定量粪便隐血试验在体检人群结直肠癌筛查中的应用  

Application of quantitative FIT for primary colorectal cancer screening of a health check-up population in Suzhou City

作　　者：刘丹[1] 严苏[1] 张代义[1] 马文霞[2] 赵玲美 Liu Dan;Yan Su;Zhang Daiyi;Ma Wenxia;Zhao Lingmei(Health Management Center,the First Affiliated Hospital of Soochow University,Suzhou 215000,China;Quality Management Dept,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]江苏省苏州市苏州大学附属第一医院健康管理中心,苏州215000 [2]江苏省苏州市苏州大学附属第一医院质量管理处,苏州215000

出　　处：《中华健康管理学杂志》2021年第2期158-162,共5页Chinese Journal of Health Management

摘　　要：目的探讨定量免疫化学法粪便隐血试验(FIT)在健康体检人群结直肠癌筛查中的价值。方法选取2018年1月至2019年12月在苏州大学附属第一医院选择定量FIT+电子结肠镜检查项目的468例健康体检者为研究对象,根据定量FIT结果,分为阴性组(FIT<100μg/L)和阳性组(FIT≥100μg/L)。分析比较两组人群的结直肠息肉检出率及结直肠进展性肿瘤检出率,计算分析定量FIT对结直肠进展性肿瘤检测的灵敏度、特异度。同时分析结直肠息肉发生的危险因素。结果健康体检人群的定量FIT的阳性率为4.6%(95%CI:4.27%~4.93%)。与定量FIT阴性组比较,定量FIT阳性组结直肠息肉检出率明显高于阴性组(51.53%,95%CI:45.81%~57.25%比34.28%,95%CI:27.25%~41.31%,P<0.001)。定量FIT检测结直肠进展性肿瘤的灵敏度为98.55%,特异度为56.77%,阳性预测价值为50.37%,阴性预测价值为98.88%;随着定量FIT数值上升,进展性肿瘤检出率呈上升趋势(χ^(2)=20.08,P<0.001)。结直肠息肉多因素Logistic回归结果提示:既往有糖尿病病史患者发生结直肠息肉的风险明显升高(OR=3.28,95%CI:1.45~7.41);男性发生结直肠息肉的风险明显增高(OR=3.05,95%CI:1.40~6.65)。结论定量FIT是健康体检人群结直肠癌初筛的理想非侵入性检查;糖尿病病史,男性,年龄为结直肠息肉发生的独立危险因素。Objective To explore the value of the quantitative fecal immunochemical test(FIT)for primary colorectal cancer screening in health check-up population.Methods A total of 468 health check-up participants who underwent quantitative FIT and colonoscopy at the First Affiliated Hospital of Soochow University from January 2018 to December 2019 were enrolled into this study.The participants were divided into two groups-the negative group(FIT<100μg/L)and the positive group(FIT≥100μg/L)according to the results of the quantitative FIT.We compared the detection rate of colorectal polyps and colorectal advanced cancer between the two groups,and analyzed the sensitivity and specificity of the quantitative FIT for advanced colorectal cancer and the risk factors of colorectal polyps.Results The positive rate of quantitative FIT in the healthy population was about 4.6%(95%CI:4.27%-4.93%).The detection rate of colorectal polyps in the positive group was significantly higher than that of the negative group(51.53%,95%CI:45.81%-57.25%)vs(34.28%,95%CI:27.25%-41.31%,P<0.001).The sensitivity and specificity of the quantitative FIT for advanced colorectal cancer was 98.55%and 56.77%,respectively.The positive predictive value of the quantitative FIT for advanced colorectal cancer was 50.37%,while the negative predictive value was 98.88%.With the increase of FIT value,the detection rate of advanced cancer was increased(χ^(2)=20.08,P<0.001).The multivariate logistic regression of colorectal cancer suggested that the risk of colorectal polyps in patients with a history of diabetes was significantly higher(OR=3.28,95%CI:1.45-7.41,P=0.004);the risk of colorectal polyps in men was also significantly higher(OR=3.05,95%CI:1.40-6.65,P=0.005).Conclusions Quantitative FIT is an ideal non-invasive examination for primary colorectal cancer screening for a health check-up population.Patients with negative FIT are less likely to develop colorectal cancer.Diabetes history,male,and age are independent risk factors for colorectal cancer.

关 键 词：免疫化学法粪便隐血试验 结直肠癌筛查 体格检查 

分 类 号：R735.34[医药卫生—肿瘤]