医院就诊人群与普查人群中大肠癌患者临床资料的比较

背景:在我国有无必要开展大肠癌普查仍存在一定争议。目的:比较、分析医院就诊人群与普查人群中大肠癌患者临床资料的异同,探讨普查在大肠癌早期诊断中的作用。方法:就诊组:由协作组各成员医院按统一设计的调查表,前瞻性地登记2002年4月1日～2003年3月31日到医院就诊,并接受结肠镜检查的大肠癌患者的全部临床资料。普查组:采用“序贯粪便隐血筛检技术”,于2001年3～6月对北京地区约2万名35岁以上的自然人群进行大肠癌普查。两组大肠癌患者的诊断均经术后病理检查证实。结果:就诊组和普查组患者中,≥50岁者分别占81.9%和83.3%。就诊组DukesA、B期患者占41.1%,普查组占91.7%(P<0.001)。普查人群中存在大肠癌高危因素者的大肠癌检出率为0.28%,无高危因素者的检出率为0.05%(P<0.001)。就诊组中,内镜表现为隆起型病变者44.7%是DukesA、B期患者,溃疡型病变者仅10.0%是DukesA、B期患者(P<0.001);DukesA、B期患者的粪便隐血试验阳性率为78.5%,C、D期患者为81.9%(P>0.05),提示粪便隐血试验阳性率与大肠癌分期无关;DukesC、D期患者的血清CEA阳性率显著高于A、B期患者(P=0.019);高、中分化癌中DukesA、B期患者占51.8%,低分化癌中DukesA、B期患者仅占26.5%(P<0.001)。结论:近年北京地区的大肠癌发病率较以前明显上升     

无症状人群普查与大肠癌的防治

60、70年代国内大肠癌发病率仅在10／10万以下，而80、90年代普查显示我国城镇大肠癌发病率已达21～22／10万。人口密集、经济发达、老龄化比重较大的城市这一趋势更加显著。据有关方面统计，我国每年发生恶性肿瘤患者为160万，死亡者达130万之多。城市中恶性肿瘤为居民各种死亡原因之首，约占总死亡率的21．8％。1992～1995年26个省市3亿人口的抽样调查表明，消化道癌是死亡的最主要原因，其中大肠癌死亡率上升最快。上述资料表明，大肠癌有可能成为下一个世纪我国的高发恶性肿瘤之一。一、无症状人群普查是大肠癌防治的重要环节和其它恶性…     

胃癌高发区高危人群普查检出胃癌的特点分析

探讨胃癌高发区高危人群普查检出的胃癌的特点。方法采用两轮筛选法,第一轮选择３５岁以上并有胃病史或胃癌家族史者,检测血清胃蛋白酶含量并进行胃双重对经检查,第二轮进行胃镜检查及病理活检。结论胃癌高发区高危人群中胃癌检出率较高,而且早期胃癌较多,对此人群有针对性地,有计划地开展一、二级预防具有重要意义。     

高龄人群高血压研究

既往关于高龄高血压患者降压治疗显示,虽减少中风危险,但可能增加死亡率,因此在这些人群中降压治疗是否获益仍不清楚。高龄人群高血压试验（HYpertension in the Very．Elderly Trial,HYVET）证明在高龄人群中降压治疗是获益的。     

高龄男性人群非酒精性脂肪性肝病的调查

筛选2010年9月至11月在我院干诊科进行健康体检的高龄(≥75)男性人群体检资料524份,除外大量饮酒史(饮酒折合乙醇量男性每周≥140克);且无病毒性肝炎,无引起继发性脂肪肝的因素,无恶性肿瘤以及无其他进展性致命性疾病。调查资料包括详细问卷调查﹑病史采集﹑测定身高、体重、腰围、臀围、血压、腹部体检和B超、肺CT、心电图检查以及空腹状态下进行血、尿、便常规及肝肾功能、血脂、血糖等检查。结果:共调查524例,检出脂肪肝188例,患病率为35.88%。在脂肪肝组中,体重指数≥24、腰围≥90、高血压病、糖代谢异常、代谢综合征、血脂异常症、高尿酸血症的患病率均明显高于非脂肪肝组(P<0.001)。结论:高龄男性人群具有较高的NAFLD患病率。NAFLD与多种代谢性疾病如超重或肥胖、高血压、糖代谢异常、血脂异常症等密切相关。NAFLD的一级和二级预防势在必行。     

