针对高危人群结直肠癌伺机性筛查的可行性分析  

Analysis of Feasibility of Opportunistic Screening for Colorectal Cancer in High Risk Population

作　　者：鹿志军[1] 王伟强[2] 蔡欢[3] 白彬彬[1] 范占东[1] LU Zhijun WANG Weiqiang CAI Huan BAI Binbin FAN Zhandong(Department of Gastroenterology, PLA 281 Hospital, Qinhuangdao, Heibei Province （066100 Department of Gastroenterology, the 7th People＇ s Hospital of Chongqing, Chongqing Department of Internal Medicine, Hospital of Qinhuangdao Economic and Technological Development Zone, Qinhuangdao, Hebei Province)

机构地区：[1]中国人民解放军281医院消化内科,066100 [2]重庆市第七人民医院消化内科 [3]秦皇岛经济技术开发区医院内科

出　　处：《胃肠病学》2017年第7期423-425,共3页Chinese Journal of Gastroenterology

基　　金：秦皇岛市科技计划项目(201602A132)

摘　　要：背景:对结直肠癌(CRC)及其癌前病变结直肠腺瘤(CRA)的筛查是降低CRC发病率的关键。伺机性筛查是适合中国国情的CRC筛查策略,针对高危人群的伺机性筛查可能进一步缩小筛查范围,节省卫生资源。目的:分析高危因素对CRC/CRA的预测价值,探讨针对高危人群的CRC伺机性筛查的可行性。方法:1 862例于2015年2月—2016年8月在中国人民解放军281医院接受结肠镜检查的门诊患者和健康体检者纳入研究。根据最新《中国早期结直肠癌及癌前病变筛查与诊治共识意见》中高危人群的判定标准,在检查前对受检者进行问卷调查,筛选出高危人群。以结肠镜检查结果为金标准,分析高危因素对CRC/CRA的预测价值。结果:共筛选出CRC/CRA高危个体468例(25.1%),高危人群的CRC检出率显著高于非高危人群(17.5%对0.9%,P=0.000)。高危因素预测CRC的敏感性为87.2%,特异性为78.2%,阳性预测值为17.5%,阴性预测值为99.1%,漏诊率为12.8%;对于CRC/CRA,相应数据分别为83.2%、87.0%、57.3%、96.1%和16.8%。高危因素对CRC和CRC/CRA的相对危险度(RR)分别为20.35和14.78。结论:针对高危人群的CRC伺机性筛查可行性较高,适合目前我国国情。Screening of colorectal cancer （CRC） and colorectal adenoma （ CRA）, the precursor of CRC, is crucial for CRC prevention. It is believed that opportunistic screening of CRC in high risk population would narrow down the screening scope and save the health resources, and is suitable for the present status in China. Aims： To analyze the performance of high risk factors in predicting CRC/CRA, for exploring the feasibility of opportunistic screening for CRC in high risk population. Methods： A total of 1 862 outpatients and health examination subjects undergoing colonoscopy from Feb. 2015 to Aug. 2016 at the PLA 281 Hospital were recruited and asked to complete a questionnaire of high risk factors for CRC and CRA before colonoscopy. The questionnaire was designed based on the updated ＂consensus on the screening and management of early colorectal cancer and precancerous lesion in China＂. Using the results of colonoscopy as gold standard, the predictive performance of high risk factors for CRC/CRA was analyzed. Results： Four hundred and sixty- eight （25.1% ） individuals with high risk factors for CRC/CRA were screened out by the questionnaire. The detection rate of CRC in individuals with high risk factors was significantly higher than those without （ 17.5% vs. O. 9%, P = 0.000）. The sensitivity, specificity, positive and negative predictive values of high risk factors in predicting CRC were 87.2%, 78.2%, 17.5% and 99.1%, respectively, and the missed diagnosis rate was 12.8%. For CRC/CRA, the corresponding figures were 83.2%, 87.0%, 57.3%, 96.1% and 16.8%, respectively. The risk ratios （RR） of high risk factors for CRC and CRC/CRA were 20.35 and 14.78, respectively. Conclusions： Opportunistic screening of CRC in high risk population is feasible and applicable in China under present condition.

关 键 词：结直肠肿瘤 癌 腺瘤 危险因素 伺机性筛查 可行性研究 

分 类 号：R735.34[医药卫生—肿瘤]