Effectiveness of colonoscopy,immune fecal occult blood testing,and risk-graded screening strategies in colorectal cancer screening

BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detection has garnered significant attention as a novel method for CRC screening.Colonoscopy and fecal occult blood tests,when combined,can improve screening accuracy and early detection rates,thereby facilitating early intervention and treatment.However,certain risks and costs accompany it,making the establishment of a risk classification model crucial for accurate classification and management of screened subjects.AIM To evaluate the feasibility and effectiveness of colonoscopy,immune fecal occult blood test(FIT),and risk-graded screening strategies in CRC screening.METHODS Based on the randomized controlled trial of CRC screening in the population conducted by our hospital May 2020 to May 2023,participants who met the requirements were randomly assigned to a colonoscopy group,an FIT group,or a graded screening group at a ratio of 1:2:2(after risk assessment,the high-risk group received colonoscopy,the low-risk group received an FIT test,and the FITpositive group received colonoscopy).The three groups received CRC screening with different protocols,among which the colonoscopy group only received baseline screening,and the FIT group and the graded screening group received annual follow-up screening based on baseline screening.The primary outcome was the detection rate of advanced tumors,including CRC and advanced adenoma.The population participation rate,advanced tumor detection rate,and colonoscopy load of the three screening programs were compared.RESULTS A total of 19373 subjects who met the inclusion and exclusion criteria were enrolled,including 8082 males(41.7%)and 11291 females(58.3%).The mean age was 60.05±6.5 years.Among them,3883 patients were enrolled in the colonoscopy group,7793 in the FIT group,and 7697 in the graded screening group.Two rounds of follow-up screening were completed in the FIT group and the graded screening group.The graded screening group(89.2%)and the colonoscopy group(42.3%)had the lowest overall screening participation rates,while the FIT group had the highest(99.3%).The results of the intentional analysis showed that the detection rate of advanced tumors in the colonoscopy group was greater than that of the FIT group[2.76%vs 2.17%,odds ratio(OR)=1.30,95%confidence interval(CI):1.01-1.65,P=0.037].There was no significant difference in the detection rate of advanced tumors between the colonoscopy group and the graded screening group(2.76%vs 2.35%,OR=1.9,95%CI:0.93-1.51,P=0.156),as well as between the graded screening group and the FIT group(2.35%vs 2.17%,OR=1.09%,95%CI:0.88-1.34,P=0.440).The number of colonoscopy examinations required for each patient with advanced tumors was used as an index to evaluate the colonoscopy load during population screening.The graded screening group had the highest colonoscopy load(15.4 times),followed by the colonoscopy group(10.2 times),and the FIT group had the lowest(7.8 times).CONCLUSION A hierarchical screening strategy based on CRC risk assessment is feasible for screening for CRC in the population.It can be used as an effective supplement to traditional colonoscopy and FIT screening programs.

Evaluating the Efficacy of Fecal Occult Blood Test and Tumor Marker Combined Screening for Colorectal Cancer

Objective:To analyze the screening effectiveness of combining the fecal occult blood test with tumor marker detection for colorectal cancer.Methods:A total of thirty patients with colorectal cancer and thirty patients with benign colon hyperplasia who received treatment from January 2020 to January 2023 were selected.These patients were assigned to the observation group and the control group,respectively.All patients in both groups underwent both fecal occult blood tests and tumor marker detection.The levels of tumor markers between the two groups were compared,the tumor marker levels in different stages were assessed within the observation group,and the positive detection rates for single detection and combined detection were compared.Results:The levels of various tumor markers in the observation group were significantly higher than those in the control group(P<0.05).Furthermore,as the Duke stage increased within the observation group,the levels of various tumor markers also increased(P<0.05).The positive detection rate of the combined test was notably higher than that of single detection(P<0.05).Conclusion:Combining the fecal occult blood test with tumor marker detection in colorectal cancer screening can significantly improve the overall detection rate.