纤维结肠镜直接普查大肠癌效果的评价

大肠癌起病隐匿 ,病因不明 ,早期诊断困难 ,门诊诊断的往往是中晚期大肠癌 ,5年生存率低 ,无症状人群普查是防治大肠癌的最佳手段 ,通过普查可发现早期癌及癌前病变并进行早期治疗 ,达到防治的目的。我们于 1999年 7月至2 0 0 1年 8月 ,应用纤维结肠镜直接对我省 2 2 36例邮电职工进行普查 ,现将结果报道如下。一、材料和方法1.2 2 36例受检人群全部为广东省邮电职工 ,包括深圳市、宝安县、揭阳市、普宁市、顺德市、番禺市、花都市、揭东县、揭西县、惠来县、博罗县、大亚湾和广州市等 13个地区的电信与邮政职工 ,年龄 2 8～ 85岁 ,男∶女 =…     

西安市大骨节病病区16岁以上人群普查结果分析

20世纪80年代以来，由于对西安市大骨节病病区采取有效防治措施，使病情逐步得到控制，如今周至和临潼已达到国家控制标准，临潼和蓝田通过首次自查考核验收，也已达到控制标准。大面积的流行病学调查十几年来主要在学龄儿童进行，其他年龄段的情况不得而知，特别是高年龄段的老患者的情况及整体人群的病情趋势不能掌握。为此，2002年我市对大骨节病病区16岁以上人群进行全面普查。结果如下：     

"序贯粪隐血大肠肿瘤筛检方案"应用价值的再探讨

目的 通过自然人群大肠肿瘤普查了解近年北京市大肠癌发病情况，进一步探讨“序贯粪便隐血大肠癌筛检方案”的有效性和可行性。方法 选定15家医院医疗责任区内48100自然人群为本次普查靶人群。对其中30岁以上的社区或企业职工26827人进行普查登记，并连续进行3d序贯粪隐血检查。隐血阳性者接受结肠镜检查。符合高危条件者，全部接受隐血和肠镜检查。结果 预计普查人为26827人，实际普查人数为19852人，普查率为74％。男女比例为1．05：1。中位年龄50岁。序贯粪隐血阳性率为5．6％，检出大肠癌12例，其中DukesA期4例，B期7例，C期1例。Dukes A B共11例，占全部检出癌的91．66％。40岁以下人群未检出大肠癌，50岁以上人群中，检出大肠癌的比例随年龄升高而逐渐增加。高危人群中检出2例大肠癌，占该人群的0．28％，一般危险人群中检出10例大肠癌，占该人群的0．05％。结论 普查靶人群的大肠癌患病率为36．57／10^5，提示北京市城区有较高的患病率。采用“序贯粪隐血筛检方案”检出了91．66％的早期和较早期癌。提示该方案的有效性和可行性。高危人群和50岁以上的一般危险人群为大肠癌的重点普查对象。     

治疗性ERCP在78例高龄人群中的临床研究

目的高龄人群(≥70岁)行治疗性逆行胰胆管造影(ERCP)的疗效观察。方法对78例高龄胰胆管疾病患者行治疗性ERCP,分析诊治经过及并发症的处理。结果 78例患者中成功行治疗性ERCP 74例,其中胆总管结石52例,行十二指肠乳头括约肌切开术(EST)取石40例,行胆管支架引流术(ERBD)8例(3～6个月再次行ERCP取石治疗),行鼻胆管引流(ENBD)4例;胰胆肿瘤18例,均行ERBD后病情减轻;十二指肠乳头炎症4例,行EST后治愈。术后6例患者出现高淀粉酶血症,2例出现ERCP相关胰腺炎,2例合并胆管炎,1例发生小穿孔。结论 ERCP对高龄患者治疗安全有效。     

