预警症状对结直肠癌的诊断效能研究

Predictive Value of Alarm Features in Diagnosing Colorectal Carcinoma

目的:明确预警症状(腹部包块、便秘、排便习惯改变、腹泻、肛周异物感、长期腹痛、便血或肛门出血)对结直肠癌的诊断效能。方法:收集我院2016年1月至2016年12月的结肠镜检查数据,计算各个预警症状的诊断敏感度、特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比。结果:预警症状总的诊断敏感度和特异度分别是6.63%和94.33%。所有的预警症状诊断敏感度最高的是便血,敏感度为19.28%,最低的是腹泻,敏感度为2.41%。相对而言,便血和长期腹痛的准确度较高,分别达到了19.28%和11.45%。除了长期腹痛之外,其他所有的预警症状的诊断特异度都达到了90%以上。结论:超过一半的结直肠癌患者没有出现预警症状,用预警症状来诊断结直肠癌具有较低的敏感度和较高的特异度,需要更多的研究来证明预警症状的临床意义。

Objective： To investigate the diagnostic value of alarm features （abdominal mass, astriction, change of habit, diarrhea, discomfort of anus, prolonged abdominal pain, rectal bleeding or melena） for predicting colorectal cancer. Methods： Patients undergoing first-time colonoscopy in our center during January, 2016 to December, 2016 were included. As for each alarm feature, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated. Results： The overall sensitivity and specificity was 6.63% and 94.33%, respectively. Melena had the highest sensitivity （19.28%）, and diarrhea had the lowest sensitivity （2.41%）. Relatively speaking, melena and prolonged abdominal pain had a high predictive accuracy as 19.28% and 11.45%, respectively. All of alarm features achieved a specificity above 90% except for prolonged abdominal pain. Conclusions： More than half of Chinese patients with colorectal cancer presented without alarm features, low sensitivity and high specificity was observed using alarm features to diagnose eolorectal cancer, more studies investigating the significance of alarm features in diagnosis of colorectal cancer.