Colorectal cancer screening: Comparison of transferrin and immuno fecal occult blood test

AIM: To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening. METHODS: Eight hundreds and sixty-one individuals at high-risk for CRC were recruited. Six hundreds and eleven subsequently received the three fecal occult blood tests and colonoscopy with biopsy performed as needed. Fecal samples were obtained on the day before colonoscopy. Tf, immuno fecal occult blood test (IFOBT) and guaiac fecal occult blood test (g-FOBT) were performed simultaneously on the same stool. To minimize false-negative cases, all subjects with negative samples were asked to provide an additional stool specimen for a second test even a third test. If the results were all negative after testing three repeated samples, the subject was considered a true negative. The performance characteristics of Tf for detecting CRC and precancerous lesions were examined and compared to those of IFOBT and the combination of Tf, IFOBT and g-FOBT. RESULTS: A total of six hundreds and eleven subjects met the study criteria including 25 with CRC and 60 with precancerous lesions. Sensitivity for detecting CRC was 92% for Tf and 96% for IFOBT, specificities of Tf and IFOBT were both 72.0% (95% CI: 68.2%-75.5%; χ2 = 0.4, P > 0.05); positive likelihood ratios of those were 3.3 (95% CI: 2.8-3.9) and 3.4 (95% CI: 2.9-4.0), respectively. In precancerous lesions, sensitivities for Tf and IFOBT were 50% and 58%, respectively (χ 2 = 0.8, P > 0.05); specificities of Tf and IFOBT were 71.5% (95% CI: 67.6%-75.1%) and 72.2% (95% CI: 68.4%-75.8%); positive likelihood ratios of those were 1.8 (95% CI: 1.3-2.3) and 2.1 (95% CI: 1.6-2.7), respectively; compared to IFOBT, g-FOBT+ Tf+ IFOBT had a significantly higher positive rate for precancerous lesions (83% vs 58%, respectively; χ 2 = 9.1, P < 0.05). In patients with CRC and precancerous lesions, the sensitivities of Tf and IFOBT were 62% and 69% (χ 2 = 0.9, P > 0.05); specificities of those were 74.5% (95% CI: 70.6%-78.1%) and 75.5% (95% CI: 71.6%-79.0%); positive likelihood ratios of those were 2.5 (95% CI: 2.0-3.1) and 2.8 (95% CI: 2.3-3.5). Compared to IF-OBT alone, combining g-FOBT, IFOBT and Tf led to significantly increased sensitivity for detecting CRC and cancerous lesions (69% vs 88%, respectively; χ 2 = 9.0, P < 0.05). CONCLUSION: Tf dipstick test might be used as an ad- ditional tool for CRC and precancerous lesions screening in a high-risk cohort.

To scope or not-the challenges of managing patients with positive fecal occult blood test after recent colonoscopy

BACKGROUND Colorectal cancer(CRC) is a major health problem. There is minimal consensus of the appropriate approach to manage patients with positive immunochemical fecal occult blood test(iFOBT), following a recent colonoscopy.AIM To determine the prevalence of advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia.METHODS The study recruited i FOBT positive patients who underwent colonoscopy between July 2015 to March 2020. Data collected included demographics, clinical characteristics, previous and current colonoscopy findings. Primary outcome was the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT and previous colonoscopy. Secondary outcomes included identifying any clinical and endoscopic predictors for advanced neoplasia.RESULTS The study included 1051 patients(male 53.6%;median age 63). Forty-two(4.0%) patients were diagnosed with CRC, 513(48.8%) with adenoma/sessile serrated lesion(A-SSL) and 257(24.5%) with advanced A-SSL(AA-SSL). A previous colonoscopy had been performed in 319(30.3%). In this cohort, four(1.3%) were diagnosed with CRC, 146(45.8%) with A-SSL and 56(17.6%) with AA-SSL. Among those who had a colonoscopy within 4 years, none had CRC and 7 had AA-SSL. Of the 732 patients with no prior colonoscopy, there were 38 CRCs(5.2%). Independent predictors for advanced neoplasia were male [odds ratio(OR) = 1.80;95% confidence interval(CI): 1.35-2.40;P < 0.001), age(OR = 1.04;95%CI: 1.02-1.06;P < 0.001) and no previous colonoscopy(OR = 2.07;95%CI: 1.49-2.87;P < 0.001).CONCLUSION A previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within four years of a positive iFOBT result, was protective against CRC.

