粪便SDC2基因甲基化检测在广州市增城区居民结直肠癌筛查的应用研究  

Study on the application value of fecal SDC2 gene methylation detection in colorectal cancer screening of urban residents in Zengcheng District in Guangzhou City

作　　者：何滟 徐方芳 左海军 陈伟 刘志彬 刘泽帮 陈雪珍 惠庆申 邹耿文 蔡榛彬 刘扬 谭浩顺 周宏锋 汪建平[7] He Yan;Xu Fangfang;Zuo Haijun;Chen Wei;Liu Zhibin;Liu Zebang;Chen Xuezhen;Hui Qingshen;Zou Gengwen;Cai Zhenbin;Liu Yang;Tan Haoshun;Zhou Hongfeng;Wang Jianping(Department of Colorectal Anal Surgery,Foresea Life Insurance Guangzhou General Hospital,Guangzhou 511330,China;Health Management Centre,Foresea Life Insurance Guangzhou General Hospital,Guangzhou 511330,China;Endoscopy Center,Foresea Life Insurance Guangzhou General Hospital,Guangzhou 511330,China;People′s Government of Shitan Town,Zengcheng District,Guangzhou 511330,China;Public Health Committee Office of Shitan Town,Zengcheng District,Guangzhou 511330,China;Department of Oncology,China Medical University,Shenyang 110001,China;Department of Colorectal Surgery,The Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]前海人寿广州总医院结直肠肛门外科,广州511330 [2]前海人寿广州总医院健康管理中心,广州511330 [3]前海人寿广州总医院内镜中心,广州511330 [4]广州市增城区石滩镇人民政府,广州511330 [5]广州市增城区石滩镇公共卫生委员会办公室,广州511330 [6]中国医科大学肿瘤科,沈阳110001 [7]中山大学附属第六医院结直肠外科,广州510630

出　　处：《中华预防医学杂志》2024年第7期1020-1028,共9页Chinese Journal of Preventive Medicine

基　　金：广东省卫济医学发展基金项目(K-202207-2)。

摘　　要：目的探讨粪便黏结蛋白聚糖2(Syndecan-2,SDC2)基因甲基化(methylatedSDC2,mSDC2)检测在广州市城镇地区居民结直肠癌筛查的应用。方法采用横断面研究方法,于2022年7—12月期间,针对广州市增城区石滩镇40~74岁常住居民展开结直肠癌社区筛查。筛查人群直接进行粪便mSDC2检测,对初筛阳性者建议其接受肠镜复查,对肠镜异常者建议接受进一步治疗。观察mSDC2检测初筛的阳性率、肠镜依从率、肠道病变检出率及其临床病理特征;同时探究mSDC2检测的CT值与肠道病变恶性程度的预测关系,评估筛查成本效益。结果共计发放粪便采集装置8877份,实际回收粪便样本8189份,样本回收率92.25%,合格样本8048份,样本合格率98.28%。筛查对象中,男性3182例(39.54%),女性4866例(60.46%),年龄范围为40~74岁、平均年龄56岁。mSDC2初筛阳性率7.99%(643/8048),肠镜依从率73.10%(470/643),470例完成肠镜检查的居民中,通过病理诊断发现结直肠癌20例(4.25%),进展期腺瘤109例(23.19%),非进展期腺瘤145例(30.85%),息肉79例(16.81%),整体肠道病变检出353例,肠道病变检出率75.11%。肠道病变检出率在男性中高于女性(χ^(2)=19.200,P<0.001),各年龄组间肠道病变检出率具有明显差异,且与年龄增长呈正相关(χ^(2)=18.200,P<0.001)。检出的20例结直肠癌术后病理分期为0~Ⅰ期15例,Ⅱ~Ⅲ期4例,未知分期1例。mSDC2检测结果CT值与进展期肿瘤的比例呈负相关,差异具有统计学意义(χ^(2)=16.063,P<0.001)。本次筛查总成本433.95万元,筛查效益2850.62万元,效益成本比6.57。结论粪便mSDC2检测初筛结合肠镜精筛的结直肠癌筛查模式,具有较高的肠镜依从性和肠道病变检出率,有利于发现早期结直肠癌,具有良好的成本经济效益。粪便mSDC2检测CT值与肠道肿瘤的恶性程度可能具有相关性。Objective To investigate the application value of fecal Syndecan-2(SDC2)gene methylated SDC2(mSDC2)detection in colorectal cancer(CRC)screening among urban residents in Guangzhou City.Methods A cross-sectional study was conducted in Shitan Town,Zengcheng District,Guangzhou City from July to December 2022.A community-based screening program for CRC was conducted among residents aged 40-74 years old.mSDC2 detection was employed in the participants,and those with positive results should be recommended to receive colonoscopy examination.The positive rate of mSDC2 detection,colonoscopy compliance rate,detection rate of intestinal lesions and clinicopathological characteristics were observed.The relationship between cycle threshold(CT)value of mSDC2 and intestinal lesions was explored.Further,the cost-effectiveness of screening was evaluated.Results A total of 8189 fecal samples were collected from 8877 participants with the recovery rate of 92.25%.8048 qualified samples were enrolled in this study,consisted of 3182 males(39.54%)and 4866 females(60.46%),with the average age of 56 years old(40-74 years).The positive rate of mSDC2 detection was 7.99%(643/8048),and the compliance rate of colonoscopy was 73.10%(470/643).20 cases(4.25%)of colorectal cancer,109 cases(23.19%)of advanced adenoma,145 cases(30.85%)of non-advanced adenoma,79 cases(16.81%)of polyps were detected.The detection rate of intestinal lesions was 75.11%and indicated significant differences in gender and age.20 CRCs included 15 of stage 0-I,4 of stageⅡ-Ⅲand 1 of unknown stage.The CT value of mSDC2 was negatively correlated with the proportion of advanced colorectal neoplasms(χ^(2)=16.063,P<0.001).The total cost of the screening was 4.3395 million yuan,the screening benefit was 28.5062 million yuan,and the benefit-cost ratio was 6.57.Conclusion The CRC screening strategy of fecal mSDC2 detection combined with colonoscopy has high colonoscopy compliance and detection rate of intestinal lesions,which is conducive to the detection of early CRCs,and has g

关 键 词：结直肠癌筛查 粪便SDC2基因甲基化 成本-效益分析 

分 类 号：R735.34[医药卫生—肿瘤]