胶体金法和免疫比浊法大便隐血检测在人群结直肠癌筛查中的应用

Application of Colloidal Gold Method or Immunoturbidimetry Fecal Occult Blood Test in Screening for Colorectal Cancer

[目的]比较胶体金法和免疫比浊法大便隐血检测在人群结直肠癌筛查中的阳性预测值（positive predictive value,PPV）。[方法]在嘉善县惠民街道大肠癌筛查现场采用整群抽样方法抽取40~74岁人群共7584人,同时使用胶体金法和免疫比浊法进行粪便隐血检测,阳性者行结肠镜检查。比较两种方法检测阳性率及结直肠癌、进展期腺瘤和非进展期腺瘤的阳性预测值差异。[结果]共6446（84.99%）人按要求同时送检了两份便样,胶体金法和免疫比浊法阳性人数分别为288（4.47%）人和197（3.06%）人。胶体金法和免疫比浊法隐血阳性者中分别有236人和157人完成结肠镜检查及后续诊断,最终分别检出结直肠癌7例和13例,进展期腺瘤各27例,非进展期腺瘤39例和30例。免疫比浊法对结直肠癌的阳性预测值明显高于胶体金法（χ2=5.51,P〈0.05）,两种方法对进展期腺瘤、非进展期腺瘤的阳性预测值无统计学差异（P〉0.05））。[结论]免疫比浊法用于人群筛查结直肠癌明显优于胶体金法,但对进展期腺瘤优势不明显,进一步证明需更大样本的多中心试验。

[ Purpose ] To compare the positive predictive value（PPV） of colloidal gold method or im- munoturbidimetry fecal occult blood test in screening for colorectal cancer. [Methods] Seven thou- sand five hundred and eighty-four people aged 40~74 years old were adopted for colorectal cancer screening from Huimin,Jiashan County by cluster sampling. The fecal samples were separately de- tected by colloidal gold method and immunoturbidimetry. The positive cases from either method would be followed by colonoscopy examination. The positive rate of the two methods was com- pared, as well as the PPV of the colorectal cancer,in advanced adenoma and non-advanced adeno- ma. [Results ] A total of 6446 people （84.99%） submitted their two fecal samples,with 288 col- loidal gold method positive cases （4.47%） and 197 immunoturbidimetry positive cases（3.06%）. Two hundred and thirty-six out of the 288 positive cases in the test by colloidal gold method and 157 out of the 197 positive cases in the test by immunoturbidimetry received the colonoscopy examina- tion and further colorectal cancer positive cases detected by colloidal gold method and immuno- turbidimetry was detected in 7 and 13 cases,both 27 cases with advanced adenoma and 39 and 30 cases with non-advanced adenoma,respectively. The PPV of the colorectal cancer by immuno- turbidimetry was significantly higher than that by colloidal gold method（x2=5.51, P〈0.05）, and there were no significant differences between the two methods in the PPV of advanced adenoma and non- advanced adenoma. [Conclusion] The immunoturbidimetry is superior to colloidal gold method in colorectal cancer screening,but no obvious advantages in advanced adenoma screening, large-sample multicenter trial was need for further conclusion.