Prediction of flare-ups of ulcerative colitis using quantitative immunochemical fecal occult blood test

AIM:To examine the feasibility of predicting the flareup of ulcerative colitis (UC) before symptoms emerge using the immunochemical fecal occult blood test (IFOBT).METHODS:We prospectively measured fecal hemoglobin concentrations in 78 UC patients using the I-FOBT every 1 or 2 mo.RESULTS:During a 20 mo-period,823 fecal samples from 78 patients were submitted.The median concentration of fecal hemoglobin was 41 ng/mL (range:0-392 500 ng/mL).There were three types of patients with regard to the correlation between I-FOBT and patient symptoms;the synchronous transition type with symptoms (44 patients),the unrelated type withsymptoms (19 patients),and the flare-up predictive type (15 patients).In patients with the flare-up predictive type,the values of I-FOBT were generally low during the study period with stable symptoms.Two to four weeks before the flare-up of symptoms,the I-FOBT values were high.Thus,in these patients,I-FOBT could predict the flare-up before symptoms emerged.CONCLUSION:Flare-up could be predicted by I-FOBT in approximately 20% of UC patients.These results warrant periodical I-FOBT in UC patients.

EVALUATION OF REVERSE PASSIVE HEMAGGLUTINATION （RPHA） FECAL OCCULT BLOOD TEST IN SCREENING OF COLORECTAL NEOPLASIA

A high risk population consisting of 3034 people with history of rectal polyps or ulcers were screened for colorectal neoplasia with Reverse Passive Hemagglutination Fecal Occult Blood Test (RPHA FOB) and 60 cm fiberoptic colonoscopy. Among 2553 subjects (84.1%)who completed both tests, 11 cases of colorectal malignancies and 465 cases of polyps were detected.Using colonoscopic finding and histopathological examination as the 'gold standard' of diagnosis, results showed that FOB positivity of polyps was related to their size, macroscopic appearance and surface features but no correlation between bleeding of polyps and their location, numbers, pathological types were found. In this study the sensitivity of RPHA in screening of colorectal malignancy was 63.6% (7/11), while that for polyps was only 21.1% (98/465) . For screening of colorectal neoplasia (cancer+polyps) the overall sensitivity and specificity of RPHA FOB were 22.1% and 82.4%, the positive and negative predictive values were 22.3% and 82.2% respectively. Amoug 465 polyps there were 195 adenomas, further analysis showed that villous and tubulovillous adenomas had higher intestinal bleeding rate (FOB positive)than tubular type (45.5%,30.0% and 17.8% respectively, X2=5.8, p=0.05). The results indicate that although the sensitivity of RPHA FOB in screening for colorectal polyps was generally low, but about 40% (8/21) of villous and tubulovillous adenoma which present higher tendency of malignant transformation can be detected by RPHA FOB as a screening Procedure. So the authors suggest that screening of colorectal neoplasia be not only a procedure of secondary prevention but also a measure of primary prevention for colorectal cancer.Accepted March 22, 1994

Impact of fecal occult blood on obscure gastrointestinal bleeding:Observational study

