原发性肝癌高发现场高危人群筛检研究

探讨肝癌高发现场发现早期肝癌的有效方法，查明ＨＢＶ感染与肝癌的关系。方法：本文应用ＥＬＩＳＡ方法筛检同安县肝癌高发人群，并对筛检后的ＨＢｓＡｇ，ＡＦＰ阳性人群进行前瞻观察。结果：检出原发性肝癌，ＨＢｓＡｇ阳性肝癌检出率是ＨＢｓＡｇ阴性肝癌检出率的１１．６倍；前瞻观察结果，发现肝癌２０例，ＨＢｓＡｇ阳性者肝癌发生率是ＨＢｓＡｇ阴性者肝癌发生率的６．１１倍。     

原发性肝癌高危人群的研究

本文通过分析上海市肝癌发病情况和上海医科大学肝癌研究所的肝癌住院病人，显示上海市肝癌男性标化发病率为２９．６／１０万，女性为１０．０／１０万，男女合计为２０．１／１０万。男女发病率比约为３：１．男性肝癌发病率在３５岁前较低。以后逐渐上升，至４０岁接近男性全市平均水平，５０岁后发病率增幅较前要快，至８０岁达到高峰。女性肝癌发病率较男性低，年龄亦较晚，到５０岁才接近女性全市平均水平，发病年龄的高峰与男性相差１０年左右。肝癌患者中ＨＢｓＡｇ的阳性率显著高于自然人群，在有慢性肝炎史的肝癌患者中有近１／４的人ＨＢｓＡｇ阴性，提示有丙肝病毒感染的可能，肝癌患者的抗－ＨＣＶ阳性率为１１．１％，与ＨＢｓＡｇ的双重阳性率为５．８％，提示与ＨＢｓＡｇ独立，而在人群中抗ＨＣＶ的阳性率为２％左右，提示ＨＣＶ也是原发性肝癌的危险因素，所以肝癌的高危人群应包括抗ＨＣＶ阳性及一切有慢性病毒性肝炎史者。本文认为，在上海市，男性４５岁以上，女性５０岁以上，ＨＢｓＡｇ阳性或抗ＨＣＶ阳性或有慢性肝炎史的人群是肝癌的高危人群。     

高危人群中筛检发现的肝癌临床分析

本文分析应用ＡＦＰ和／或Ｂ超筛检发现的原发性肝癌２９８例。资料表明，ＡＦＰ≤５０ｍｇ／Ｌ的ＰＨＣ依赖Ｂ超发现，ＡＦＰ５１～４００ｍｇ／Ｌ的ＰＨＣ依赖ＡＦＰ与Ｂ超筛检而诊断，两者合计占３ｌ．２％，显示Ｂ超基本解决ＡＦＰ低水平或阴性肝癌的诊断问题。高危险肝癌人群筛检可发现近４／５（７９．５％）为早期肝癌。晚期肝癌仅占２％，其ＡＬＴ、ＡＬＰ、ｒＧＴ、胸透、Ｂ超的阳性率较低，而单个癌结节、门脉无癌栓小肝癌发现率手术探查率。切除率及生存率较高。高危险人群中进行筛检具有经济、实用、有效、具有积极的临床意义。不失为肝癌早期发现Ⅱ级预防的有效途径之一。     

肝癌高发现场的普查及筛检研究

在肝癌高发的江苏省启东地区,自7O年代起,开展了大规模的自然人群普查和高危人群筛检,在肝癌的早期发现、早期诊断、及时治疗、提高疗效方面获得了一定的成效。本文就肝癌高发现场自然人群普查及其高危人群筛检进行简要阐述。l发展史肝癌高发现场的筛检研究,经历了三个阶段：70年代为第一阶段,初期采用琼脂双扩散和对流免疫电泳法检测al;P78637人,发现App阳性159例,其中30例无任何自觉症状,经过半年随访,证实均为肝癌。显示了周T检测对肝癌诊断的准确性和早期价值。嗣后应用灵敏简便的血球凝集试验和火箭电泳自显影法,在当地进…     

南汇县肝癌高危人群界定的研究

在南汇县原发性肝癌危险因素定群研究的基础上，以累积发病概率P=[1＋exp（8．8440－0．9321*性别-0．0446*年龄-0．0380*肝炎暴露时间-0．1220·小河水饮用时间）]-1=0．004作为肝癌病、低危人群的划分点时，该高危人群的肝癌发病率为137.53／10万，约为自然人群的3．17倍，肝癌发病数占整个自然人群肝癌发病数的71．3％．其中女性肝癌病人占20．8％，筛出每例肝癌的平均费用约4．700无，证明是费用低而效果好的肝癌高危人群确定方法．     

