海报库PosterKeep
PO.PS01.09 · 人群科学

2型糖尿病、药物与多发性结直肠息肉风险：一项使用自然语言处理的基于结肠镜检查的研究

Type-2 Diabetes, medications, and risk of multiple colorectal polyps: A colonoscopy-based study using natural language processing

编号 7603 展板 23 时间 4/22 09:00–12:00 区域 Section 35 主讲 Jessica van Onselen, BS;MS
分会场 Risk Prediction Modeling, Screening, Early Detection, and Preneoplastic and Tumor Markers
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作者与单位 Authors & Affiliations

Jessica van Onselen1, Ryzen Benson2, Stephanie Richardson3, Maci Winn1, Candace Winterton3, Svenja Pauleck3, Ainhoa Gomez-Lumbreras3, Polly A. Newcomb4, Cornelia M. Ulrich1, John Inadomi5, Sheetal Hardikar1

1University of Utah Huntsman Cancer Institute, Salt Lake City, UT,2Department of Radiation Oncology, University of California, San Fransico, San Francisco, CA,3Huntsman Cancer Institute, Salt Lake City, UT,4Fred Hutchinson Cancer Center, Seattle, WA,5Department of Internal Medicine, University of Utah, Salt Lake City, UT

摘要 Abstract

中文摘要
引言：结直肠息肉是已知的结直肠癌（CRC）前体，息肉数量较多与CRC风险增加相关。本研究旨在探讨2型糖尿病（T2D）及其治疗对息肉数量的影响。 方法：我们利用犹他大学（UofU）企业数据仓库（EDW）中的病理报告，开发了一个基于规则的自然语言处理流程，从2011—2020年间在UofU胃肠病学诊所接受结肠镜检查的38,038名患者中提取息肉诊断及特征（部位、数量）。我们通过ICD编码和抗糖尿病药物处方识别出6,556名T2D患者。从EDW提取患者特征，包括年龄、性别、种族、吸烟、BMI、抗炎药物使用，以及胰岛素、二甲双胍、磺脲类、GLP-1激动剂和DPP-4抑制剂的活跃处方。息肉数量分为无、一个或多个。采用多项logistic回归计算息肉数量的校正比值比（OR）和95%置信区间（CI）。 结果：患者平均年龄56岁，84%为白人，51%为女性，平均BMI为30 kg/m²。73%的T2D患者使用抗糖尿病药物。单纯T2D与多发性息肉无关联，但服用抗糖尿病药物的T2D患者总体上息肉风险较低，无论息肉数量如何。与其他药物相比，胰岛素使用与一个或多个息肉风险增加相关[OR(95%CI)分别为1.29(1.08—1.54)和1.40(1.18—1.66)]。与服用二甲双胍或GLP-1激动剂以外药物的患者相比，二甲双胍和GLP-1激动剂均与一个[二甲双胍OR(95% CI)=0.71(0.59—0.85)，GLP-1=0.79(0.64—0.99)]或多个息肉[二甲双胍OR(95% CI)=0.71(0.52—0.73)，GLP-1=0.63(0.51—0.77)]风险降低相关。与不服用任何抗糖尿病药物的患者相比，服用胰岛素、二甲双胍、DPP-4抑制剂或磺脲类药物的患者至少有一个息肉的风险增加，而服用GLP-1激动剂的患者多发性息肉风险较低[OR(95%CI)=0.81(0.63—1.03)]。DPP-4抑制剂和磺脲类药物的多发性息肉风险也较低[OR(95%CI)分别为0.79(0.64—0.97)和0.80(0.68，0.96)]。 结论：总体而言，单纯T2D与息肉数量无关联，但药物使用改变了这一关系。与服用其他抗糖尿病药物的患者相比，胰岛素使用与风险增加相关，而二甲双胍、GLP-1激动剂、DPP-4抑制剂和磺脲类药物的使用与一个或多个息肉风险降低相关。这些结果凸显了T2D药物选择在改变结直肠息肉风险方面的潜在作用，强调需要更多研究其潜在机制以指导可能的干预措施。
查看英文原文 English abstract
Introduction : Colorectal polyps are known precursors to colorectal cancer (CRC), and a higher polyp count is associated with an increased CRC risk. This study aimed to investigate the impact of type-2 diabetes (T2D) and its treatments on polyp count. Methods: We leveraged pathology reports from the University of Utah (UofU) Enterprise Data Warehouse (EDW) to develop a rule-based natural language processing pipeline, to extract polyp diagnoses and features (site, count) for 38,038 patients who underwent colonoscopy at the UofU Gastroenterology clinic from 2011-2020. We identified 6,556 patients with T2D via ICD codes and anti-diabetes medication prescriptions. Patient characteristics were extracted from the EDW, including age, sex, race, smoking, BMI, anti-inflammatory medication use, and active prescriptions for insulin, metformin, sulfonylureas, GLP-1 agonists, and DPP-4 inhibitors. Polyp count was categorized as none, one, or multiple. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for polyp counts were calculated using multinomial logistic regression. Results: Patients were on average 56 years old, 84% White, 51% female, with a mean BMI of 30 kg/m 2 . 73% of patients with T2D used anti-diabetes medications. T2D alone was not associated with multiple polyps, but patients with T2D taking anti-diabetes medications had a lower risk of polyps overall, irrespective of polyp count. Insulin use was associated with an increased risk of one or multiple polyps [OR(95%CI)=1.29(1.08-1.54) and 1.40(1.18-1.66), respectively], compared to other medications. Metformin and GLP-1 agonists were both associated with a decreased risk of one [Metformin OR(95% CI)=0.71(0.59-0.85), GLP-1=0.79(0.64-0.99)] or multiple polyps [Metformin OR(95% CI)=0.71(0.52-0.73), GLP-1=0.63(0.51-0.77)], compared to patients taking medications other than metformin or GLP-1 agonists, respectively. Compared to patients taking no anti-diabetes medications, those on insulin, metformin, DPP-4 inhibitors, or sulfonylureas had an increased risk of at least one polyp, while patients taking GLP-1 agonists had a lower risk of multiple polyps [OR(95%CI)=0.81(0.63-1.03)]. DPP-4 inhibitors and sulfonylureas also had a lower risk of multiple polyps [OR(95%CI)=0.79(0.64-0.97) and 0.80(0.68, 0.96), respectively]. Conclusion: Overall, T2D alone was not associated with polyp count, but medication use modified this relationship. Insulin use was associated with increased risk, whereas the use of metformin, GLP-1 agonists, DPP-4 inhibitors, and sulfonylureas was associated with decreased risk of one or multiple polyps, compared to patients taking other anti-diabetes medications. These results highlight the potential role of T2D medication choice in altering colorectal polyp risk, underscoring the need for more research into underlying mechanisms to guide potential interventions.
利益披露 Disclosure
J. van Onselen, None.. R. Benson, None.. S. Richardson, None.. M. Winn, None.. C. Winterton, None.. S. Pauleck, None.. A. Gomez-Lumbreras, None.. P. A. Newcomb, None.. J. Inadomi, None.

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