结直肠肿瘤筛查评分对症状性人群结肠镜检查必要性的评价  

Evaluation of necessity of colonoscopy in symptomatic subjects with colorectal neoplasia screeningscore

作　　者：窦燕[1] 曹海龙[1] 许梦雀 王斯南[1] 董文逍 王邦茂[1] 

机构地区：[1]天津医科大学总医院消化科,天津300052

出　　处：《中华消化内镜杂志》2017年第5期314-317,共4页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金（81300272,81470796,81570478）

摘　　要：目的探讨结直肠肿瘤筛查评分是否适合评价症状性人群结肠镜检查的必要性。方法前瞻性收集2015年10月至2015年12月在天津医科大学总医院消化内镜中心进行常规结肠镜检查的患者资料，应用APCS及HKCS结直肠肿瘤筛查评分评估不同危险分层中结直肠肿瘤的检出情况，以评价症状性人群进行结肠镜检查的必要性。结果共815例患者进行结肠镜检查前评分，平均年龄（51．2±14．8）岁，结直肠肿瘤检出率为20．9％（170／815），进展期结直肠肿瘤为5．3％（43／815）。APCS评分分为一般危险度（AR）、中等危险度（MR）和高危险度（HR），在本组资料中分别为234例、400例和161例，各组结直肠肿瘤检出率分别为9．5％、20．0％及41．0％，进展期结直肠肿瘤分别为0％、5．5％及13．0％；HR人群结直肠肿瘤检出率为AR人群的6．7倍（95％C1：3．9-11．2）。HKCS评分分为AR和HR，在本组资料中分别为633例和182例，两组结直肠肿瘤检出率分别为16．3％和36．8％，进展期肿瘤分别为3．2％和12．6％；HR人群结直肠肿瘤检出率为AR人群的3．0倍（95％CI：2．1～4．3）。结论APCS和HKCS结直肠肿瘤筛查评分可能同样适合症状性人群进行结肠镜检查必要性的评价，对任一评分为HR的个体应及时推荐进行结肠镜检查以尽旱发现结直肠肿瘤，而对于APCS评分为AR者可暂缓结肠镜检查以节省医疗资源并避免不必要的并发症发生。Objective To evaluate necessity of colonoscopy in symptomatic subjects with colorectal neoplasia screening score. Methods Data of consecutive patients who underwent routine colonoscopy between October 2015 and December 2015 were prospectively collected. APCS score and HKCS score were used to evaluate the detection rate of colorectal tumors in groups of different risks and to predict the necessity of colonoseopy in symptomatic subjects. Results There were 815 subjects with mean age of 51.2± 14. 8 years. Colorectal neoplasia and advanced neoplasia were identified in 170 （ 20. 9% ） and 43 （ 5.3% ） cases. APCS score was classified as average risk （AR）, moderate risk（MR） and high risk（HR） ,which included 234,400 and 161 cases, respectively. The detection rates of coloreetal neoplasia in AR, MR and HR groups were 9. 5%, 20. 0% and 41. 0%, respectively, and those of advanced neoplasia were 0%, 5.5% and 13.0%, respectively. Detection rate of eolorectal neoplasia in the HR group showed 6. 7 times of that in the AR group （95%CI：3.9-11.2）. HKCS score was classified as AR and HR, which included 633 and 182 cases in the present study. The detection rates of colorectal neoplasia in these groups were 16. 3% and 36. 8%, and those of advanced neoplasia were 3.2% and 12.6%. Detection rate of co[orectal neoplasia in HR group was 3.0 times of that in AR group （95% CI： 2. 1-4. 3 ）. Conclusion APCS score and HKCS score are both suitable for evaluating the necessity of eolonoscopy in symptomatic subjects. It is necessary for HRpatients to undergo colonoscopy to detect colorectal neoplasia, however, AR patients evaluated by APCS score can delay colonoscopy to economize medical resources and avoid unnecessary complications.

关 键 词：结肠镜检查 结直肠肿瘤 筛查 症状性人群 

分 类 号：R574.62[医药卫生—消化系统]