胃癌高发现场高危人群综合防治研究

目的：通过对我国辽宁庄河及山东临朐胃癌高发区胃癌及其高危人群的筛选及癌前状态的干预研究。建立切实切可行的胃癌筛查方案,模索胃癌化学干预中期生物学评估指标。方法：利用血清胃蛋白酶原检测,双对比造影＋胃镜、胃粘膜活检两轮筛查法进行胃癌及其高危人群的筛选;利用限制性片断长度多态性分析方法对胃癌高危人群进行胃蛋白酶原C基因多态性检测,采用随机对照干预实验,对胃幽门螺杆菌感染者及高危人群分别实施抗幽门螺杆菌治疗、中药阻断治疗及大蒜素＋VitC治疗,并对干预效果进行评价;对全民进行以改变不良饮食习惯为主的群体行为干预。结果：庄河现场早期胃癌检出率为56．82％;现场普查中发现的胃癌患者3年生存率为7607％;作为胃癌初筛方法,血清胃蛋白酶原含量检测优于对比造影,国人血清胃蛋白酶原含量检测初筛胃癌的参考临界值（Cut-off)可以考虑由P1≤50＋P1／P2≤3;胃癌组胃蛋白酶原C基因EcorR Ⅰ稀有片断出现频率高于正常组而常见片断有缺失,对4例携带稀有片断的胃癌家系成员进行追踪随访,发现有2例分别在2．5年及5年后罹患者早期胃部,IL－8、PCNA、P53粘、粘蛋白与Hp感染呈正相关而p16与其呈负相关;细胞凋亡下Hp感染相关性胃疾病的发生发展过程相关。结论：庄河现场及监朐已成可以开展前瞻性胃癌流行病学、病因学及大规模人群筛查及随机对照干预实验的胃癌高发区研究 基地、胃癌高危人群一、二级预防一、二级预防初见成效。     

肝癌高危人群监查的研究进展

筛检和监查高危人群是发现早期肝癌的主要措施。对乙型，丙型肝炎病毒感染，肝硬化等肝癌高危人群，每6个月监查一次B超和（或）血清AFP。早期发现的肝癌患者经有效治疗后，生存期延长，生存率提高。     

社区肝癌高危人群筛查间隔时间的探索

[目的]研究和检验高危人群筛查间隔时间与肝癌早发现两者间的关系。[方法]在自愿基础上筛查对象选择年龄35至59岁,血清检查证实有HBV感染标志者;有慢性迁延性肝炎或肝硬化史5年以上者;有肝癌家族史者;甲胎蛋白低持阳性者。检查项目首次列入监测者作血“二对半”、血甲胎蛋白(放射免疫法)、肝脏B超,如有慢性迁延性肝炎者加做肝功能,以后间隔半年复查一次,复查项目为血AFP+肝B超。[结果]3年共复查6次,除第2次未发现肝癌病人外,其余每次都发现肝癌,检出率为0.56％。按半年定期复查病人发现的肝癌都是亚临床期,肝肿瘤结节平均在2.4cm×2.9cm。未定期复查(漏查)发现的病人全部是中晚期,肝肿瘤结节平均在7.7cm×8.4cm。[结论]坚持半年复查一次者,能及时发现亚临床期肝癌。     

胃癌高发现场高危人群综合干预研究方案实施

肿瘤预防学是肿瘤研究前沿科学,病因学预防（一级预防）是肿瘤预防研究的核心内容。胃癌仍是目前我国最高发恶性肿瘤,死亡率高居恶性肿瘤榜首。随着胃癌病因学研究进展,有针对性地对胃癌采取干预措施以实现胃癌预防已成为可能。“九五”期间,胃癌被列为我国重点进行预防研究的恶性肿瘤之一。我国胃癌高发区辽宁庄河现场,针对胃癌高危人群的综合干预措施已经付诸实施。１胃癌高发研究现场的选择１１基本情况 流行病学研究资料表明,胃癌分布存在着地区差异。我国胃癌的地区分布特点是全国范围内均有发生,但以西部山地丘陵地带和东南沿…     

