上海某社区结合体质辨识的大肠癌筛查危险因素分析

目的研究社区人群大肠癌危险因素现况与高危人群的中医体质类型的分布规律。方法以2016年1—12月上海浦兴社区50～74岁常住居民为调查对象,进行问卷调查和粪便潜血试验(FOBT)初筛,判定为高危人群者进行中医体质辨识分析并随访肠镜检查结果。结果 4 136人完成初筛,1 102人判定为高危人群,阳性率为26. 64%(95%CI:25. 30%～27. 99%),1 006人FOBT结果为阳性,占24. 90%(95%CI:23. 57%～26. 23%)。接受后续精筛228人,结肠镜顺应率为20. 69%(228/1 102),结肠息肉检出率为24. 56%(56/228),大肠癌检出率为1. 31%(3/228)。中医体质辨识结果最高为平和质,占37. 9%(418/1 102),偏颇体质以痰湿质28. 9%(319/1 102)]、气虚质12. 8%(142/1 102)]、阳虚质9. 6%(106/1 102)]为主。结论中老年人群中大肠癌高危人群占比较高,肠镜结果以息肉多见,值得引起重视。中医体质辨识平和质最高,提示中老年人大肠癌高危人群具有较高隐匿性,开展大肠癌筛查具有必要性。偏颇体质以痰湿、气虚、阳虚为主,提示中老年人群应高度重视大肠癌早期防治,通过中医干预进行防治有一定研究价值,治疗原则可以从健脾、益气、温阳入手。

Analysis of risk factors for colorectal cancer with TCM physical identification in a community of Shanghai

Objective To study the current situation of the risk factors of colorectal cancer and the distribution of the TCM physique type in high risk population of colorectal cancer in the community. Methods A survey of residents aged 50-74 years in Puxing community in Shanghai, using questionnaire survey and fecal occult blood test (FOBT) screening, the high-risk population were analyzed to determine the TCM physical identification and follow-up colonoscopy results. Results A total of 4 136 people completed the screening, 1 102 were judged to be high risk population, and the positive rate was 26.64% (95% CI:25.30%-27.99%), The results of FOBT were positive in 1 006 people, accounting for 24.90% (95% CI:23.57%-26.23%). And 228 people were screened for follow-up, and the compliance rate of colonoscopy was 20.69% (228/1102). The detection rate of colonic polyps was 24.56% (56/228), and the detection rate of colorectal cancer was 1.31% (3/228). The results of TCM physical identification showed that the gentle type was in the highest level of 418 people (37.9%), the biased constitution was mainly in phlegm dampness type 319 people (28.9%), qi deficiency type 142 people (12.8%), and Yang deficiency type 106 people (9.6%). Conclusion High risk population of colorectal cancer is in a higher level among middle-and-old-aged people, the results of colonoscopy is mainly polyps, and the TCM physical identification is mainly gentle type. It is suggested that the high-risk population of colorectal cancer in middle and old aged people has higher concealment, so it is necessary to carry out colorectal cancer screening. The biased constitution was mainly in phlegm dampness type, qi deficiency type, and Yang deficiency type. It shows that the middle-and-old-aged people should pay high attention to the early prevention and treatment of colorectal cancer. The TCM intervene can start with strengthening spleen, replenishing qi and warming Yang.