提高大肠癌早期诊断率的主要途径和方法

据国内资料统计．临床上早期大肠癌诊断率多徘徊在10％～15％，因此．大肠癌患的5年生存率不足50％。欲提高大肠癌患的长期存活率．当务之急是提高早期病人的检出率。就目前国内外的经验．提高早诊率最有效的方法有三种策略：自然人群普查、癌前疾病随访和遗传性大肠癌患病风险预测。     

大肠癌筛查方法研究新进展

大肠癌筛查能够有效降低大肠癌相关发病率及死亡率,现有多种基于人群的大肠癌筛查方法,本文对其筛查方法的研究进展进行概述,并展望未来发展趋势。     

大肠癌筛查开始年龄的研究

早期大肠癌筛查是有效降低大肠癌发病率和死亡率的重要方法。近来研究表明,不同种族、性别及吸烟、肥胖状况的无症状平均风险人群,大肠癌的发病风险各有不同,筛查开始年龄也有所差异。因此,本文就目前大肠癌筛查开始年龄的研究进行概述。     

大肠癌筛查方法的研究进展

定期大肠癌筛查是有效降低大肠癌发病率和死亡率的重要方法。近年来随着分子生物学、医学影像学等技术的发展,筛查方法不断获得改进和创新,为大肠癌的防治提供了更多技术选择。筛查方法因检测原理和目标的不同,效能不尽相同,本文就大肠癌常用筛查方法及研究进展进行综述。     

Similar fecal immunochemical test results in screening and referral colorectal cancer

AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODS: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage). RESULTS: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, SD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, SD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mLvs 613 ± 368 ng/mL,P = 0.02). Tissue tumor stage (T stage) distribution was dif-ferent between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P 0.001). Per tumor stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mLvs 870 ± 258 ng/mL,P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10). CONCLUSION: Differences in T stage distribution largely explain differences in FIT results between screening and referral cohorts. Therefore, FIT results should be reported according to T stage.     

Canadian Association of Gastroenterology position statement on screening individuals at average risk for developing colorectal cancer: 2010

The Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation published guidelines on colon cancer screening in 2004. Subsequent to the publication of these guidelines, many advances have occurred, thereby necessitating a review of the existing guidelines in the context of new technologies and clinical knowledge. The assembled guideline panel recognized three recent American sets of guidelines and identified seven issues that required comment from a Canadian perspective. These issues included, among others, the role of program-based screening, flexible sigmoidoscopy, computed tomography colonography, barium enema and quality improvement. The panel also provided context for the selection of the fecal immunochemical test as the fecal occult blood test of choice, and the relative role of colonoscopy as a primary screening tool. Recommendations were also provided for an upper age limit for colon cancer screening, whether upper endoscopy should be performed following a negative colonoscopy for a positive fecal occult blood test and when colon cancer screening should resume following negative colonoscopy.     

Awareness and attitudes of Greek medical students on colorectal cancer screening

AIM: To prospectively assess the knowledge and attitudes of medical students (MS), as tomorrow’s physicians, about colorectal cancer (CRC) and its screening modalities.METHODS: Three hundred fourth year MS of the University of Athens were enrolled in this survey. Their selection was random, based on student identification card number. All participants completed an anonymous written questionnaire over a 4 month period. The questionnaire was divided into 4 sections and included queries about CRC-related symptoms, screening with colonoscopy and MS awareness and attitudes in this field. Following collection and analysis of the data, the results are presented as percentages of answers for each separate question. RESULTS: Two hundred and sixty-five students an-swered the questionnaire over a 4 mo period. Interestingly, only 69% of the study population considered CRC to be a high-risk condition for public health. However, the vast majority of participants identified CRC-related symptoms and acknowledged its screening to be of great value in reducing CRC incidence and mortality. A very small proportion (38%) had received information material regarding CRC screening (either during their medical training or as a part of information provided to the general public) and only 60% of the participants declared willingness to receive further information. Regarding colonoscopy, 85% would prefer an alternative to colonoscopy methods for CRC screening. Moreover, 53% considered it to be a painful method and 68% would appreciate more information about the examination.CONCLUSION: MS in Greece need to be better informed about CRC screening and screening colonoscopy.     

