SPA免疫便潜血试验和直肠粘液T抗原试验互补普查大肠癌及其随访

本文联合采用人血红蛋白抗血清包被的含A蛋白葡萄球菌(SPA)进行免疫便潜血试验(SPA试验)和直肠粘液T抗原检测(T抗原试验)用于大肠癌普查初筛并对筛检人群进行随访。结果表明,在4843例无症状人群中,SPA和T抗原试验阳性者分别为472例(9.75％)和297例(6.13％).共769例阳性者行纤维结肠镜检查,检出大肠癌4例,腺瘤48例(>1.0cm者17例,占35.4％)。其中,SPA试验中仅3例癌,29例腺瘤阳性,T抗原试验中2例癌,27例腺瘤阳性,提示联合这两种初筛试验可提高大肠癌及其腺瘤的检出率。为验证普查后减少大肠肿瘤发生的效果,2年后对这些人群采用同样的普查方案随访,结果在受检的3641例人群中,共477例阳性者行纤维结肠镜检查,未发现大肠癌病例,腺瘤18例(>1.0cm者仅4例,占22.2％)。将两次检出的腺瘤进行不典型增生程度的比较,第二次检出的腺瘤轻度不典型增生病变占88.89％(16例),中重度不典型增生病变仅占11.11％(2例),而第一次检出腺瘤、中重度不典型增生病变占25％(12例)。上述结果表明利用这两种初筛试验进行互补性普查。可提高大肠癌及癌前病变的检出率,随访结果提示在无症状人群普查,不仅可使大肠癌及腺瘤的再检出率明显减少,且可使中重度不典型增生病变的发病机会明显减少。

A Follow-up Study on the Complementary Scheme by Combining SPA Immunological Fecal Occult Blood Test and T-antigen Detection of Rectal Mucus for Screening of Colorectal Cancer in an Asymptomatic Population

Background/Aims and Methods: Mass screening is an important way to search for early colorectal cancer. With sequential fecal occult blood test (FOBT) and colonoscopy, there was still misdetection. In this study, both SPA immunological fecal occult blood test (SPA-test) and T antigen detection in rectal mucus (T-test) were used as screening test in asymptomatic mass screening to evaluate their complementary effect. Results: Positivity was seen in 472 (9.75%) by SPA-test and 297 (6.13%) by T-test among 4843 subjects. In 769 cases with positive screening tests, 4 cancers (2 early cases) and 48 adenomas (17 cases > 1.0cm, 35.4%) were identified by colonoscopy, in which, 3 cancers and 29 adenomas showed SPA-test positive and 2 cancers and 27 adenomas T-test positive. Combined use of the two tests could enhance the detective rate. The same screening scheme was taken 2 years latter in this population, 281 (7.72%) by SPA-test and 196 (5.58%) by T-test were positive among 3641 subjects. No cancer and only 18 adenomas (4> 1.0cm, 22.2%) were found in 477 positive cases in follow-up. 88.89% (16 cases) adenomas showed mild atypical hyperplasia and only 11.11% (2 cases) moderate to severe, while screening of 2 years ago, the moderato to severe atypical hyperplasia was 25%. Conclusions: The combined use of SPA- and T-tests for mass screening will not only decrease the incidence of colorectal tumors, but also decrease the occurrence of severe atypical hyperplasia.