直肠粘液T抗原检测在大肠癌临床筛检中的应用

目的　选取结直肠癌及非癌病例作直肠粘液Ｔ抗原检测（Ｓｈａｍ试验）与粪隐血试验的对比分析,评价直肠粘液Ｔ抗原在大肠癌早期初筛中的价值。方法对１９９７～２０００年间５２例结直肠癌及非癌病例进行直肠粘液Ｔ抗原检测及粪隐血试验。结果２９例结直肠癌病例中Ｔ抗原阳性者２６例（８９．７％）、粪隐血阳性者１５例（５１．７％）,２３例非癌病变者Ｔ抗原阳性８例（３４．８％）、粪隐血阳性１１例（４７．８％）。结论直肠粘液Ｔ抗原检测可以取代粪隐血试验成为大肠癌普查的新方法。     

Accuracy and value of the Hemoccult test in symptomatic patients

Hemoccult faecal occult blood testing is widely advocated as a screening test for colorectal cancer but few studies have shown its correlation with conventional methods of investigation for colorectal disease. In a prospective study of 802 symptomatic patients with suspected colorectal disease there was good patient compliance (92.5%) and a high specificity for colorectal cancer (85.4%). The false positive rate was 8.6% (12 of 140 patients with positive results), and while the test result was positive in 22 of 26 colonic cancers the false negative rate for rectal cancer (45.4%) should not detract from its value as a screening test if proper digital anorectal and proctosigmoidoscopic examination are widely practised. A positive Hemoccult test result is a useful indicator for the need to proceed to full colorectal investigation, including colonoscopy.     

上海某社区人群大肠癌伺机性筛查结果分析

目的了解社区人群大肠癌危险因素现况,验证分析序贯模式的伺机性筛查效率。方法上海欧阳社区50～85岁常住居民问卷调查和粪便潜血试验（FOBT）初筛,阳性者行肛指、血清肿瘤标记物和结肠镜精筛。结果1206人完成初筛,FOBT总阳性率4％（45／1206）,评估为高危176人,阳性率15％,均接受后续精筛,结肠镜顺应率100％。结肠息肉检出率9％（15／176）,大肠癌检出率5％（8／176）,其中结肠癌5例（63％）,直肠癌3例（37％）。结论社区人群大肠癌高危因素聚焦在遗传背景、腹型肥胖和体力活动缺乏。序贯模式的伺机性筛查顺应性好、效率高、成本低,适合社区人群大肠癌筛查应用。     

Familial colorectal cancer and the screening of family members

A case-control study was undertaken of the family histories of colorectal cancer in 128 patients with colorectal cancers and those of 61 patients with colorectal adenomas and matched surgical control patients who were attending a regional surgical service in Western Australia. One family with multiple polyposis of the colon was excluded from the study. A history of colorectal cancer in one or more first-degree relatives was associated with a relative risk of colorectal cancer of 2.5 (95% confidence interval, 0.8 to 8.0), of adenoma of 2.0 (95% confidence interval, 0.5 to 8.0) and of any colorectal neoplasm of 2.3 (95% confidence interval, 0.9 to 5.6). Four patients with colorectal cancer and one patient with colorectal adenoma had more than one first-degree relative with colorectal cancer, whereas no control subject gave this history. The five families that were represented by these cases each showed some other features of non-polyposis familial colorectal cancer. It was estimated that familial factors could explain 60% of colorectal cancer in persons with a family history of the disease in a first-degree relative and 5% of colorectal cancer in the population as a whole. Haemoccult II tests were posted to 629 living first-degree relatives of the patients with colorectal cancers and adenomas; 44% of these relatives returned the completed tests. Four relatives with positive results of tests both before and after dietary restriction were investigated; all four subjects had colorectal adenomas. In addition, one subject had a short segment of ulcerative colitis. A further mailing of Haemoccult II tests one year later gave a 39% response rate; no further cases of colorectal neoplasia were found. One relative developed carcinoma of the caecum 10 months after a negative result in the first round of Haemoccult screening. Persons with two or more first-degree relatives with colorectal cancer, with or without other features of non-polyposis familial colorectal cancer, are at a high risk of the development of colorectal cancer. The comparatively-poor response to an offer of Haemoccult II testing and its known insensitivity and lack of specificity suggest that it is not a satisfactory method of screening these high-risk subjects.     

