粪便免疫化学检测联合粪菌标志物M3基因检测在结直肠癌中的筛检效能  

Screening efficiency of fecal immunochemical testing combined with fecal bacterial marker M3 gene detection in colorectal cancer

作　　者：胥俊越 赵亚虹 张莎娜 李奕 贾淑静 王志华 郭为为 蔡月 吴晓红 XU Jun-yue;ZHAO Ya-hong;ZHANG Sha-na(Electric Power Teaching Hospital,Capital Medical University,Beijing 100073,China)

机构地区：[1]首都医科大学电力教学医院,北京100073

出　　处：《临床和实验医学杂志》2024年第19期2114-2118,共5页Journal of Clinical and Experimental Medicine

基　　金：国中康健科技项目(编号:SGTYHT/21-JS-223);首都卫生发展科研项目(编号:2022-2G-40210)。

摘　　要：目的研究粪便免疫化学检测(FIT)联合粪菌标志物M3基因检测在结直肠癌中的筛检效能。方法纳入2021年1月至2023年6月在首都医科大学电力教学医院消化内科或门诊就诊的145例患者,收集其粪便标本,根据诊断结果将患者分为结直肠癌组45例,腺瘤组40例,良性病变组30例,对照组30例。收集入组对象的临床资料,实验室、影像学检查结果以及肝功能、肾功能、血糖、血脂等生化指标水平。采用实时荧光定量聚合酶链式反应(qRT-PCR)法检测粪便M3基因表达量,FIT检测粪便潜血,比较4组研究对象的M3基因表达量和FIT检测值。采用受试者操作特征(ROC)曲线评估FIT、M3基因及两者联合检测对结直肠癌及腺瘤的诊断价值。结果对照组、良性病变组、腺瘤组和结直肠癌组在年龄、血小板计数(PLT)、白蛋白和多种肿瘤标志物上比较,差异均有统计学意义(P<0.05),特别是结直肠癌组的肿瘤标志物的数值最高。对照组、良性病变组、腺瘤组和结直肠癌组在M3基因表达量和FIT检测值方面比较,差异均有统计学意义(P<0.05);腺瘤组和结直肠癌组的M3基因表达量和FIT检测值均显著高于对照组和良性病变组,差异均有统计学意义(P<0.05),其中以结直肠癌组最高。在诊断腺瘤方面:FIT检测的曲线下面积(AUC)为0.679(95%CI:0.556~0.803,P=0.011)。M3基因检测的AUC为0.880(95%CI:0.800~0.961,P<0.001)。两者联合检测的AUC最高,达到0.918(95%CI:0.855~0.982,P<0.001)。在诊断结直肠癌方面:FIT检测的AUC为0.706(95%CI:0.590~0.822,P=0.003)。M3基因检测的AUC为0.788(P<0.001,95%CI:0.680~0.895)。联合检测的AUC最高,达到0.845(95%CI:0.749~0.940,P<0.001)。结论FIT检测和M3基因检测筛检腺瘤和结直肠癌具有较好的效能,且两者联合检测的诊断效能更高,有助于早期结直肠癌和癌前病变的临床筛查及指导干预治疗,对改善患者预后有积极作用。Objective To study the screening efficiency of fecal immunochemical testing(FIT)combined with fecal bacterial marker M3 gene testing in colorectal cancer.Methods Clinical data and fecal samples were collected from 145 patients who visited the Department of Gastroenterology or Outpatient Clinic of Electric Power Teaching Hospital,Capital Medical University from January 2021 to June 2023.Stool specimens were collected and patients were divided into the colorectal cancer group(45 cases),the adenoma group(40 cases),the benign lesions group(30 cases)and the control group(30 cases).The clinical data,laboratory,imaging examination results,liver function,renal function,blood glucose,blood lipid and other biochemical indicators of the subjects were collected.The expression level of the fecal M3 gene was detected using quantitative reverse transcription polymerase chain reaction(qRT-PCR).FIT was used to detect fecal occult blood.The M3 gene expression and FIT detection values of the four groups were compared.The diagnostic value of FIT,M3 gene,and their combination for colorectal cancer and adenoma was evaluated using receiver operating characteristic(ROC)curves.Results There were statistically significant differences in age,platelet count(PLT),albumin and multiple tumor markers between the control group,benign lesion group,adenoma group and colorectal cancer group(P<0.05),especially the value of tumor markers in the colorectal cancer group was the highest.The expression levels of the M3 gene and FIT test values showed statistically significant differences among the four groups(P<0.05).The expression levels of the M3 gene and FIT test values in the adenoma group and the colorectal cancer group were statistically significantly higher than those in the control group and the benign lesion group(P<0.05),with the highest levels observed in the colorectal cancer group.In diagnosing adenoma:the area under the curve(AUC)for the FIT test was 0.679(95%CI:0.556-0.803,P=0.011).The AUC for the M3 gene test was 0.880(95%CI:0.800-0.961,P

关 键 词：结直肠肿瘤 粪便 免疫化学 粪菌标志物 M3 基因 QRT-PCR 

分 类 号：R735.3[医药卫生—肿瘤] R730.43[医药卫生—临床医学]