Therefore, we investigated the possibility of an association between NAFLD and colorectal adenoma. Methods: We reviewed the records of 3,106 subjects who had undergone colonoscopy and abdominal ultrasonography between April 2007 and August 2009. Results: The sex ratio (male/female) was 4.94 : 1 and the mean age was $50.6{\pm}9.7$ years in patients with colorectal adenoma; the corresponding numbers were 2.23 : 1 and $45.0{\pm}9.2$ years in patients without colorectal adenoma (p<0.001). The prevalence of NAFLD was 26.0% in the adenoma group and 21.4% in the control group (p=0.013). Additionally, there were positive associations between colorectal adenoma and BMI and lipid profile. Among the risk factors selected by univariate analysis, older age (OR 2.592; 95% CI 2.087~3.219), and being male (OR 2.470; 95% CI 1.878~3.247) were independent risk factors for colorectal adenoma. Patients with NAFLD had more colorectal adenomas (p=0.005) and their adenomas were located more in the proximal colon (p=0.009). Conclusions: NAFLD is not associated with increased risk for colorectal adenoma. However, among patients with NAFLD, colorectal adenomas were likely to be increased in number and they were likely to be located in the proximal colon.

목적: 대장암의 위험 인자로 비만, 고지혈증, 고혈당, 고인슐린혈증, 인슐린 저항성이 있으며, 이러한 인자들은 비알코올 지방간 질환에서도 중요한 병리기전이다. 하지만, 대장암의 전구병변인 대장 선종과 비알코올 지방간 질환의 관련성에 대하여는 알려진 바가 적어, 비알코올 지방간 질환과 대장 선종과의 연관성을 알아보고자 하였다. 대상 및 방법: 2007년 4월부터 2009년 8월까지 분당제생병원 건강증진센터를 방문하여 대장내시경검사와 복부초음파검사를 받은 3,106명을 연구대상으로 하였다. 대장내시경검사에서 정상이거나 과형성 용종, 기타 양성병변을 보였던 2,476명은 대조군으로, 선종이 발견된 630명은 선종군으로 분류하였다. 결과: 대상 환자 중 선종군과 대조군의 남녀비는 4.94 : 1과 2.23 : 1이었고(p<0.001), 평균 나이는 $50.6{\pm}9.7$세와 $45.0{\pm}9.2$세였다(p<0.001). 비알코올 지방간 질환의 빈도는 선종군에서 26.0%이었고, 대조군에서 21.4%였다(p=0.013). 그 외의 변수인 체질량지수, 총 콜레스테롤, 중성지방, LDL-콜레스테롤, HDL-콜레스테롤 등에서도 양 군에 유의한 차이를 보였다. 이들 변수에 대한 다변량 분석에서 대장 선종은 50세 이상의 연령(OR 2.592; 95% CI 2.087~3.219)과 남성(OR 2.470; 95% CI 1.878~3.247)에서만 유의하게 증가하는 양상을 보였다. 그러나, 비알코올 지방간 질환의 유무에 따른 대장 선종의 특성을 분석하였을때, 비알코올 지방간 질환이 병발한 대장 선종은 2개 이상이며(p=0.005), 근위부 대장에 분포하는 양상을 보였다(p=0.009). 결론: 비알코올성 지방간 질환의 유무에 따라 대장 선종의 빈도는 차이가 없었다. 하지만, 비알코올 지방간 질환이 병발시에 대장 선종의 개수가 증가하며 근위부 대장에 분포하는 양상을 보여, 이에 대한 향후 전향 연구가 필요하리라 생각한다.

Keywords

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