合肥市社区居民结直肠癌筛查及其患病危险因素分析

目的 探讨社区居民结直肠癌患病的危险因素,为构建结直肠癌及其癌前病变的早期筛查方法提供依据。 方法 基于哈佛癌症风险指数方法改良后适用于我国人群的癌症风险评估系统,对合肥市7个行政区域社区内40~69岁居民进行流行病学问卷调查和癌症风险评估,随后对评定为结直肠癌高危人群者进一步行肠镜检查等临床筛检,以发现结直肠癌及其癌前病变,最后按是否为结直肠癌及其癌前病变为因变量,做二分类Logistic流行病学多因素回归分析。 结果 采用经改良后哈佛疾病健康指数癌症风险评估系统对29 750名社区居民进行结直肠癌危险度评价,发现结直肠癌高危因素者4 696人(15.78%),其中40~44岁及65~69岁组不同性别间高危因素者比例差异存在统计学意义(P<0.05),40~岁组和50~岁组CRC患病率显著高于60~岁组。进而对高危人群进行临床筛查,发现结肠癌1例和癌前病变86例。对结直肠癌及其癌前病变进行多因素Logistic分析表明慢性结直肠炎等消化道疾病、丙型肝炎、高血压为危险因素,职业为服务业、被动吸烟、乙型肝炎为保护因素。 结论 采用以生活方式为主要内容的疾病健康指数方法对社区居民结直肠癌进行风险评价,进而对高危人群作临床筛查,符合疾病早期预防和卫生经济学原则,可提升社区居民对结直肠癌早诊早治的依从性,值得探索。对慢性结直肠炎、肝炎,尤其是丙型肝炎等慢性病应积极关注,倡导健康生活方式有利于结直肠癌的预防。 

Analysis of colorectal cancer screening and risk factors assessment for community residents in Hefei

Objective To investigate risk factors of colorectal cancer in community residents,and provide the basis for the early cancer detection. Methods A self-administered questionnaire based on cancer risk assessment systems that modified from Harvard Cancer Risk Index were used in the survey.The community residents aged 40 to 69 of seven administrative region of Hefei were assessed.The high-risk population were then suggested to do further colonoscopy check and clinical screening to detect colorectal cancer or precancerous lesions.Disease or health as the dependent variable,the related risk factors were analyzed by binary logistic regression method. Results Total 4 696 people (15.78%) in 29 750 cases were detected for colorectal cancer risk factors by Harvard Cancer Risk Index evaluation.There were significant differences between the sexes,and between the age groups in 40-44 and 65-69 year (P<0.05).The prevalence in group of 40-and 50-were significantly higher than group 60-.One colon cancer and eighty-six precancerous lesions cases were found by clinical colonoscopy examination.Multivariate logistic regression analysis showed that chronic colonic enteritis,gastrointestinal disease,hepatitis C,high blood pressure were the risk factors,and service industry,passive smoking,hepatitis B were protective factors. Conclusion It is conforming to the principle of early disease prevention and health economics with assessing risk of colorectal cancer by disease health index of lifestyle and then doing clinical examination for the high-risk,which promote the residents'attention of early detection and treatment.Treating chronic colonic enteritis,hepatitis,especially hepatitis C actively,learning healthy lifestyle could be beneficial to the prevention of colorectal cancer.