AIM: To elucidate the association between small bowel diseases(SBDs) and positive fecal occult blood test(FOBT) in patients with obscure gastrointestinal bleeding(OGIB).METHODS: Between February 2008 and August 2013, 202 patients with OGIB who performed both capsule endoscopy(CE) and FOBT were enrolled(mean age; 63.6 ± 14.0 years, 118 males, 96 previous overt bleeding, 106 with occult bleeding). All patients underwent immunochemical FOBTs twice prior to CE. Three experienced endoscopists independently reviewed CE videos. All reviews and consensus meeting were conducted without any information on FOBT results. The prevalence of SBDs was compared between patients with positive and negative FOBT.RESULTS: CE revealed SBDs in 72 patients(36%). FOBT was positive in 100 patients(50%) and negative in 102(50%). The prevalence of SBDs was significantly higher in patients with positive FOBT than those with negative FOBT(46% vs 25%, P = 0.002). In particular, among patients with occult OGIB, the prevalence of SBDs was higher in positive FOBT group than negative FOBT group(45% vs 18%, P = 0.002). On the other hand, among patients with previous overt OGIB, there was no significant difference in the prevalence of SBDs between positive and negative FOBT group(47% vs 33%, P = 0.18). In disease specific analysis among patients with occult OGIB, the prevalence of ulcer and tumor were higher in positive FOBT group than negative FOBT group. In multivariate analysis, only positive FOBT was a predictive factors of SBDs in patients with OGIB(OR = 2.5, 95%CI: 1.4-4.6, P = 0.003). Furthermore, the trend was evidentam on g patients with occult OGIB who underwent FOBT on the same day or a day before CE. The prevalence of SBDs in positive vs negative FOBT group were 54% vs 13% in patients with occult OGIB who underwent FOBT on the same day or the day before CE(P = 0.001), while there was no significant difference between positive and negative FOBT group in those who underwent FOBT two or more days before CE(43% vs 25%, P = 0.20).CONCLUSION: The present study suggests that positive FOBT may be useful for predicting SBDs in patients with occult OGIB. Positive FOBT indicates higher likelihood of ulcers or tumors in patients with occult OGIB. Undergoing CE within a day after FOBT achieved a higher diagnostic yield for patients with occult OGIB.

具核梭杆菌在结直肠癌筛查中的应用价值

目的探讨具核梭杆菌(Fn)在结直肠癌筛查中的临床价值。方法前瞻性纳入于2022年7月至2023年12月期间在首都医科大学附属北京友谊医院行结肠镜检查者。于结肠镜检查前3 d内留取粪便样本,采用定量聚合酶链反应(qPCR)法检测粪便中菌群Fn的相对丰度,同时行粪便隐血试验(FOBT)。采用受试者操作特征(ROC)曲线评估Fn对结直肠癌的诊断效能。结果共纳入271例受试者,其中诊断结直肠癌58例(21.40%)。结直肠癌组患者粪便中的Fn相对丰度显著高于非结直肠癌组[6.602(3.716,8.997)vs.1.665(0.593,4.752)],差异有统计学意义(P<0.05)。Fn诊断结直肠癌的曲线下面积(AUC)为0.750(95%CI:0.680~0.820,P<0.05),对应敏感度、特异度和阴性预测值分别为0.724、0.742和0.908。在FOBT结果阴性者中,Fn诊断结直肠癌的敏感度、特异度和阴性预测值分别为0.714、0.730和0.983。Fn联合FOBT诊断结直肠癌的AUC为0.894(95%CI:0.848~0.940,P<0.05),对应敏感度、特异度和阴性预测值分别为0.897、0.765和0.964,诊断效能显著优于单独检测Fn(P<0.05)。结论粪便Fn在结直肠癌筛查中具有较高的敏感性、特异性和阴性预测值,与FOBT联合应用可进一步提升结直肠癌检出率。因此,粪便Fn是结直肠癌筛查有价值的无创生物标志物,可有效避免FOBT阴性者中结直肠癌的漏诊。粪便Fn丰度升高者应尽快行结肠镜检查,若Fn与FOBT均阴性,则可基本排除结直肠癌。

Early diagnostic strategies for colorectal cancer

At present,cancer is still an important factor threatening human health.Colorectal cancer(CRC)is one of the top three most common cancers worldwide and one of the deadliest malignancies in humans.The latest data showed that CRC incidence and mortality rank third and second,respectively,among global malignancies.Early and accurate diagnosis is crucial to reduce the morbidity,mortality and improve survival of patients with CRC,but the current early diagnostic methods have limitations.The effectiveness and compliance of diagnostic methods have a certain impact on whether people choose screening.In this editorial,we explore strategies for the early diagnosis of CRC,including stool-based,blood-based,direct visualization,and imaging examinations.

