粪便隐血试验在大肠癌筛检中的作用

目的 :分析粪便隐血在大肠癌发生、发展中的规律 ,进而发挥粪便隐血检测在大肠癌诊断中的作用。方法 :收集以北京地区为主的 2 7所医院 2 0 0 2年 4月 1日～ 2 0 0 3年 4月 1日内镜 (病理 )诊断的大肠癌患者 5 97例 ,粪便免疫隐血条形试纸检测粪便隐血 ,分析粪便隐血与癌胚抗原 (CEA)、肉眼血便、肿瘤部位、病理分型及分期的相关性。结果 :44 8例有隐血结果 ,其中阳性 3 64例 ,阳性率为 81 2 5 % ;隐血试验对大肠癌检出的阳性率为 79 75 % ,CEA检出率为 45 45 % ;3 0 8例肉眼血便中粪便隐血试验阳性率为88 96% ,14 0例无肉眼血便的患者粪便隐血试验阳性率为 64 2 9% ;左半结肠癌粪隐血阳性率为 81 3 9% ,右半结肠癌为 81 60 % ;中、高分化腺癌隐血阳性率为 81 3 5 % ,类癌阳性率为 3 3 3 3 % ;Duck’sA、Duck’sB粪隐血阳性滤为 78 48% ,Duck’sC、Duck’sD期粪隐血阳性率为 81 86%。结论 :粪便隐血试验仍是大肠肿瘤筛检的重要手段 ,且阳性率优于CEA ;隐血试验操作时要参考有无肉眼血便 ;隐血试验的阳性与否与发病部位及分期无关 ,但与大肠癌的病理分型有关。

Role of fecal occult blood test in colorectal cancer screening

Objective:To analyze the regularity of changes in fecal occult blood test(FOBT) during pathogenesis and development of colorectal cancer and to give full play to its significance in diagnosis of colorectal cancer.Methods:597 cases of colorectal cancer confirmed by colonoscopy and histopathology were collected from 27 hospitals in Beijing area from April 1,2000 to April 1,2003.For all the patients,the correlation of FOBT with carcinoembryonic antigen (CEA) test,gross blood stool,the sites of tumor,the stages of tumor and histopathologic types was analysed.Results:FOBT positivity rate was 81.25%(364/448).The positive predictive value of FOBT for colorectal cancer was 79.75% while the positive predictive value of CEA for colorectal cancer was only 45.45%.In the 364 cases with gross blood in stool,88.96% presented with positive FOBT whereas in the 140 cases without gross blood stool,only 64.29% showed positive FOBT;the FOBT positive rate in right colic cancer vs left colic cancer was 81.39% vs 81.60%; for highly and moderately differentiated adenocarcinoma,the FOBT positive rate was 81.35%; in patients with carcinoid,FOBT positive rate was 33.33%.In patients on stages of Duke's A and B,FOBT positive rate was 78.48% while in patients on Duke's C and D,FOBT positive rate was 81.86%.Conclusions:FOBT is sill an important method in colorectal tumor screening with a better positivity rate over CE (79.75% vs 45.45%).Whether or not there was gross blood in stool should be taken into consideration when FOBT was due to be undertaken.The positivity of FOBT was not related with the sites of the cancer but with pathologic typings.