2019-2021年厦门市社区结直肠癌早期筛查结果分析  

Analysis of early screening results of colorectal cancer in Xiamen communities from 2019 to 2021

作　　者：施华秀[1] 曾青泉 施珊珍 冯佳兴 林玉妹 陈建民[1] SHI Huaxiu;ZENG Qingquan;SHI Shanzhen;FENG Jiaxing;LIN Yumei;CHEN Jianmin(Department of Gastroenterology,Zhongshan Hospital Af filiated to Xiamen University,Xiamen 3610o0,China;Deparment of Cardiovascular Medicine,The First Af filiated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]厦门大学附属中山医院消化内科,福建厦门361000 [2]温州医科大学附属第一医院心血管内科,浙江温州325000

出　　处：《社区医学杂志》2023年第11期545-550,共6页Journal Of Community Medicine

基　　金：厦门市慢性胃肠病防治中心经费(厦卫疾控[2016]600号)。

摘　　要：目的 了解厦门市结直肠癌高危人群2019-2021年的结直肠病变情况,为优化结直肠癌筛查策略提供参考依据。方法 选取2019-01-01-2021-12-31厦门市15家社区的本市户籍居民和本市居住时间>6个月的非本市户籍居民为研究对象。采用风险评估问卷及免疫化学法粪便潜血试验(FIT)对其进行筛查,初筛出高危人群,高危患者行结肠镜筛查和病理组织学确诊,根据结肠镜和病理检查对结果进行分析。采用χ^(2)检验、logistic回归模型进行统计学分析。结果 92 270名筛查对象,共评估出结直肠癌高危人群5 716人,其中完成肠镜检查者425人,肠镜检查依从率为7.44%。FIT初筛阳性者886人,风险度评估表阳性者4 602人,两者均阳性者228人。不同初筛方法阳性率比较,风险度评估表阳性率为5.23%,高于FIT的1.21%,差异有统计学意义,χ^(2)=527.407,P=0.001。不同年龄间初筛阳性率差异有统计学意义,χ^(2)=42.290,P=0.001;且在40~75岁年龄段中,随着年龄的增长初筛阳性率呈上升趋势。男性、女性初筛阳性率分别为6.32%、6.09%,差异无统计学意义,χ^(2)=2.035,P=0.154。未婚/丧偶/离婚/未知者的初筛阳性率为8.23%,高于已婚者的6.11%,χ^(2)=26.854,P<0.001。不同文化程度间初筛阳性率差异有统计学意义,χ^(2)=218.207,P<0.001。logistic回归分析结果显示,年龄(OR=1.362,95%CI为1.320~1.406,P<0.001)、婚姻状况(OR=1.312,95%CI为1.161~1.482,P<0.001)、文化程度(OR=1.327,95%CI为1.286~1.370,P<0.001)对初筛阳性率有影响。初筛阳性者中共有425人完善结肠镜检查,其中有病变者312例。男性总病变检出率为45.17%,高于女性的28.24%,χ^(2)=14.510,P=0.001。对不同年龄组分析发现,随着年龄的增长(≤75岁)病变检出率呈增长趋势,χ^(2)=12.861,P=0.011。结论 FIT联合风险度评估表对结直肠癌筛查具有重要意义,但厦门市2019-2021年初筛阳性居民肠镜检查顺应性较差,在今后的筛查工作中应加强Objective To investigate the status of colorectal lesions in the high-risk population of colorectal cancer in Xiamen from 2019to 2021,and to provide a reference for optimizing the colorectal cancer screening strategy.Methods Residents with registered residence in this city and non-registered residence residents who have lived in this city for more than6months were selected from 15communities in Xiamen from January 1,2019 to December 31,2021.Risk assessment questionnaire and fecal immunochemical test(FIT)were used to screen out the high-risk groups initially.Colonoscopy and histopathology were used to confirm the diagnosis,and then the results were analyzed according to colonoscopy and pathological examination.Statistical analysis usingχ^(2)-test and logistic regression model.Results Among 92 270subjects,a total of5 716high-risk populations of colorectal cancer were evaluated,and 425of them completed colonoscopy,with a compliance rate of 7.44%,886were positive in FIT initial screening,4 602were positive in risk assessment form,and 228were positive in both.Comparing the positive rates of different primary screening methods,the positive rate of the risk assessment form was 5.23%,higher than 1.21%of FIT,with a statistically significant difference(χ^(2)=527.407,P=0.001).There were significant differences in the positive rate of primary screening among different ages(χ^(2)=42.290,P=0.001),and the positive rate of primary screening showed an increasing trend with the increase of age in the age group of 40-75years old.There was no significant difference between sex(6.32%vs 6.09%,χ^(2)=2.035,P=0.154).The positive rate of primary screening was higher in unmarried/widowed/divorced/uninformed people than in married people(8.23%vs 6.11%,χ^(2)=26.854,P<0.001).There was a statistically significant difference in the positive rate of primary screening among different educational levels,χ^(2)=218.207,P<0.001.Logistic regression analysis showed that age(OR=1.362,95%CI:1.320-1.406,P<0.001),marital status(OR=1.312,95%CI:1.161-1

关 键 词：结直肠癌 筛查方法 检出率 厦门市 

分 类 号：R735.3[医药卫生—肿瘤]