Early colorectal cancer screening–no time to lose

In this editorial,we comment on the article entitled“Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?”by Agatsuma et al.Colorectal cancer(CRC)is emerging as an important health issue as its incidence continues to rise globally,adversely affecting the quality of life.Although the public has become more aware of CRC prevention,most patients lack screening awareness.Some poor lifestyle practices can lead to CRC and symptoms can appear in the early stages of CRC.However,due to the lack of awareness of the disease,most of the CRC patients are diagnosed already at an advanced stage and have a poor prognosis.

基于FIB、HB、FOBT、CEA构建的Logistic回归模型对结直肠癌的诊断价值

目的 评价纤维蛋白原(FIB)、血红蛋白(HB)、癌胚抗原(CEA)和粪便隐血试验(FOBT)联合检测在结直肠癌患者中的诊断价值,为结直肠癌诊断提供参考。方法 选取宁夏医科大学总医院2021年1月至2022年6月结直肠外科收治的110例结直肠癌患者作为癌症组,选取同期病房收治的43例良性结直肠疾病患者为非癌症组。回顾性分析并比较癌症组及非癌症组常规实验室指标(血常规、生化常规、肿瘤标志物、细胞因子、FOBT)结果,采用Logistic回归分析结直肠癌的影响因素并构建Logistic回归模型,采用受试者工作特征(ROC)曲线分析Logistic回归模型对结直肠癌的诊断价值;进一步构建诊断结直肠癌的列线图并绘制校准曲线图进行内部验证。结果 癌症组患者血FIB、CEA水平及FOBT阳性率高于非癌症组,A/G、HB水平低于非癌症组,差异均有统计学意义(P<0.05)。将FIB、HB、FOBT、CEA进行多因素Logistic回归分析,建立Logistic回归模型作为4项指标联合检测模型:P=1/[1+e^(-(13.792-0.144×X_(1)+1.057×X_(2)+0.560×X_(3)+3.029×X_(4)))],其中X_(1)为HB水平,X_(2)为FIB水平,X_(3)为CEA水平,X_(4)为FOBT检测结果(阳性=1,阴性=0)。ROC曲线分析结果显示,当最大约登指数为0.841时,Logistic回归模型诊断结直肠癌的灵敏度为86.4%,特异度为97.7%,曲线下面积(AUC)为0.961(95%CI:0.933~0.988)。建立Logistic回归模型的列线图,并绘制校准曲线图,结果提示该模型的预测概率与实际概率具有较好的一致性。结论 基于FIB、HB、CEA和FOBT 4项指标构建的Logistic回归模型,对结直肠癌有着较好的诊断价值,也为临床对结直肠癌的早期筛查和诊断提供了一定的方向。

粪便隐血试验在体检人群中对大肠癌早期筛查的价值

目的研究免疫化学法粪便隐血试验(FIT)在体检人群中大肠癌早期筛查的应用价值。方法选取2017年9月至2020年9月该院体检中心健康体检人群,收集行FIT患者的基本资料,根据内镜下有无新生物、FIT检测值、新生物直径及位置进行分组;采用单样本K-S检验、Kruskal-Wallis H检查、χ^(2)检验进行组间统计分析,Spearman法分析双变量关系,多重线性回归模型分析性别、年龄及新生物病理类型、位置、直径、个数对FIT的预测价值。结果315例患者满足FIT>100 ng/mL并完成肠镜检查,包括大肠癌(腺癌)19例,腺瘤性息肉94例,增生性息肉59例,正常及其他疾病143例,男性大肠癌发病比率高于女性(χ^(2)=15.74,P<0.01)。FIT检测值平均中位水平:肿瘤组>腺瘤性息肉组>无新生物组>增生性息肉组,除无新生物组与增生性息肉组之间差异无统计学意义(P=0.206),其余各组间差异均有统计学意义(P<0.05)。随着FIT检测值的增加,肠镜正常和增生性息肉的占比下降,腺瘤和腺癌的占比升高(P<0.01)。新生物直径中位水平:肿瘤组>腺瘤性息肉组>增生性息肉组(P<0.01)。随着新生物直径的增加,增生性息肉百分比下降,肿瘤所占比例增加(P<0.01)。左半结肠发病率显著高于结肠其他部位(P<0.01)。双变量相关分析显示,FIT检测值与新生物病理类型、直径、个数呈正相关(r=0.291、0.591、0.354,P<0.01)。多重线性回归分析显示新生物病理类型、直径、个数是影响FIT检测值的独立影响因素,线性方程式为Y=-584.875+319.315×1+264.241×2+109.942×3(×1、×2、×3分别代表新生物病理类型、直径、个数),P<0.01。结论FIT能够有效应用于大肠癌的早期筛查,其检测值高低与肠道新生物癌变程度、直径呈正相关,男性患者、左半结肠病变、大直径新生物易发生癌变。

