高危因素量化问卷与亚太结直肠癌筛查评分及分别联合粪便免疫化学检测在进展期结直肠肿瘤筛查中效果的比较  

Efficacy comparison among high risk factors questionnaire and Asia-Pacific colorectal screening score and their combinations with fecal immunochemical test in screening advanced colorectal tumor

作　　者：朱柠 黄彦钦[1] 宋永茂[3] 张苏展[1] 郑树[1] 袁瑛[1,2] Ning Zhu;Yanqin Huang;Yongmao Song;Suzhan Zhang;Shu Zheng;Ying Yuan(Cancer Institute,Key Laboratory of Cancer Prevention and Intervention,Ministry of Education,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Medical Oncology,Key Labaratory of Cancer Prevention and Intervention,Ministry of Education,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Colorectal Surgery and oncology,Key Laboratory of Cancer Prevention and Intervention,Ministry of Education,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院肿瘤研究所(恶性肿瘤预警与干预教育部重点实验室),杭州310009 [2]浙江大学医学院附属第二医院肿瘤内科(恶性肿瘤预警与干预教育部重点实验室),杭州310009 [3]浙江大学医学院附属第二医院大肠外科(恶性肿瘤预警与干预教育部重点实验室),杭州310009

出　　处：《中华胃肠外科杂志》2022年第7期612-620,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点研发计划(2016YFC1302803)。

摘　　要：目的评价高危因素量化问卷(HRFQ)与亚太结直肠癌筛查评分(APCS)及分别联合粪便免疫化学检测(FIT)在进展期结直肠肿瘤筛查中的效果,为结直肠肿瘤早筛方法的优化提供依据。方法采用回顾性队列研究的方法,总结分析2017年3月至2018年7月间在浙江嘉善县对40~74岁户籍人口进行结直肠肿瘤筛查的结果。排除合并严重疾患以致不适合行结肠镜检查者以及精神、行为异常不能配合筛查者。符合HRFQ问卷以下任何一项或以上者,列为HRFQ高危人群:(1)一级亲属有结直肠癌史;(2)本人有癌症史(任何恶性肿瘤病史);(3)本人有肠道息肉史;(4)同时具有以下两项及两项以上者:慢性便秘(近两年来便秘每年在2个月以上);慢性腹泻(近两年来腹泻累计持续超过3个月,每次发作持续时间在1周以上);黏液血便;不良生活事件史(发生在近20年内,并在事件发生后对调查对象造成较大精神创伤或痛苦);慢性阑尾炎或阑尾切除史;慢性胆道疾病史或胆囊切除史。本研究中,将HRFQ评估为高危者记为“HRFQ(+)”,非高危者记为“HRFQ(-)”。APCS问卷根据年龄、性别、家族史和吸烟4项危险因素进行风险评分:(1)年龄:50~69岁为2分,70岁及以上为3分;(2)性别:男性为1分,女性为0分;(3)家族史:一级亲属患结直肠癌2分;(4)吸烟:当前或过去吸烟1分,不吸烟0分。将人群分为低危(0~1分)、中危(2~3分)、高危(4~7分)。将APCS评估为高危者记为“APCS(+)”,中、低危者记为“APCS(-)”。粪便免疫化学检测(FIT)阳性的血红蛋白阈值设定为100μg/L。将APCS评估为高危者且FIT阳性记为“APCS+FIT(+)”,将APCS评估为高危者且FIT阴性、APCS评估为中低危者且FIT为阳性和APCS评估为中低位者且FIT为阴性记为“APCS+FIT(-)”。观察指标包括:(1)队列人群筛查顺应率及进展期结直肠肿瘤检出情况;(2)HRFQ与APCS及其联合FIT筛检进展期结直肠肿瘤的阳性预测值、阴�Objective To investigate the effects of high risk factors questionnaire(HRFQ),Asia-Pacific colorectal screening(APCS)score and their combinations with fecal immunochemical test(FIT)in screening advanced colorectal neoplasia,in order to provide an evidence for further optimization of cancer screening program.Methods A retrospective cohort study method was used to summarize and analyze the results of colorectal tumor screening in Jiashan County,Zhejiang Province from March 2017 to July 2018.Those with severe diseases that were not suitable for colonoscopy and those with mental and behavioral abnormalities who can not cooperate with the screening were excluded.Those who met any one or more of the followings in the HRFQ questionnaire were classified as high-risk people of HRFQ:(1)first-degree relatives with a history of colorectal cancer;(2)subjects with a history of cancer or any other malignant tumor;(3)subjects with a history of intestinal polyps;(4)those with two or more of the followings:chronic constipation(constipation lasted for more than 2 months per year in the past two years),chronic diarrhea(diarrhea lasted for more than 3 months in the past two years,and the duration of each episode was more than one week),mucus and bloody stools,history of adverse life events(occurring within the past 20 years and causing greater trauma or distress to the subject after the event),history of chronic appendicitis or appendectomy,history of chronic biliary disease or cholecystectomy.In this study,those who were assessed as high risk by HRFQ were recorded as"HRFQ(+)",and those who were not at high risk were recorded as"HRFQ(-)".The APCS questionnaire provided risk scores based on 4 risk factors including age,gender,family history and smoking:(1)age:2 points for 50-69 years old,3 points for 70 years old and above;(2)gender:1 point for male,0 point for women;(3)family history:2 points for first-degree relatives suffering from colorectal cancer;(4)smoking:1 point for current or past smoking,0 point for non-smokers.The populati

关 键 词：结直肠癌 进展期 结直肠腺瘤 进展期 筛查 高危因素量化问卷 亚太结直肠癌筛查评分 粪便免疫化学检测 检出率 

分 类 号：R735.34[医药卫生—肿瘤]