痰隐血与胸片筛查肺癌比较研究  

Comparison of lung cancer screening methods:sputum occult blood detection versus chest X-ray

作　　者：秦德兴[1] 徐志坚[1] 孙焱 顾民[3] 陈心爱[4] 孙耘田[1] 赵华芬 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院,北京100021 [2]云南省宣威市人民医院 [3]北京大学附属首钢医院 [4]北京首都医科大学附属宣武医院 [5]来宾镇医院

出　　处：《中国肿瘤临床与康复》2009年第2期102-104,共3页Chinese Journal of Clinical Oncology and Rehabilitation

基　　金：中国初级卫生保健基金会;云南省老促会;北京首医博康医疗器械公司资助项目

摘　　要：目的比较痰隐血与X线胸片筛查肺癌效果。方法2007年1至7月在云南省宣威市来宾镇对35—70岁近3万居民（来宾镇共有人口近9万人）作肺癌首次筛查，第一阶段先作胸部X线拍片，发现肺部阴影可疑者437例，再经CT精查，175例肺内有可疑占位病变，疑诊肺癌，其中30例有手术适应证，自愿接受手术治疗；术后27例病理确诊肺癌，另3例未见癌。4个月后除X线已确诊者外，进入第二阶段痰隐血筛查共25010例，每人发给痰盒一个，早晨深咳痰，做痰隐血检测，不变色为阴性（一）。变蓝色者为阳性，当即在痰变蓝色处用竹签挑痰，涂玻璃片一张，滴纯酒精2～3滴固定标本，送细胞学检查找癌细胞。结果痰隐血阳性共2429例，列为肺癌一级高风险人群，占筛查人群的9．71％（2429／25010），其中弱阳性（＋）占66．73％（1621／2429），涂片发现癌细胞9例，癌检出率0．56％（9／1621例）；阳性（＋＋）615例，检出癌7例，癌检出率1．14％（7／615）。强阳性（＋＋＋）194例，检出癌6例，癌检出率3．09％（6／194）。痰隐血量越高肺癌检出率越高；细胞学报告上皮细胞有中度或重度不典型增生者281例，可疑癌或癌者22例，经薄层CT确诊早期肺癌者7例，这些患者先前X线片未见异常。另15例痰癌细胞阳性患者，CT未找到原发病灶，待观察。结论痰隐血与X线胸片筛查肺癌相比的优点：（1）痰隐血比X线胸片可省90％资源；（2）痰检出的肺癌多数是早中期，在胸片上看不到；（3）痰细胞不典型增生率为11．6％，提前5—10年预报癌前病变，警示肺癌高风险，X线胸片无法做到。Objective To compare between sputum occult blood detection versus X-ray for screening lung cancer. Methods From Jan 2007 to July 2007, 30 000 residents aged 35 to 70 years at Lai Bin County （a total of about 90 000 population） of Yun Nan Province in southwest China received screening for lung cancer. The residents were first examined by chest X-ray, 437 of them were found to have abnormal shadows in the lung, 175 of them were found to have suspicious lesions by the following CT scan. Thirty of the highly suspected people treated by surgery, 27 were confirmed to have lung cancer, the other 3 were not.Except the people who had abnormal shadows found by X-ray, 25010 persons received sputum occult blood test 4 months later. Everyone collected one sputum specimen by deep cough in the morning for the test, negative was defined as no color change and positive showed color change. Results A total of 2429 persons were detected as high risk people, accounting for 9.71% of the total number of the people screened. Of the occult blood positive persons, 1621 （66. 63% ） were classified as weak positive （ ＋ ） and 9 of them were found to have cancer cells by smear, so the cancer detective rate was 0. 56% ; 615 （25. 32% ） were moderate positive （ ＋ ＋ ）, and cancer detective rate was 7/615 （ 1.14% ） ; 194 （7.98%） were strong positve （ ＋ ＋ ＋ ）, and the cancer detective rate was 6/194（3.09% ）. The cancer detective rate increased with increasing positive level. Color changed sputum were selected for smear check, the smear was fixed by 100% ethanol for cytology evaluation. A total of 281 cases of moderate or heavy dysplasia, and 22 cases of cancer or suspected cancer were examined by cytology. Seven of the 22 cases with cancer or suspected cancer cells in the sputum were identified to have early stage lung cancer by CT scan, which were not detected by X-ray; but the other 15 cases were not found to have the primary lesions in the lung. Conclusion The advantages of sputum occult blood exam

关 键 词：痰隐血 肺肿瘤 筛查 

分 类 号：R734.2[医药卫生—肿瘤] R72-31[医药卫生—临床医学]