2020-2022年广州市荔湾区白鹤洞街道社区居民大肠癌初筛结果及其危险因素分析

目的分析2020—2022年广州市荔湾区白鹤洞街道常驻居民大肠癌初筛结果,探讨影响大肠癌阳性的危险因素,为临床防治大肠癌工作提供依据。方法选取2020—2022年广州市荔湾区白鹤洞街道参与大肠癌筛查的1131名居民作为研究对象,采取调查问卷和大便潜血试验(FOBT)相结合的方式进行筛查,同时对危险因素进行相关性分析。结果181例居民初筛结果为阳性,阳性率为16.01%,其中男性88例(48.6%),女性93例(51.4%);946例居民初筛结果为阴性,占比83.64%;4例无法判定,占比0.35%。初筛结果阳性组的患者有慢性便秘史、粘液血便史、慢性胆囊炎史、肠息肉史、慢性阑尾炎史和癌症病史的比例均高于初筛结果阴性组患者的比例,差异有统计学意义(P<0.05)。多因素分析结果发现:粘液血便史、肠息肉史、FOBT阳性是初筛结果阳性的危险因素(P<0.05)。结论广州市荔湾区白鹤洞街道45~74岁居民大肠癌初筛结果表明粘液血便史、肠息肉史、FOBT阳性是导致大肠癌的关键危险因素,提示有此类危险因素的人群应进行更频繁的筛查和进一步的检查,如肠镜检查等,以便早期诊断治疗和降低发病率。

结直肠癌患者血浆Septin9 DNA甲基化联合FOBT检测的临床应用价值

目的:探讨血浆Septin9 DNA甲基化及粪便隐血试验(FOBT)在结直肠癌(CRC)诊断中的应用价值。方法:回顾性收集2017年6月至2022年1月我院收治并经病理检查确诊的101例结直肠良性腺瘤患者、209例结直肠癌患者分别作为良性腺瘤组和结直肠癌组,选取同期在我院进行体检的98例健康人群作为正常对照组,比较三组一般资料及血浆Septin9 DNA甲基化及FOBT阳性情况,比较不同病理特征、不同临床分期结直肠癌患者血浆Septin9 DNA甲基化、FOBT阳性情况,采用受试者工作曲线(ROC)评估血浆Septin9 DNA甲基化、FOBT单项及联合检测对结直肠癌的诊断价值。结果:三组血浆Septin9 DNA甲基化、FOBT阳性率比较,结直肠癌组高于良性腺瘤组及正常对照组,良性腺瘤组高于正常对照组(P<0.05);肿瘤低分化、淋巴结转移、脉管/神经侵犯的结直肠癌患者血浆Septin9 DNA甲基化和FOBT阳性率高于肿瘤高分化、中分化及未发生淋巴结转移、未发生脉管/神经侵犯的结直肠癌患者(P<0.05);随着结直肠癌TNM临床分期升高,血浆Septin9 DNA甲基化及FOBT阳性率升高,差异具有统计学意义(P<0.05);血浆Septin9 DNA甲基化和FOBT联合诊断结直肠癌的敏感度、曲线下面积(AUC)(87.08%、0.885)均高于两者单独诊断(59.33%、0.744和52.63%、0.643,P<0.05);血浆Septin9 DNA甲基化诊断结直肠癌的特异度、阳性预测值和阴性预测值分别为89.45%、85.52%和67.68%;FOBT分别为76.38%、70.06%和60.56%,两者联合诊断分别为89.95%、90.10%和86.89%。联合诊断优于单项诊断。结论:随着结直肠病变恶性程度的增加,血浆Septin9 DNA甲基化和FOBT阳性率升高,血浆Septin9 DNA甲基化、FOBT联合检测对结直肠癌具有较高的诊断价值,可作为结直肠癌的实验室诊断指标。

