胃肠息肉原来是这么长出来的!

2016-12-26 医学界消化频道 中山大学附属东华医院消化内科 叶火旺 医学界消化频道 叶火旺

日常工作中,碰到病人常问这么一个问题:为什么别人不会长胃息肉/肠息肉,而我却长了?到底是为什么?今天小大夫就来个“开坛讲经”。

日常工作中,碰到病人常问这么一个问题:为什么别人不会长胃息肉/肠息肉,而我却长了?到底是为什么?今天小大夫就来个“开坛讲经”。

第1讲:为什么会长胃息肉?

☆ 遗传因素:基因变异与胃息肉的形成息息相关,具体机制未明;

☆ 幽门螺旋杆菌感染:幽门螺旋杆菌能释放多种炎症介质及细胞因子,对胃黏膜造成损伤,刺激胃上皮细胞增生,导致胃息肉产生;

☆ 胆汁反流:十二指肠液含有胆酸、胰酶,反流入胃内,可损害胃黏膜,并引起胃黏膜的炎症性增生,导致胃息肉产生;同时,大量反流液使胃内pH值升高,使得胃泌素增生,导致增生性息肉产生;

☆ 抑酸药:长期服用抑酸药可导致高胃泌素血症,可促进胃腺体囊状扩张,形成胃息肉;胃底腺息肉多与服用该药密切相关,部分该类患者停用抑酸药后胃底腺息肉可消失;

☆ 吸烟:吸烟会增生胃息肉的发病风险,可能与吸烟会增加幽门螺旋杆菌的感染率等因素相关;另一方面,烟草烟雾中含有大量的致癌物质可结合DNA形成加合物,干扰细胞复制,影响DNA修复,使胃黏膜发生不可逆转的基因改变,促进息肉的形成;

☆ 饮酒:可损伤胃黏膜,慢性胃发生率明显增加,细菌繁殖增加,促进亚硝胺类致癌物质合成,从而增加胃息肉发生的风险;

另外,有研究认为较多肉类(尤其是牛肉、羊肉之类的红肉)、腌制食物、油炸食物,较少进食蔬菜类,高脂血症、肥胖等会增加罹患胃息肉的风险。老年人比青年人、男性比女性更易罹患胃息肉;

第2讲:为什么会长大肠息肉?

☆ 遗传因素:基因变异同样与大息肉的形成有关,具体机制未明;

☆ 果蔬摄入少:果蔬中含有大量叶酸及食物纤维等有益物质。叶酸在蔬菜及水果中广泛存在,具有保持DNA的稳定性,叶酸摄入不足易促进肠道息肉发生;另外,食物纤维不能被降解,使粪便量增多,稀释肠道内致癌物,促进致癌物排出体外;尚能吸附对肠道有害的胆汁酸盐,食物纤维摄入不足,不利于有害物质的排泄;

☆ 高脂饮食:高脂饮食能促进胆汁的分泌,胆汁在肠道菌丛的作用下转化成次级胆酸,该物质对结肠隐窝上皮细胞有细胞毒作用,造成不可修复的细胞DNA损伤,这些细胞逐步演变成息肉;

☆ 微量元素与维生素:钙离子可与脂质结合形成不溶性钙皂,抑制脂肪酸和胆酸,对肠道上皮起保护作用;硒可抑制细胞增殖,抑制促瘤因素的作用;抗氧化维生素可抑制自由基反应而防止DNA的氧化剂损伤,保护肠道黏膜;

☆ 肠道疾病:溃疡性结肠炎、克罗恩病等其他可导致肠道炎症的疾病,均可能引起肠道黏膜的过度增生,形成息肉;

☆ 便秘:便秘患者可使肠道内致癌物存留时间延长;另外,便秘患者多有服用市场上卖的通便药(如排毒养颜胶囊、芦荟胶囊、肠润茶等),该类药物多含有蒽醌类成分,该物质可增强细胞增殖活性,抑制细胞凋亡,还可能导致DNA变异,促进肠道息肉形成;

☆ 幽门螺旋杆菌感染:幽门螺旋杆菌促进肠道息肉形成可能育胃泌素、环氧合酶-2有关。Hp感染可促进胃泌素分泌,而胃泌素可刺激肠道黏膜增生;Hp尚可影响环氧合酶-2的高表达,通过某种途径促进肠道息肉发生;

☆ 吸烟:烟草烟雾中含有大量的致癌物质可结合DNA形成加和物,促使黏膜发生不可逆转的基因该变,促进息肉的形成;

☆ 饮酒:可能导致肠道菌群紊乱,促进亚硝胺类致癌物质合成,从而增加肠息肉发生的风险;

同样地,进食较多肉类(尤其是牛肉、羊肉之类的红肉)、腌制食物、油炸食物,高脂血症、肥胖等会增加罹患大肠息肉的风险。老年人比青年人、男性比女性更易罹患大肠息肉;

