免疫法与化学法粪便隐血试验在大肠癌早期筛查中的应用比较

Application comparison of immune and chemical fecal occult blood tests in early screening of colorectal cancer

目的比较免疫法与化学法粪便隐血试验(OBT)在大肠癌早期筛查中的应用效果。方法选取2018年5月—2020年1月南昌市洪都中医院收治的50例疑似为大肠癌早期患者作为研究对象,收集50例患者的粪便,行免疫法与化学法OBT检查,并以活检病理结果作为诊断“金标准”,比较免疫法与化学法OBT早期筛查大肠癌的诊断效能,比较大肠癌不同预后患者免疫法粪便隐血试验(iFOBT)值,绘制受试者工作特征(ROC)曲线,分析iFOBT值预测大肠癌患者预后的价值。结果经活检病理检查确诊,50例疑似早期大肠癌患者中有早期大肠癌30例(60.00%),大肠息肉12例(24.00%),炎性肠病8例(16.00%)。免疫法OBT诊断大肠癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值(96.67%、90.00%、94.00%、93.55%、94.74%)高于化学法OBT(70.00%、55.00%、64.00%、70.00%、52.38%),差异有统计学意义(P<0.05)。预后不良组患者iFOBT值高于预后良好组,差异有统计学意义(P<0.05)。iFOBT值诊断大肠癌的ROC曲线下面积(AUC)>0.7,iFOBT值在预测大肠癌预后中具有较高价值,当达到最佳阈值时,可达到最佳预测价值。结论与化学法OBT比较,免疫法OBT应用于大肠癌早期筛查中的临床价值较高,筛查效果更佳,且可通过iFOBT值对大肠癌预后进行预测。

Objective To compare the effect of immune and chemical fecal occult blood tests(OBT)in the early screening of colorectal cancer.Methods A total of 50 suspected early colorectal cancer patients in Nanchang Hongdu Hospital of Traditional Chinese Medicine from May 2018 to January 2020 were selected as the research objects.The feces of the 50 patients were collected,and immune and chemical OBT tests were performed.The pathological results of biopsy were used as the"gold standard"for diagnosis.The diagnostic efficacy of immune and chemical OBT for early screening of colorectal cancer was compared.The immunofecal occult blood test(iFOBT)values of colorectal cancer patients with different prognosis were compared,and the receiver operating characteristic(ROC)curves were drawn to analyze the iFOBT values to predict the prognosis of colorectal cancer patients.Results Among the 50 suspected cases of early colorectal cancer,there were 30 cases(60.00%)of early colorectal cancer,12 cases(24.00%)of colonic polyp and 8 cases(16.00%)of inflammatory bowel disease were confirmed by biopsy and pathological examination.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value(96.67%,90.00%,94.00%,93.55%,94.74%)of immune OBT in the diagnosis of colorectal cancer were higher than those of chemical OBT(70.00%,55.00%,64.00%,70.00%,52.38%),and the differences were statistically significant(P<0.05).The IFOBT value of patients with poor prognosis was higher than that of patients with good prognosis,and the difference was statistically significant(P<0.05).The area under the ROC curve(AUC)of the iFOBT value was>0.7 in diagnosis of colorectal cancer.The iFOBT value had a high value in predicting the prognosis of colorectal cancer,and the best predictive value could be reached when the optimal threshold was reached.Conclusion Compared with chemical OBT,immune OBT has higher clinical value and better screening effect in the early screening of colorectal cancer,and the prognosis of colorectal cancer can be predicted by the iFOBT value.