外周血SEPT9基因甲基化检测在老年结直肠癌筛查中的意义  

The significance of peripheral blood SEPT9 gene methylation in screening of colorectal cancer in a senile cohort

作　　者：康倩 李娜 金鹏 杨浪 安贺娟 盛剑秋 KANG Qian;LI Na;JIN Peng;YANG Lang;AN Hejuan;SHENG Jianqiu(Department of Gastroenterology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China)

机构地区：[1]中国人民解放军总医院第七医学中心消化内科,北京100700

出　　处：《胃肠病学和肝病学杂志》2019年第5期503-507,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：保健专项科研课题(12BJZ04)

摘　　要：目的探讨外周血SEPT9基因甲基化检测在老年结直肠癌筛查中的意义。方法筛查对象为1 407例军队退休干部体检者。IFOBT、TF、SEPT9基因甲基化检测三者任一结果为阳性,通知受试者行结肠镜检查。分别计算IFOBT、TF、IFOBT+TF(双联)、SEPT9基因甲基化检测和三者联合检测在老年结直肠癌筛查的性能指标。结果 1 407例军队退休干部体检者中1 369例体检者均进行了TF、IFOBT和SEPT9基因甲基化检测,至少1项结果为阳性者有176例(12.9%),其中96例(54.5%)接受了结肠镜检查,共检出9例结直肠癌和15例进展性腺瘤。使用IFOBT、TF、IFOBT+TF(双联)检测、SEPT9基因甲基化和三种方法联合检测对结直肠癌和进展期腺瘤的检出率分别为0.4%、0.1%、0.5%、1.2%、1.8%;SEPT9基因甲基化检测对结直肠癌和进展期腺瘤的检出率优于IFOBT+TF(双联)(1.2%vs 0.5%,P=0.04),但三者联合检出率较单纯SEPT9基因甲基化检测,差异无统计学意义(1.8%vs 1.2%,P=0.27),对筛查对象进行性别和年龄分层分析显示,各项检测指标男女差别不大,但SEPT9基因甲基化检测在70岁以上患者中筛查优势明显。结论 SEPT9基因甲基化是一种简单无创的结直肠癌筛查新技术,单独使用对结直肠癌和腺瘤的检出率显著高于IFOBT和TF联合检测,因此SEPT9基因甲基化检测可作为老年人结直肠癌早期筛查的首选策略。Objective To investigate the significance of peripheral blood SEPT9 gene methylation test in screening of colorectal cancer in a senile cohort. Methods A senile cohort of 1 407 cases of retired military cadres was enrolled in the study. Colonoscopy was performed for individuals whose examination was positive of SEPT9, TF or IFOBT. Performance for SEPT9, IFOBT, IFOBT+TF (parallel), combination of the 3 methods were calculated and assessed respectively. Results There were 1 369 of 1 407 retired military cadres who had been tested by TF, IFOBT and SEPT9 gene methylation test, and there were 176 cases (12.9%) with positive examination for at least one examination. Colonoscopy was performed in 96 of the 176 individuals, 9 colorectal cancers and 15 advanced adenomas were detected. The detection rates of colorectal cancer and advanced adenoma were 0.4%, 0.1%, 0.5%, 1.2% and 1.8% by IFOBT , TF, IFOBT+TF (parallel), SEPT9 gene methylation test and combined detection rate of the 3 methods, respectively . SEPT9 gene methylation test had higher detection rate of colorectal cancer and advanced adenomas compared with IFOBT+TF (parallel)(1.2% vs 0.5%, P =0.04), but the combined detection rate of the 3 methods detection was not obviously better than SEPT9 gene methylation test (1.8% vs 1.2%, P =0.27). Stratified screening object by sex and age showed little difference between men and women, but SEPT9 gene methylation test showed better proformance in screening subjects older than 70 years old. Conclusion SEPT9 gene methylation is a simple and non-invasive new screening technology for colorectal cancer, meanwhile the detection rate of colorectal cancer and adenoma can be significantly higher than that of IFOBT+TF. Therefore, SEPT9 gene methylation test can be used as the preferred strategy of colorectal cancer screening in the elderly.

关 键 词：SEPT9基因 转铁蛋白 粪隐血试验 结直肠癌 进展期腺瘤 筛查 

分 类 号：R735.3[医药卫生—肿瘤]