Patients undergoing colorectal cancer screening underestimate their cancer risk and delay presentation for screening

BACKGROUND:

Colorectal cancer (CRC) is the third most common cancer in Canada. Screening guidelines recommend that first-time screening should occur at 50 years of age for average-risk individuals and at 40 years of age for those with a family history of CRC.

OBJECTIVE:

To examine whether persons with a positive CRC family history were achieving screening at 40 years of age and whether average-risk persons were achieving screening at 50 years of age.

METHODS:

The present study was a cross-sectional analysis of subjects who entered a colon cancer screening program and were undergoing CRC screening for the first time.

RESULTS:

A total of 778 individuals were enrolled in the present study: 340 (174 males) with no family history of CRC, and 438 (189 males) with a positive family history of CRC. For the group with a positive family history, the mean (± SD) age for primary screening was 54.4±8.5 years, compared with 58.2±6.4 years for the group with no family history. On average, those with a positive family history initiated screening 3.8 years (95% CI 2.8 to 4.8; P<0.05) earlier than those without. Adenoma polyp detection rate for the positive family history group was 20.8% (n=91) compared with 23.5 % (n=80) for the group with no family history.

CONCLUSIONS:

Individuals with a positive CRC family history are initiating screening approximately four years earlier than those without a family history; nevertheless, both groups are undergoing screening well past current guideline recommendations.     

Willingness to pay for colorectal cancer screening in Guangzhou

AIM To measure the willingness to pay for colorectal cancer screening in Guangzhou, and to identify those factors associated with it. METHODS A face-to-face questionnaire survey for pre-screening population from free and non-free colonoscopy districts was used to collect information on demographic characteristics, health behaviours, the intention of the cancer screenings and willingness to pay for colorectal cancer screening. A total of 1243 participants who took part in the pre-screening for colorectal cancer in Guangzhou were collected in the study. Categorical data were compared using the χ~2 test to analyse significant differences. Non-conditional logistic regression and multi-class logistic regression were also performed for multivariate analysis and to estimate the odds ratios.RESULTS The percentage of participants willing to pay for colorectal cancer screening was 91.7%. "Unnecessary" was the dominant reason that participants gave for their unwillingness, accounting for 63.1%. Of those who were willing to pay, 29.2%, 20.7%, 14.8%, 13.0% and 22.4% of participants were willing to pay less than $100, $100-$199, $200-299, $300-$399 and more than $400, respectively. Non-logistic regression analysis showed that respondents who were male, had a high level of education, were from the family with more children/older to raise, and accepted colorectal cancer screening were willing to pay for this screening. Multi-class logistic regression analysis showed that respondents with higher annual household income per capita, from government and private enterprises, government agency/institution and peasants, and less family medical expenditure were willing to pay more.CONCLUSION Willingness to pay for colorectal cancer screening in Guangzhou is high, but the amount of willing to pay is not much.     

粪便转铁蛋白和免疫粪隐血试验在结直肠癌筛查中效能的比较

目的评估粪便转铁蛋白(TF)和免疫粪隐血试验(IFOBT)在筛查结直肠癌中的效能。方法筛查对象为1 943例无症状受试者。收集1次粪便标本,同时用于TF和IFOBT检测。两者任一结果为阳性,即通知受试者行结肠镜检查。分别计算TF、IF-OBT和两者联合检测的性能指标。结果共有1 737例受试者接受TF和IFOBT检查,其中251例(14.5%)至少1项结果为阳性。共有193例接受结肠镜检查,共发现3例结直肠癌和43例进展期腺瘤。与单独使用IFOBT相比,TF和IFOBT联合检测(并联)明显提高了结直肠癌和进展期腺瘤的检出率(2.6%vs 1.6%,P=0.034)。结论 TF和IFOBT联合检测能提高筛查时结直肠癌和进展期腺瘤的检出率。