知道长胃、肠息肉的原因,那么如何预防胃、肠息肉的形成就有答案了:

★ 多吃蔬菜瓜果,适当控制肉类的摄入量,少吃腌制食物、油炸食物;少饮酒、吸烟;适当运动,控制体重;

★ 科学地治疗便秘;

★ 根除幽门螺旋杆菌;


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  2. [GetPortalCommentsPageByObjectIdResponse(id=2069913, encodeId=bfe020699136f, content=<a href='/topic/show?id=ea918328689' target=_blank style='color:#2F92EE;'>#胃肠息肉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83286, encryptionId=ea918328689, topicName=胃肠息肉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9c94141, createdName=liuquanmn, createdTime=Tue Nov 21 12:36:00 CST 2017, time=2017-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165974, encodeId=93a11659e420, content=学习了,很好的科教知识!, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57D9FE6543CB32530.jpg, createdBy=6f211949553, createdName=行好, createdTime=Tue Dec 27 07:53:35 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165939, encodeId=009f16593979, content=学习了!谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Tue Dec 27 06:22:08 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165916, encodeId=18c116591606, content=肠胃息肉,学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a3e1928208, createdName=顾小北大魔王, createdTime=Tue Dec 27 00:01:47 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165911, encodeId=34a816591116, content=这个研究感觉不是很透彻吧,个人感觉, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Mon Dec 26 23:53:21 CST 2016, time=2016-12-26, status=1, ipAttribution=)]
    2016-12-27 行好

    学习了,很好的科教知识!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2069913, encodeId=bfe020699136f, content=<a href='/topic/show?id=ea918328689' target=_blank style='color:#2F92EE;'>#胃肠息肉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83286, encryptionId=ea918328689, topicName=胃肠息肉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9c94141, createdName=liuquanmn, createdTime=Tue Nov 21 12:36:00 CST 2017, time=2017-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165974, encodeId=93a11659e420, content=学习了,很好的科教知识!, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57D9FE6543CB32530.jpg, createdBy=6f211949553, createdName=行好, createdTime=Tue Dec 27 07:53:35 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165939, encodeId=009f16593979, content=学习了!谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Tue Dec 27 06:22:08 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165916, encodeId=18c116591606, content=肠胃息肉,学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a3e1928208, createdName=顾小北大魔王, createdTime=Tue Dec 27 00:01:47 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165911, encodeId=34a816591116, content=这个研究感觉不是很透彻吧,个人感觉, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Mon Dec 26 23:53:21 CST 2016, time=2016-12-26, status=1, ipAttribution=)]
    2016-12-27 半夏微凉

    学习了!谢谢分享

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2069913, encodeId=bfe020699136f, content=<a href='/topic/show?id=ea918328689' target=_blank style='color:#2F92EE;'>#胃肠息肉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83286, encryptionId=ea918328689, topicName=胃肠息肉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9c94141, createdName=liuquanmn, createdTime=Tue Nov 21 12:36:00 CST 2017, time=2017-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165974, encodeId=93a11659e420, content=学习了,很好的科教知识!, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57D9FE6543CB32530.jpg, createdBy=6f211949553, createdName=行好, createdTime=Tue Dec 27 07:53:35 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165939, encodeId=009f16593979, content=学习了!谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Tue Dec 27 06:22:08 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165916, encodeId=18c116591606, content=肠胃息肉,学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a3e1928208, createdName=顾小北大魔王, createdTime=Tue Dec 27 00:01:47 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165911, encodeId=34a816591116, content=这个研究感觉不是很透彻吧,个人感觉, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Mon Dec 26 23:53:21 CST 2016, time=2016-12-26, status=1, ipAttribution=)]
    2016-12-27 顾小北大魔王

    肠胃息肉,学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2069913, encodeId=bfe020699136f, content=<a href='/topic/show?id=ea918328689' target=_blank style='color:#2F92EE;'>#胃肠息肉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83286, encryptionId=ea918328689, topicName=胃肠息肉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9c94141, createdName=liuquanmn, createdTime=Tue Nov 21 12:36:00 CST 2017, time=2017-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165974, encodeId=93a11659e420, content=学习了,很好的科教知识!, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57D9FE6543CB32530.jpg, createdBy=6f211949553, createdName=行好, createdTime=Tue Dec 27 07:53:35 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165939, encodeId=009f16593979, content=学习了!谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Tue Dec 27 06:22:08 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165916, encodeId=18c116591606, content=肠胃息肉,学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a3e1928208, createdName=顾小北大魔王, createdTime=Tue Dec 27 00:01:47 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165911, encodeId=34a816591116, content=这个研究感觉不是很透彻吧,个人感觉, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Mon Dec 26 23:53:21 CST 2016, time=2016-12-26, status=1, ipAttribution=)]
    2016-12-26 䖝二

    这个研究感觉不是很透彻吧,个人感觉

    0