粪便miRNA-92a表达与粪便隐血试验联合诊断结直肠癌的应用

目的 探讨粪便miRNA-92a表达与粪便隐血试验串联、并联对结直肠癌的诊断价值。方法 选取2020年1月~2022年12月郴州市第一人民医院收治的100例结直肠癌患者为结直肠癌组和100例结直肠腺瘤患者为结直肠腺瘤组,另选取同期200例年龄、性别匹配的健康体检者为对照组。比较各组粪便miRNA-92a和粪便隐血试验结果,采用logistic回归分析结直肠癌发生的影响因素;分析miRNA-92a表达水平与结直肠癌发生的关系;比较结直肠癌组不同临床病理特点患者的粪便miRNA-92a表达差异;采用Spearman分析粪便miRNA-92a表达与结直肠癌病情的相关性;采用ROC曲线分析粪便miRNA-92a、粪便隐血试验及其串联、并联诊断对结直肠癌的诊断价值。结果 各组粪便miRNA-92a表达水平、粪便隐血阳性率比较,均为结直肠癌组>结直肠腺瘤组>对照组(P<0.05);结直肠腺瘤患者粪便miRNA-92a高表达发生结直肠癌的风险是低表达患者的3.547倍;进展期腺瘤、多发息肉史、粪便miRNA-92a、粪便隐血试验阳性是结直肠癌发病的独立危险因素(P<0.05);结直肠癌组中,不同肿瘤直径、T分期、N分期、M分期、分化程度及是否有淋巴结转移的患者粪便miRNA-92a表达比较,差异均有统计学意义(P<0.05);粪便miRNA-92a表达与肿瘤直径、T分期、N分期、M分期、分化程度及淋巴结转移均呈正相关(P<0.05);粪便miRNA-92a、粪便隐血试验串联、并联试验诊断结直肠癌的曲线下面积分别为0.685、0.795;串联试验灵敏度较低,特异度较高,并联试验灵敏度较高,特异度较低。结论 粪便miRNA-92a高表达可增加结直肠癌发生风险,与粪便隐血试验串联、并联试验可分别提高临床诊断的特异度、灵敏度。

氩等离子凝固术与EMR术对结肠息肉患者术后粪便潜血情况的影响

目的探讨氩等离子凝固术与内镜下粘膜切除术(EMR)术对结肠息肉患者术后粪便潜血情况的影响。方法选取我院收治的80例患者作为研究对象,采用随机数字表法将其分APC组和EMR组,各40例,APC组采取氩等离子凝固术(APC)治疗,EMR组采取EMR治疗,术后评价两组疗效,比较两组大便潜血试验(FOBT)结果。结果APC组与EMR组治疗有效率无显著差异(均≥90%),但FOBT结果显示APC组阳性率低于EMR组,差异具有统计学意义(P<0.05)。结论氩等离子凝固术与EMR术治疗结肠息肉疗效均较好,但前者术后粪便潜血风险更低。

血浆 Septin9 基因甲基化检测对结直肠癌诊断的价值研究

目的探讨血浆中Septin9基因甲基化(methylated Septin 9,mSEPT9)检测在结直肠癌(colorectal cancer,CRC)诊断中的应用价值。方法收集2020年5月至2022年4月在右江民族医学院附属医院收治并经病理学诊断为非CRC患者42例和CRC患者129例,分别作为非CRC组和CRC组,分析患者血浆mSEPT9检测、大便隐血试验(FOBT)、癌胚抗原(CEA)和CA199检测结果,评价其单项检测和基于血浆mSEPT9的联合检测在CRC诊断中的应用价值。结果①CRC组mSEPT9检测阳性率为58.14%(75/129),非CRC组mSEPT9检测阳性率为19.05%(8/42),两组差异具有统计学意义(P<0.001)。②血浆mSEPT9检测CRC的敏感度为58.14%,高于CEA(39.53%)和CA199(19.38%);特异度为80.95%,高于FOBT(47.62%),基于血浆mSEPT9检测的联合检测敏感度均高于其单项检测。结论mSEPT9检测在CRC诊断中具有较高的敏感性和特异度,基于mSEPT9的联合检测敏感度高于单项检测,是CRC诊断重要的辅助手段。

