不同变量问卷表在结直肠癌早诊早治筛查中的效果评价

The Effect of Variables Questionnaire in Screening for Colorectal Cancer Early Diagnosis and Treatment

[目的]评价两种不同变量问卷调查表在结直肠癌筛查中的效果,为进一步优化筛查方案提供科学依据。[方法]根据《中国癌症筛查及早诊早治指南》制订结直肠癌筛查实施方案,对海宁市40～74岁目标人群开展筛查。初筛包括流行病学问卷调查和大便隐血试验（FOBT）确定高危人群,其中部分应检对象采用新版问卷调查表,即在原病史问卷内容的基础上增加了腹痛、贫血、大便习惯性质改变和不明原因体重减轻4个变量。精筛即对高危人群进一步做电子结肠镜检查。[结果]海宁市2010～2012年完成流行病学问卷调查240 177人,顺应率88.25%。采用新版病史问卷调查91 997人,病史阳性率为6.99%;检出肠道病变（息肉、腺瘤、癌）2369例。病史阳性诊断肠道病变的灵敏度为47.24%,特异性为71.71%。旧版病史问卷调查148 180例,病史阳性率为5.54%,检出肠道病变4183例,病史阳性诊断肠道病变的灵敏度为38.90%,特异性为69.37%。[结论]新版问卷调查表病史阳性率高、对肠道病变灵敏度、特异性均高于旧版,在进行结直肠癌筛查时新版问卷调查表值得推荐。

[Purpose] To investigate the effect of new and old version of history questionnaire for colorectal cancer screening,and to provide the scientific basis for the further optimization of the screening program. [ Methods ] Based on the China Cancer Screening and Early Diagnosis and Early Treatment for Colorectal Cancer Screening Guidelines,target population with 40-74 years-old in Haining city were carried out screening,including epidemiological survey and fecal occult blood test（FOBT） to identify high-risk populations. New questionnaire increased 4 variables including ab- dominal pain, anemia, defecated changes, unexplained weight loss. Fine screen for high-risk groups underwent further electronic colonoscopy. [Results] A total of 240 177 people completed the epi- demiological survey with rate of 88.25% in Haining city from 2010 to 2012. Of 91 997 people with new version questionnaire,the positive medical history was 6.99%;and 2369 people were checked out the intestinal lesions （polyp,adenoma, carcinoma）. The medical history diagnosed intestinal le- sions with a sensitivity of 47.24% and a specificity of 71.71%. Of 148 180 people with old version questionnaire, the positive medical history was 5.54%, and 4183 people were checked out the in- testinal lesions. The medical history diagnosed intestinal lesions with a sensitivity of 38.90% and a specificity of 69.37%. [Conclusion] The new version questionnaire has a higher detected rate of medical history,and a higher sensitivity and specificity than the old version questionnaire for diag- nosing intestinal lesions. The new version of the questionnaire is recommended for screening for colorectal cancer.