肝癌高发区不同水体对健康人微核率的影响

应用微核检测技术，研究不同类型饮用水诱发健康人外周血淋巴细胞的微核效应，结果表明：①不同饮用水的细胞毒作用依次为宅沟水＞泯沟水＞自来水＞重蒸水，其微核诱变效应为泯沟水＞自来水＞重蒸水。②不同饮用水诱发的微核率与饮用相应类型水的居民的肝癌发病率呈平行关系。进一步证实了肝癌高发区饮用水与原发性肝癌的发生密切相关。提示饮用深井水、改进饮水质量是一项行之有效的干预性措施；如能长期坚持，对预防肝癌有着积极的意义。     

Colonoscopy Screening Results in at Risk Iranian Population

Objectives: To investigate the prevalence of colorectal adenomas and other advanced lesions in first degreerelatives of Iranian patients diagnosed with colorectal cancer by colonoscopy and pathologic evaluation. Methods:Iranian colorectal cancer patients (probands) were identified through pathologic reports of the regional cancerregistry. First degree relatives (siblings, parents and offspring) of probands were evaluated for the existence ofpolyps and precancerous lesions via colonoscopy screening. Control patients were chosen among average riskpopulation with no family history of colorectal cancer who agreed to colonoscopy screening. Results: A total of184 subjects underwent colonoscopy screening from April 2007 to March 2009. From 90 cases among familiesof probands, 70 (77.8%) had a normal colonoscopy result, 18 (20%) demonstrated polyps and 2 (2.2%) werediagnosed with colorectal cancer. Colonoscopy screening in 94 average risk control patients discovered polypsin 4 (4.3%) cases and the other 90 (95.7%) patients had normal total colonoscopy results. Mean age of caseswith advanced lesions was 48.4±10.2 and 41.5±18.4 in control patients with polyps. The incidence of polyps wassignificantly higher in males, and in family case patients compared to controls. Conclusions: Based on colonoscopyscreening, the prevalence of colorectal adenoma and precancerous lesions in first degree relatives of patientsdiagnosed with colorectal cancer is significantly higher than in the average risk population.     

食管癌高发区人群内镜筛查

[目的]探讨在高发区高危人群中发现早期癌及癌前病变的有效途径。[方法]林州市“食管癌早诊早治示范基地”依据中国癌症基金会对基地高危人群筛查方案．2005～2007年在林州市合涧镇的目标人群中按照顺应性70％的要求,对8432例40～69岁的6048例人群进行了内镜＋食管碘染色＋指示性活检和贲门脊根部活检。[结果]发现癌症患者100例,其中食管癌38例,贲门癌54例,胃癌7例,下咽癌1例．其中早期癌83例．检出率1．65％;癌前病变（高级别上皮内瘤变）148例,检出率2．45％。[结论]提高高危人群对癌症的认知度,推广食管碘染色和贲门脊根部常规活检技术．是提高食管贲门癌早期发现的关键。     

非高发区食管癌筛查人群食管病理分布

摘 要：［目的］探讨非高发区食管癌筛查人群的食管病理分布,评价食管癌筛查检出效果。［方法］采用整群抽样的方法,以食管癌发病率不高于河南省平均发病水平的3个县/市为研究现场,对当地40～69岁居民进行风险问卷评估,对高危人群开展以食管碘染色及指示性活检为技术的食管内镜检查,并对内镜下异常的病变进行病理活检确诊。诊断结果以病理结果为标准。描述不同性别及年龄组人群食管病理分布。［结果］ 参加食管癌内镜筛查人数23 733人,进行活检人数13 679人,活检率57.64%。食管疾病发病率由高到低依次为食管炎性疾病、鳞状上皮轻度异型增生、鳞状上皮中度异型增生、鳞状上皮重度异型增生、食管早期癌、浸润癌。食管各类病变发病率随年龄增长而增加,且在男性人群中发病率均高于女性。内镜活检病理人群中,各类食管异常病理占比39.92%,癌前病变及食管癌占比7.28%,早期癌及以上病变占0.69%。内镜筛查人群中,各类食管异常病理占23.00%,癌前病变及食管癌占4.19%,早期癌及以上病变占0.39%。［结论］ 内镜下碘染色技术用于非高发区人群食管癌筛查,阳性检出率明显低于高发区食管癌筛查检出率。非高发区人群的食管癌筛查策略需要进一步改进。     

食管癌高危人群年龄界定探讨--附16763例细胞学结果分析

目的探讨食管癌高危人群年龄的界定.方法以16763例40～65岁村民细胞学普查结果和癌前病变人群3年自然变率为样本,根据细胞学五级六类诊断标准特点,普查结果采用H检验.癌前病变人群的自然癌变统计,以40～65岁普查诊断的正常人群为参照采用RR分析.结果 H检验除＜45岁与45～49岁年龄组比较P＞0.05以外,其它各组比较均P＜0.05.在45岁～,50岁～和60岁～三个年龄组中,癌前病变的RR分别为3.97,8.93和13.57.P＜0.05.结论食管癌高危人群年龄界定在45岁以上为宜.     