结直肠癌高危人群中医体质类型分析

为研究结直肠癌高危人群中医体质类型的分布规律,筛选2020年9月—2022年12月深圳市龙岗区南湾街道45~74岁居民为受试对象,进行结直肠癌问卷调查联合粪便潜血试验初筛,判定为高危人群则进行中医体质辨识,完善肠镜并记录随访结果。结果显示,805名高危人群中,613人问卷调查为高风险,占76.15%;粪便潜血试验阳性者324人,占40.25%。进一步完善肠镜检查,顺应率为29.19%(235/805),155名居民完善活检,其中病变检出结肠息肉81人(52.26%),肠炎17人(10.97%),腺瘤15人(9.68%),结直肠癌2人(1.90%)。中医体质辨识结果为平和质25人,占3.11%;偏颇体质780人,占96.89%。研究发现,结直肠癌高危人群中医体质类型具有特异性,多为偏颇体质,痰湿质、阳虚质、气虚质、湿热质、气郁质为易感体质。男性以痰湿质、阳虚质、湿热质为主,女性则主要为阳虚质、气郁质、气虚质。结直肠癌高危人群肠镜结果以息肉、腺瘤及肠炎为主,年龄、性别是其危险因素。

天津市大肠癌筛查初步结果分析

目的：在40～74岁天津市自然人群中开展大肠癌筛查，评价问卷调查、大便潜血检查（stool occult blood test，FOB）和全结肠镜检查的筛查效果，为探索大肠癌筛查策略提供参考。方法：筛查方法采用问卷调查结合FOB的两步筛查模式，经初筛确定的高危人群行全结肠镜检查明确诊断。结果：2012年5月至2014年12月，实际完成初筛2117304例，初筛顺应性39.72%；检出高危人群126118例，高危人群比例5.96%；全结肠镜检查25837例，检出腺瘤8095例，进展期腺瘤1236例、伴中重度异型增生的其他病变134例、早期癌112例、晚期癌336例，早诊率为81.52%。结论：天津市大肠癌筛查方案可以显著浓缩大肠癌高危人群，提高全结肠镜检查的阳性率，节省医疗资源。

免疫法与化学法粪便潜血试验在结肠癌筛查中价值的荟萃分析

目的系统性评价免疫法粪便潜血试验（immunochemical fecal occult blood tests,iFOBT）与愈创木脂化学法粪便潜血试验（guaiac-based fecal occult blood tests,gFOBT）相比,是否能获得更高的筛检进展期结直肠肿瘤的临床应用价值。方法利用中英文检索词检索相关电子数据库,纳入直接比较iFOBT与gFOBT筛查结直肠肿瘤的随机临床试验,并提取其特征信息。根据QUADAS质量评价标准评价纳入文献的质量,荟萃分析各项研究中不同潜血试验方法对结直肠肿瘤的检出率和患者的依从性,计算相应的OR值和95%可信区间。通过漏斗图肉眼观察是否存在发表偏倚,并做Egger检验进一步验证。结果共5项随机临床试验（共22 709例）符合纳入标准。iFOBT与gFOBT对于结直肠癌及进展期腺瘤的检出率分别为2.23%和1.24%,合并OR值为1.50（95%CI：0.94~2.39）。而这种优越性主要体现在iFOBT与传统的化学法HemoccultⅡ相比时（OR=2.12,95%CI：1.66~2.71）。患者对于iFOBT和gFOBT的依从性分别为52.66%和43.93%,合并OR值为1.40（95%CI：1.16~1.68）。结论与传统gFOBT相比,iFOBT能够提高结直肠肿瘤筛检的准确性及患者的依从性。