在血吸虫病流行区以线网擦取直肠粘膜在直肠癌普查中的意义

1977年我们在浙江省海宁县利用线网细胞采集器擦取直肠粘膜细胞作涂片镜检,在86,673例涂片中发现78例核异质细胞,10例腺癌细胞,并经病理切片证实,两者符合率100％。在涂片中还发现各类寄生虫卵,如血吸虫卵2,576例,钩虫卵887例,蛔虫卵14,759例。通过大量工作实践,我们认为用线网细胞采集器擦取直肠粘膜细胞涂片镜检,作大肠癌诊断,方法安全、可靠,简便,易行,阳性率高,可作为大肠癌普查的手段之一,对肠道寄生虫病的诊断也有一定帮助。文中并对直肠粘膜各类脱落细胞的特征作了较详细的描述,强调了肠粘膜细胞易于退变,特别是肿胀性退变的特点。国内类似资料尚较少见。     

Effect of dietary restriction on participation in faecal occult blood test screening for colorectal cancer

OBJECTIVES: To determine if participation in colorectal cancer screening using faecal occult blood testing (FOBT) is affected by a restrictive diet and if it is associated with certain demographic variables. PARTICIPANTS AND SETTING: 1,203 residents of South Australia aged 50-69 years, with no "currently active bowel disease", randomly selected from a database of people willing to be contacted about unspecified health issues. DESIGN: Randomised controlled trial: participants were offered screening by immunochemical FOBT by mail in 1998. Half were randomly allocated to a group instructed to follow a low-peroxidase diet, as required for guaiac FOBT, while the other group was not so restricted. MAIN OUTCOME MEASURES: Effect of diet restriction on participation (return of correctly completed FOBT sample cards within 15 weeks); time taken to return cards; relationships between participation and demographic variables. RESULTS: Participation rates were 65.9% (no-diet group) and 53.3% (diet group) (difference, 12.6%; 95% CI, 7.1%-18.1%). In the first week, rates of return as a proportion of all tests returned were 13.1% (no-diet) and 1.6% (diet) (difference, 11.5%; 95% CI, 8.6%-14.4%), increasing to 54.3% and 44.5%, respectively, after five weeks (difference, 9.8%; 95% CI, 4.2%-15.4%). Participation was significantly associated with older age (odds ratio, 1.40; 95% CI, 1.10-1.78), but not sex, Index of Social Disadvantage or rural versus urban address. CONCLUSIONS: Dietary restrictions create a barrier to FOBT-based screening for colorectal cancer. The use of immunochemical rather than guaiac FOBT removes this barrier.     

Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics

OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.     

Colorectal cancer screening for the natural population of Beijing with sequential fecal occult blood test: a multicenter study

Objective To assess the prevalence of colorectal cancer(CRC)in Beijing and the reliability or the sequential fecal occult blood test(SFOBT)for CRC screening.Methods Of the natural population(48 100 persons)in several Beijing communities,we screened 26 827 persone with age over 30 using the SFOBT screening program,Guaiacum Fecal Occult Blood Test(GFOBT),lmmuno Fecal Occult Blood Test(IFOBT),and colonoscopies.Results The screening rate of the population was 74%.The positive rate of SFOBT was 5.6%.The prevalence of CRC in the entire population of Beijing was therefore calculated to be 36.57/10^5.Of 12 CRC detected patients,4 cases were in stage DukesA (33.33%),7 cases in stage Dukes B(58.33%),only 1 case(8.34%)in stage Dukes C.Conclusions The prevalence of CRC in Beijing is one of the highest in China,Individuals at high risk for CRC or those over 50 years of age should be considered as primary candidates for screening,SFOBT screening is a cost-effective and reliable method for early detection of CRC.     

