中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (6): 401-406.doi: 10.19401/j.cnki.1007-3639.2018.06.001

• 论著 • 上一篇    下一篇

上海市社区居民大肠癌筛查便隐血检测效果分析

彭 鹏,龚杨明,鲍萍萍,吴春晓,顾 凯,张敏璐,向詠梅,施 亮,邹 珍,施 燕   

  1. 上海市疾病预防控制中心慢性非传染病与伤害防治所肿瘤防治科,上海 200336
  • 出版日期:2018-06-30 发布日期:2018-07-20
  • 通信作者: 施 燕 E-mail:shiyan@scdc.sh.cn
  • 基金资助:
    国家重点研发计划(2017YFC1308800,2016YFC1303200);上海市第四轮公共卫生3年行动计划慢病重点学科建设项目(15GWZK0901,15GWZK0801)。

The analysis of immunochemical fecal occult blood test results in colorectal cancer screening in Shanghai

PENG Peng, GONG Yangming, BAO Pingping, WU Chunxiao, GU Kai, ZHANG Minlu, XIANG Yongmei, SHI Liang, ZOU Zhen, SHI Yan   

  1. Division of Chronic and Non-communicable Diseases, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
  • Published:2018-06-30 Online:2018-07-20
  • Contact: SHI Yan E-mail: shiyan@scdc.sh.cn

摘要: 背景与目的:上海市为符合条件的居民提供免费的大肠癌筛查服务,通过对上海市居民大肠癌筛查中两次便隐血检测和后续诊断检查结果的分析,评价筛查中两次便隐血检测的效果,为基于人群的疾病筛查项目提供科学依据。方法:筛查的目标人群为50~74岁的上海居民,使用两次免疫法便隐血检测和危险度评估为初筛,初筛阳性者进行肠镜检查。结果:筛查期间,共有809 528人完成了两次便隐血检测,便隐血检测阳性者共有104 953人,其中第一次阳性的人数为47 421人,阳性率为5.9%,第二次阳性的人数为36 462人,阳性率为4.5%,两次阳性的人数为21 070人,阳性率为2.6%。便隐血检测阳性的筛查对象中,有49 339人接受了肠镜检查,肠镜检查顺应性为47.0%。两次阳性的筛查对象的肠镜参与率明显高于单次阳性的筛查对象(P<0.001)。在所有筛查出的大肠癌和癌前期病变中,仅进行一次便隐血检测可以诊断出大肠癌1 200例,占79.5%;发现癌前期病变3 777例,占68.1%。进行第二次便隐血检测可以多诊断出大肠癌310例,占20.5%;发现癌前期病变1 767例,占31.9%。结论:相比于单次便隐血检测, 进行两次便隐血检测的初筛可以更有效地检测出阳性对象,两次便隐血检测可提高后续肠镜检查的参与率,所检出的大肠癌和癌前期病变数量也均有所提高且增量成本较低。因此建议在以人群为基础的大肠癌筛查中采用两次或更多次数的便隐血检测,以提高筛查效率。

关键词: 大肠癌, 筛查, 便隐血检测, 社区居民

Abstract: Background and purpose: Shanghai provides free colorectal cancer screening services to eligible residents. This study aimed to analyze immunochemical fecal occult blood test results in colorectal cancer screening to assess the effectiveness of twice fecal occult blood test, and to provide the evidence for community-based screening programs. Methods: Shanghai residents aged 50-74 years were target population. Twice immunochemical fecal occult blood test and risk assessment were used for initial screening, along with colonoscopy for individuals whose initial results were positive. Results: During the screening, 809 528 participants completed immunochemical fecal occult blood test twice, and 104 953 people’s test results were positive. There were 47 421 people whose initial results were positive, and the positive rate was 5.9%. There were 36 462 people who got positive results in the second test, and the positive rate was 4.5%. Another 21 070 people got positive results in both tests, and the positive rate was 2.6%. Among the individuals with positive immunochemical fecal occult blood test, 49 339 people underwent colonoscopy, and the overall colonoscopy compliance was 47.0%. The participation rate of colonoscopy was significantly higher in participants who had double positive results than in the participants with single positive result. One thousand two hundred cases (79.5%) of colorectal cancer were diagnosed and 3 777 cases (68.1%) of precancerous lesions were detected by only one fecal occult blood test. Three hundred and ten cases (20.5%) of colorectal cancer were diagnosed and 1 767 cases (31.9%) of precancerous lesions were detected by an additional fecal occult blood test. Conclusion: Compared with the only one immunochemical fecal occult blood test, the twice tests were more effective. The compliance of colonoscopy was improved among participants with double positive results, and the detective rates of colorectal cancer and precancerous lesions were increased. To improve the screening efficiency, twice or more immunochemical fecal occult blood test should be carried out in the community-based colorectal cancer screening.

Key words: Colorectal cancer, Screening, Fecal occult blood test, Community residents