Factors Associated with Periductal Fibrosis Daignosied by Ultrasonography Screening among a High Risk Population for Cholangiocarcinoma in Northeast Thailand

Background The population in northeast Thailand continues to present with hepatobiliary abnormalities, particularly periductal fibrosis (PDF) which is the result of chronic infection with liver fluke (Opisthorchis viverini; OV) and may lead to the development of cholangiocarcinoma (CCA). Although the prevalence of OV infection has been decreased due to a liver fluke control program over decades, the prevalence of PDF remains high. This study aimed to investigate demographic factors associated with PDF risk based on ultrasonography (US) screening. Materials and Methods This cross-sectional study is part of the Cholangiocarcinoma Screening and Care Program (CASCAP), a prospective cohort study. Multiple logistic regression was used for data analysis. Results In 55,246 subjects, the overall prevalence of PDF was 33.0% (95%CI 32.6 - 33.4). Males (33.9 %) were at higher risk for developing PDF than females (32.2 %) (ORcrude 0.93; 95%CI 0.89 - 0.96; p-value < 0.001). Factors associated with an increased PDF risk, in addition to OV infection, included old age ( 70 years) (ORadj 1.28, 95% CI 1.14 - 1.44, <0.001) and hepatitis B infection (ORadj 1.31, 95% CI 1.11 - 1.55, p 0.001). In contrast, number of praziquantel treatments (> 2 times) (ORadj 0.54, 95% CI 0.47 - 0.63, <0.001) and diabetes mellitus (ORadj 0.57, 95% CI 0.49 - 0.65, <0.001) were significantly associated with a decreased PDF risk. Conclusions Future US screening should closely examine older people and hepatitis B subjects for the purpose of PDF surveillance among high risk groups for CCA. However, the results of inverse associations require further investigation in order to confirm our findings.     

High Risk Breast Cancer Screening is a Double Edged Sword: A Qualitative Study of Patient Perspectives on the Ontario High Risk Breast Cancer Screening Program

BackgroundMRI-based breast cancer screening for high-risk women has been associated with false positives. This study explored the benefits and drawbacks of MRI-based screening using in-depth patient interviews.MethodsThis was a qualitative study of interviews with women participating in the High Risk Ontario Breast Screening Program. Women enrolled at two centers who had completed at least one round of screening were invited to participate. Recruitment was suspended when thematic saturation was reached. Semi-structured telephone interviews were conducted and transcribed verbatim. Emergent themes were identified and a coding framework established.Results21 women (median age 41 years) participated in telephone interviews. Women had been in the program a median of 4 years (IQR 1-5), and 71% had experienced at least one abnormal screen. Eight participants (38%) had undergone biopsies. Six women (29%) were BRCA mutation carriers. MRIs were described as intimidating, uncomfortable, and claustrophobic. Participants were concerned about long-term exposure to gadolinium contrast. Compared to MRI, mammography alone was viewed as painful, less sensitive, and a “useless…waste of time.” MRI provided a “psychological safety net” that outweighed the distress associated with abnormal screens. Many women accepted this trade-off as a “two-edged sword” that was “worth it” and provided a sense of control. Suggestions for improvement included more information regarding the risks of MRI, and access to counselling.ConclusionsWomen participating in MRI-based screening strongly value reassurance from a highly sensitive screening test. This outweighed the distress of abnormal screens. There are areas for improvement around patient communication and psychosocial support.     

叶绿酸对肝癌高发区黄曲霉毒泰暴露人群的干预研究

[目的]评估叶绿酸能否降低肝癌高危人群尿中黄曲霉毒素(AFT)-N7-鸟嘌呤的水平.[方法]采用随机双育、以安慰剂为对照的预防干预试验.将180名健康成人随机分成叶绿酸干预组(服用100mg叶绿酸)和安慰剂对照组.采用顺序免疫亲和色谱法和液相色谱法结合电子喷射质谱法测定尿中AFT-N7-鸟嘌呤的变化.[结果]在169份尿样中,105份检出AFT-N7-鸟嘌呤.叶绿酸组尿中AFT-N7-鸟嘌呤比安慰剂组下降了55%(P=0.036).未见副作用.[结论]应用叶绿酸或富含叶绿素的食物进行预防干预是可能阻断肝癌的有效手段.