消化科门诊应用粪便潜血筛检大肠肿瘤的研究

目的探究粪便潜血检查对于大肠肿瘤的筛检意义。方法纳入北京协和医院消化科门诊行粪便潜血和结肠镜检查并有病理学检查结果的512例患者,以结肠镜及病理检查结果为标准,评价粪便潜血结果的诊断价值。结果512例患者中,203例粪便潜血结果阳性,353例结肠镜检查正常,115例有各种息肉,病理检查结果示9例高度不典型增生、21例为大肠癌。粪便潜血检查对于大肠腺瘤性息肉检出的灵敏度、特异度、阳性似然比和阴性似然比分别是42．8％、60．9％、1．09和0．93;对大肠癌及高度不典型增生的灵敏度、特异度、阳性似然比和阴性似然比分别是76．6％、62．5％、2．05和0．37。结论在消化内科就诊的患者中,粪便潜血检查对于大肠癌有一定的诊断和筛查意义,有助于临床医生合理临床决策,但尚需前瞻性研究以建立更可靠的大肠癌筛查模型。     

上海市金山区某社区大肠癌筛查效果评估

目的 评估社区大肠癌筛查工作现况,为完善大肠癌社区筛查工作提供理论参考。 方法 选取2013年5月—2015年1月期间在上海市金山区朱泾社区卫生服务中心进行大肠癌筛查的40岁以上社区居民的筛查资料,采用SPSS 19.0统计软件对这些居民的大便潜血检查结果、危险度评估结果与肠镜检查和活检的最终结果进行一致性分析。 结果 2013年5月—2015年1月期间共计7 787例辖区居民进行大肠癌社区初筛,筛出1 727例阳性,检出率22.4%;其中,大便潜血阳性1 447例,检出率为18.8%,问卷危险度评估阳性438例,阳性率为5.7%,2种方法检出的阳性重复病例为158例,重复率为9.15%。转诊818例(47.37%),确诊病例303例(37.04%),大便潜血和危险度评估确诊率分别为36.24%、39.90%。经检验,2种办法与诊断结果一致性也并不显著(P＞0.05)。 结论 我国社区目前在大肠癌初筛过程中所使用的危险度评估和大便潜血检验方法,筛查效能相当且重复率较低,这就保障了卫生资源的充分利用。多种低重复、高效度筛查指标协同配合可有效提高社区人群大肠癌筛查的早发现、早诊断,但人群转诊依从性有明显限效作用需进一步提高。      

西咪替丁在体外对大肠癌细胞的敏感性

目的探讨西咪替丁在体外对大肠癌细胞药物敏感性。方法采用MTT法体外检测西咪替丁对54例大肠癌患者癌细胞的药物敏感性，依其性别、年龄、部位、Dukes分期、p53蛋白表达分组，统计分析各组病例的敏感药物的差异。结果西咪替丁在54例大肠癌患者中有14例敏感，敏感率为25．9％；结肠癌的敏感率为46．2％，显著高于直肠癌（7．1％）；p53阳性表达者的敏感率为40％，显著高于p53阴性者（8．3％）；性别、年龄、Dukes分期与药物的敏感率无关。结论西咪替丁在体外对部分大肠癌患者癌细胞有抑制作用，特别是对结肠癌和p53阳性表达的患者。     

2015—2017年上海市松江区中山街道社区大肠癌筛查情况和肠镜检查顺应性及其异常病变的影响因素研究

目的　描述2015—2017年上海市松江区中山街道社区大肠癌筛查情况,探索影响肠镜检查顺应性及其异常病变的影响因素。方法　根据上海市社区居民大肠癌筛查工作规范,于2015—2017年纳入50~74岁上海市松江区中山街道社区常住居民。第1年纳入全部符合标准的居民,后2年分别纳入前1年初筛阳性者和当年新入50岁人群。对社区居民进行危险度评估问卷和便隐血试验（FOBT）相结合的大肠癌初筛,任意阳性者即为初筛阳性。建议初筛阳性者进一步至定点医院进行肠镜检查以确诊。结果　2015—2017年,松江区中山街道社区共计筛查6 994例次,2015年筛查4 132例次、2016年筛查1 604例次、2017年筛查1 258例次。总体初筛阳性率为25.25%（1 766/6 994）,FOBT阳性率为5.96%（417/6 994）,问卷阳性率为21.12%（1 477/6 994）,FOBT与问卷双阳性率为1.83%（128/6 994）。接受肠镜检查者239例次（13.53%）,肠镜检查结果异常者124例次（51.88%）,肠镜检查异常病变中,腺瘤检出率较高,肠炎次之。多因素Logistic回归分析结果显示,单一FOBT阳性〔OR=42.967,95%CI（22.019,83.844）〕、FOBT与问卷双阳性〔OR=30.059,95%CI（11.723,77.074）〕是首次初筛阳性者肠镜检查顺应性的影响因素（P<0.001）;年龄〔OR=3.104,95%CI（1.177,8.189）〕是首次肠镜筛查者肠镜检查异常病变的影响因素（P=0.022）。结论　2015—2017年松江区中山街道社区大肠癌筛查初筛阳性率与上海市其他社区相仿,但是高危人群肠镜检查顺应性明显低于上海市其他地区。初筛阳性和年龄是影响社区居民肠镜检查顺应性及其异常病变的影响因素。     

