定量免疫法粪便隐血试验在体检人群结直肠肿瘤早期筛查中的应用

The application of quantitative immune fecal occult blood test for the screening of colorectal cancer in health check-up participants

目的评价定量免疫法粪便隐血试验(fecal occult blood test,FOBT)在健康体检人群结直肠肿瘤筛查中的应用价值。方法以2017年7月—2018年6月在苏州大学附属第二医院健康管理中心选择定量免疫法FOBT或化学法+免疫胶体金双联法FOBT(简称"双联法FOBT")检查项目的健康体检人群为研究对象,排除存在干扰因素的体检者。对初筛阳性者进行肠镜检查,发现息肉样病变即取活检或摘除,病理确诊。比较两种方法的初筛阳性率、肠镜依从率和肠镜病理结果,分析定量免疫法FOBT在不同性别、不同年龄组、不同体检性质的受检率、初筛阳性率、肠镜依从率和肠镜病理结果。结果选择定量免疫法FOBT的有18728人,同期选择双联法FOBT的有6212人,2组人群性别、年龄差异均无统计学意义(P均>0.05),具有可比性。定量免疫法FOBT受检率高于双联法FOBT(74.62%比32.23%,P<0.001),初筛阳性率低于双联法FOBT(4.11%比5.34%,P=0.003),初筛阳性人群肠镜依从率高于双联法FOBT(27.83%比13.08%,P=0.001),差异均有统计学意义。定量免疫法FOBT初筛阳性人群中肠镜总病变检出率为71.88%,双联法FOBT为42.86%,差异无统计学意义(P=0.05)。不同性别、年龄、体检性质的人群定量免疫法FOBT受检率差异均有统计学意义(P均<0.001),男性受检率高于女性(79.14%比68.75%),40~59岁人群的受检率较高(79.96%),个人体检者受检率高于团体体检者(90.08%比66.07%)。不同年龄组初筛阳性率差异有统计学意义(P=0.001),60岁及以上年龄组最高(5.59%)。定量免疫法FOBT初筛阳性人群中50岁及以上人群肠镜依从率较高(36.96%)。男性肠癌病变检出率高于女性(11.11%比0,P=0.009),不同年龄组间炎症检出率差异有统计学意义(P<0.001)。随着粪便隐血数值的升高,癌病变的检出率有增高的趋势(P=0.041)。结论定量免疫法FOBT是健康体检人群中结直肠癌早期筛查较理想的非侵入性检查,具有重要的应用价值。

Objective To evaluate the application value of quantitative immune fecal occult blood test(FOBT)in colonoscopy for the screening of colorectal cancer in health check-up participants.Methods The subjects were selected from July 2017 to June 2018 in the Health Management Center of the Second Affiliated Hospital of Suzhou University.The subjects were the healthy individuals who chose quantitative immune FOBT or chemical method plus immunogold double-method FOBT(referred to as"double-method FOBT"),excluding those who had interfering factors.Individuals with a positive result in primary screening were selected and conducted with colorectal cancer by colonoscopy.If the polyploidy lesions were observed during colonoscopy,the biopsy or excision was performed,and the pathological diagnosis was performed.The positive rate of primary screening,compliance rate of colonoscopy and pathological results of colonoscopy were compared between the two methods.Quantitative immunoassay FOBT was analyzed in different gender,age group,physical examination nature,positive rate of primary screening,compliance rate of colonoscopy and pathological results of colonoscopy.Results 18728 people chose quantitative immunoassay FOBT and 6212 people chose double-method FOBT at the same time.There was no significant difference in gender and age between the two groups(all P>0.05),which was comparable.The detection rate of quantitative immune FOBT was higher than double-method FOBT(74.62%vs 32.23%,P<0.001).The positive rate of quantitative immune FOBT in primary screening was lower than double-method FOBT(4.11%vs 5.34%,P=0.003).The colonoscopy screening rate in positive population by quantitative immune FOBT was higher than double-method FOBT(27.83%vs 13.08%,P=0.001).These differences were statistically significant.The detection rate of total lesions by colonoscopy was 71.88%in positive population by quantitative immune FOBT.It was 42.86%in double-method FOBT.There was no statistical difference between the two methods(P=0.05).The detection rates of quantitative immune FOBT were significantly different among different genders,ages and physical properties(all P<0.001).The detection rate was higher in males than in females(79.14%vs 68.75%).The detection rate was highest in the group between 40 and 59 years old(79.96%).The individual detection rate was higher than the group(90.08%vs 66.07%).The positive rates in primary screening were significantly different among different ages(P=0.001).It was highest in the group aged 60 or above(5.59%).The colonoscopy screening rate in positive population by quantitative immune FOBT was highest in the group aged 50 or above(36.96%).The detection rate of inflammatory lesions were significantly different among different ages(P<0.001).The detection rate of colorectal cancer in males was higher than in females(11.11%vs 0.00%,P=0.009).In addition,with the increasing of fecal occult blood value,the detection rate of cancer was increased(P=0.041).Conclusion The quantitative immune FOBT is an ideal non-invasive examination for early screening of colorectal cancer.It has important application values.