免疫法粪便隐血试验对早期大肠癌流行病学研究的临床意义

目的探讨以免疫法粪便隐血试验(iFOBT)为主要筛查方法,提高早期大肠癌诊断率的临床意义。方法应用问卷调查、实验室检测(iFOBT、CEA、CA72-4、M-CSF)、肠镜及病理检查,对10000名自然人群进行大肠癌的序贯筛查。结果收回有效问卷6997份,依据调查问卷分值分为低度危险组(≤5分)、可疑组(>5～<8分)、高度危险组(≥8分)3组,3组共3697例进行iFOBT检测,各组iFOBT阳性率分别为13.34%、18.23%、99.17%,3组阳性率比较,差异具有统计学意义(P<0.05或P<0.01)。检出早期结肠癌6例,其中高度危险组5例,可疑组1例。结肠癌患者iFOBT(定量)以及CEA、CA72-4、M-CSF等血清学指标均高于结肠息肉、溃疡性结肠炎、慢性结肠炎患者(P均<0.05)。结论以iFOBT为主的序贯筛查法是发现早期大肠癌的主要方法,与某些血清指标相结合,可提高大肠癌的检出率,肠镜及病理检查可最后确诊。

Clinical significance of epidemiological research on early colorectal cancer with immunologic fecal occult blood test

Objective To discuss the clinical significance of improving diagnosis rate of early colorectal cancer with immunologic fecal occult blood test(iFOBT) as main screening method.Methods The sequential screening program on colorectal cancer in 10 000 natural population was performed by questionnaire,laboratory test including iFOBT,carcinoembryonic antigen(CEA),CA72-4 and macrophage colony stimulating factor(M-CSF),colonoscopy and pathology.Results A total of 6 997 valid questionnaires were regained and divided into low risk group(≤5),questionable group(>5-<8) and high risk group(≥8) according to the value of the questionnaire.The positive rates of iFOBT in low risk group,questionable group and high risk group raised in turn,and the difference had statistical significance(P<0.05 or P<0.01).Six cases of early colorectal cancer were detected,and in them 5 cases presented in high risk group,1 case in questionable group.iFOBT(quantitative determination),some serum indexes including CEA,M-CSF and CA72-4 were higher than those in patients with colorectal polyp,ulcerative colitis and chronic colitis.Conclusions The sequential screening program mainly based on iFOBT is a main method to detect early colorectal cancer.Combining iFOBT with serum indexes could raise detectable rate of early colorectal cancer.Colonoscopy and pathologic biopsy may acquire confirmed diagnosis to preliminary screening results.