Influence of non-steroidal anti-inflammatory drugs on the outcome of faecal occult blood tests in screening for colorectal cancer

Non-steroidal anti-inflammatory drugs have been accused of causing false positive results in faecal occult blood tests for colorectal cancer. A study was therefore performed in 10,931 people undergoing faecal occult blood screening tests to assess the effect of these drugs on the predictive value of a positive test result. Those with a positive result were interviewed and a full drug history was taken before they underwent a full colorectal examination. Of the 455 people with a positive result, 50 were taking non-steroidal anti-inflammatory drugs: 10 (20%) had colonic neoplasia. Of the 405 who were not taking non-steroidal anti-inflammatory drugs, 129 (32%) had colonic neoplasia. These detection rates were not significantly different, and the predictive value of a positive result for an adenoma larger than 1 cm was 14% in the group not taking anti-inflammatory drugs and 26% in the group taking them (not significant). These results suggest that a finding of occult faecal blood cannot be attributed to upper gastrointestinal tract bleeding caused by non-steroidal anti-inflammatory drugs and should be followed by a thorough colorectal examination.     

对半乳糖氧化酶检测大肠癌价值的初探

本文对177例患者进行直肠指检，取粘液作半乳糖氧化酶（GO）试验，同时作纤结镜检查。结果发现：19例大肠癌GO试验阳性18例（94．7％）；非癌性组中大肠息肉24例阳性18例（75％），其它疾病105例阳性23例（21．9％），正常结肠粘膜29例阳性3例（10．3％）。所查病例中大肠癌术后6例阳性3例（2例肠癌复发，1例息肉）。资料表明：GO试验对大肠癌和息肉的敏感性分别为94．7％及75％，特异性为72．2％及71．2％。提示GO试验可作为大肠癌及癌前病变的普查筛检试验，并可用作大肠癌术后病人的随访。     

大肠癌术前血清CEA、CRP联合检测的临床价值

目的 探讨大肠癌术前血清ＣＥＡ、ＣＲＰ联合检测的临床价值。方法 对２９７例大肠癌患者测定其ＣＥＡ、ＣＲＰ,从病理分期、癌肿部位和手术方式方面进行研讨。结果 联合检测的总阳性率为９０．５７％,明显高于单项检测者：两项阳性者与手术方式有密切关系：右半结肠癌与左半结肠癌直肠癌的ＣＲＰ阳性率和均值相比,差异明显。结论 术前血清ＣＥＡ、ＣＲＰ联合检测具有显著的互补性和临床实用价值。     

Mass detection of bacteriuria by combination of two screening tests

The Uriglox screening test was compared with the modified Griess Nitrite test and with standard urine cultures in the detection of significant bacteriuria on 400 ambulant and asymptomatic residents of the Athens Home for the Aged. The modified Nitrite test alone detected 62%, and the Uriglox test 79% of the 103 cases with positive urine cultures in the examined group. There was significant overlap in the positive cases picked up by each screening test separately, the Uriglox test identifying more Klebsiella infections. Since there were no false-positive cases with either one of the employed tests, the cases identified by one or the other or both screening tests amounted to 95% of the total number of bacteriuric samples. The combination of the moderately sensitive but highly specific test of Nitrite, with the very sensitive test of Uriglox, can effectively substitute for the expensive and time-consuming quantitative bacterial counts with pour-plate techniques in mass screening for bacteriuria.     

