无症状人群大肠肿瘤发生风险评分系统的构建及验证  

Structure and validation of a clinical scoring system to predict the risks of colorectal neoplasms

作　　者：张琴[1] 崔梅花[1] 马文彬[1] 杨成[1] ZHANG Qin, CUI Meihua, MA Wenbin, YANG Cheng(Department of Gastroenterology, Aerospace Center Hospital, Beijing 100049, Chin)

机构地区：[1]航天中心医院北京大学航天临床医学院消化科,北京100049

出　　处：《胃肠病学和肝病学杂志》2018年第3期245-250,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：航天科工集团公司医疗卫生科研项目(2015-LCYL-005)

摘　　要：目的构建并验证一种临床评分系统预测大肠肿瘤发生的风险,指导受试者选择有效的检查方法。方法回顾性研究航天中心医院2011-2015年行结肠镜体检的无症状患者(构建组)的临床资料,运用Logistic回归分析影响大肠肿瘤发生的独立危险因素,制定相应的评分系统,并在2016-2017年行结肠镜体检的无症状患者(验证组)中采用上述已构建的风险评分系统对其预测大肠肿瘤发生的价值进行评估。结果多因素Logistic回归分析显示,性别、年龄、体质量指数(BMI)、吸烟史、糖尿病史是大肠肿瘤的独立危险因素。ROC曲线下面积为0.783,根据分值将0~2分定义为平均风险(AR),将≥3分定义为高风险(HR)。建立的大肠肿瘤风险评分系统在构建组中的敏感度为76.1%,特异度为69.9%。在验证组中,平均风险组及高风险组的腺瘤检出率分别为15.8%、20.9%;在验证组中评分系统的敏感度为56.3%,特异度为52.2%。结论性别、年龄、BMI、吸烟史、糖尿病史是大肠肿瘤的独立危险因素。根据以上危险因素建立的评分系统对于无症状人群大肠肿瘤发生风险的预测准确度较高,对大肠肿瘤的发生风险有一定的诊断价值。Objective To construct and validate a clinical scoring system to predict the risks of colorectal neoplasms in asymptomatic groups and to guide the subjects to choose an effective method for examination. Methods The clinical data of asymptomatic screening participants（ derivation cohort） who underwent colonoscopy from 2011 to 2015 were reviewed retrospectively and the independent influencing factors of colorectal neoplasms were evaluated,the scoring system was formulated,the other screening participants enrolled from 2016 to 2017 for screening colonoscopy as the validation cohort. Results Gender,age,history of smoking,body mass index（ BMI） and diabetes were identified as independent predictive factors with Logistic regression analysis. The area under curve was 0. 783. According to the scoring system,0-2 were classified as average risk（ AR） and 3-6 as the high risk（ HR）. In the derivation cohort,the sensitivity and specificity of this model were 76. 1% and 69. 9%,respectively,while in the validation cohort,the sensitivity and specificity were 56. 3% and 52. 2%,respectively. Conclusion Gender,age,history of smoking,BMI and diabetes are independent predictive factors. The forecasting tool has relatively high diagnostic and predictive efficiency to predict the risks of colorectal neoplasms in asymptomatic groups. There is significant for the colorectal neoplasms screening.

关 键 词：大肠肿瘤 无症状人群 筛查 评分系统 

分 类 号：R735.34[医药卫生—肿瘤]