Report of colon cancer detection in mass surveys using immunological occult blood test (latex method)

Occult blood test for the screening of colon cancer has been made by immunological method using tatex agglutination for 4 years since 1988. A total of 35,139 persons have received the screening test and out of 1886 persons, that is, 5.4% showed positive. Five hundred seventy of the positive result subjects (30.2%) underwent barium enema examination. Three hundred fifty nine subjects (62.8%) showed some abnormal findings. They underwent colonoscopic examination and 45 of them (7.9%) had colon cancer. Twenty six of these were of early stage type and 19 persons were of advanced stage.     

粪便脱落细胞学与粪隐血试验联合检测在结直肠癌诊断的临床意义

目的:通过分析粪便脱落细胞学与粪便隐血在结直肠癌发生、发展中的规律,进而评判粪便脱落细胞学与粪便隐血试验在结直肠癌诊断中的临床意义。方法:对243例患者粪便脱落细胞学与粪便隐血试验与癌胚抗原(CEA)的关系进行分析。结果:243例患者中,粪便隐血试验阳性率为79.5%;粪便脱落细胞学阳性率83.5%;CEA检出率为45.4%或52.9%。结论:粪便脱落细胞学与粪便隐血试验对结直肠癌的诊断有重要的临床意义,是结直肠癌筛检的重要手段,所以在临床应用中,采取两者互补的方法,可大大提高结直肠癌的检出率,且阳性率优于CEA。     

粪便多基因联合检测在结直肠癌早期筛查中的应用

目的 研究联合检测粪便中sFRP2、Vimentin和HPP1基因甲基化状态在结直肠癌早期筛查中的应用。 方法 将杭州市第三人民医院2017年10月—2019年10月期间收治的结直肠癌患者60例为结直肠癌组,由腺瘤性息肉患者60例及正常健康人30例组成非结直肠癌组(90例),收集清晨粪便标本,提取粪便DNA,并进行亚硫酸氢盐修饰处理,采用甲基化特异性PCR检测sFRP2、Vimentin和HPP1基因甲基化状态,分析其与结直肠癌临床病理特征的关系,比较3个基因联合检测诊断敏感度及特异度。 结果 在结直肠癌患者中,检测sFRP2、Vimentin和HPP1单基因甲基化敏感度分别为46.7%、43.3%、53.3%,特异度分别为73.3%、75.6%、76.7%;联合组以3个基因中任1个基因甲基化表达阳性判为阳性,联合检测诊断结直肠癌的敏感度为83.3%,特异度为46.7%,敏感度均高于sFRP2、Vimentin和HPP1单基因甲基化检测。3个基因甲基化状态与结直肠癌患者的性别、年龄、肿瘤部位、淋巴结转移及TNM分期均无关(均P>0.05)。 结论 在结直肠癌患者粪便DNA中sFRP2、Vimentin和HPP1基因异常甲基化发生率明显高于非结直肠癌患者,联合检测粪便多基因筛查结直肠癌优于单基因检测,在结直肠癌早期筛查应用中具有重要意义。      

Predictive value of rectal bleeding in screening for rectal and sigmoid polyps

Overt rectal bleeding is a common symptom of colorectal cancer and polyps but also occurs in apparently healthy people. It is not known how often this represents bleeding from an undiagnosed rectal or sigmoid polyp or cancer. Three hundred and nineteen apparently healthy men aged over 50, selected by random sampling, were interviewed and underwent flexible sigmoidoscopy to at least 30 cm. Polyps of 10 mm or more in diameter were diagnosed in 12, one of whom also had an adenocarcinoma. Rectal bleeding during the previous six months was reported by 48, four of whom were found to have polyps; seven polyps and one cancer were diagnosed among the 271 who reported no rectal bleeding. Rectal bleeding had a specificity of 86%, a sensitivity of 33%, and a positive predictive value of 8% for rectal or sigmoid polyps or cancer. Restricting the analysis to those subjects who regularly inspected their stools did not improve the predictive value. Sigmoidoscopy in apparently healthy subjects with rectal bleeding will not result in the diagnosis of appreciable numbers of rectal and sigmoid polyps or cancers.