摘要
目的探讨定量免疫法便潜血试验(FIT)在结直肠肿瘤伺机性筛查中的意义,提出最适宜的阈值,提高结直肠肿瘤的早期筛查水平。方法以解放军总医院消化内镜中心就诊拟行结肠镜检测的人群为研究对象进行伺机性筛查,患者结肠镜检查前留取晨起自然便,应用OC-MICRO全自动便潜血分析仪进行免疫法便潜血试验,对便潜血结果进行分析,分别计算不同阳性阈值下的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。结果最终纳入研究对象1448例,其中男714例(49.3%),女734例(50.7%),根据结肠镜和病理结果共检测出结直肠肿瘤242例,其中进展性腺瘤157例、结直肠癌85例。FIT阈值从50μg/L升至200μg/L,阳性率由11.5%降至8.6%,FIT检测结直肠肿瘤的敏感性随FIT阈值升高由47.9%降至38.8%,但是特异性由96.8%升高至98.2%,并且阳性预测值由82.3%升高至87.0%。结直肠癌的漏检率随FIT阈值升高,由11.8%(n=10)增高至17.6%(n=15),但是阳性阈值100μg/L和150μg/L的漏检率相同12.9%(n=11)。结论免疫法便潜血阈值100μg/L用于伺机性筛查对进展性腺瘤和结直肠癌的诊断具有较高的敏感性和特异性,该方法操作简便、检测快捷,是较好的大肠良恶性疾病筛查和诊断的参考指标。
Objective To investigate the significance of quantitative fecal immunochemical test(FIT)for opportunistic screening of colorectal neoplasia,and to propose the most optimal thresholds to improve the screening level of early colorectal neoplasia.Methods The opportunistic screening participants were recruited from the Department of Gastroenterology&GI Endoscopy Center of the Seventh Medical Center of PLA General Hospital,and stool sample was collected before colonoscopy and the quantitative FIT was analyzed by OC-MICRO analysator for each patient.We assessed test performance in detecting colorectal neoplasia(advanced adenoma and CRC)with different thresholds on sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV).Results A total of 1448 objects were enrolled in this study,including 714 male(49.3%)and 734 female(50.7%).All participants were classified according to the result of colonoscopy and pathology,and 242 cases of colorectal neoplasia were found,containing 157 advanced adnoma and 85 colorectal cancer.The FIT threshold increased from 50μg/L to 200μg/L,while the positivity rate dropped from 11.5%to 8.6%and the sensitivity in detecting colorectal neoplasia dropped from 47.9%to 38.8%.However,the specificity increased from 96.8%to 98.2%and the positive predictive value increased from 82.3%to 87.0%.The miss rate of colorectal cancer increased from 11.8%(n=10)to 17.6%(n=15)along with the increase in FIT thresholds,but the miss rate of 100μg/L and 150μg/L was the same as 12.9%(n=11).Conclusions Quantitative FIT,which is simple and fast,with the threshold of 100μg/L for opportunistic screening,has a high sensitivity and specificity for the diagnosis of colorectal neoplasia,and is an important index in screening and diagnosis of colorectal neoplasia.
作者
康倩
李娜
苏惠
杨浪
何玉琦
贾康妹
王昕
金鹏
盛剑秋
Kang Qian;Li Na;Su Hui;Yang Lang;He Yuqi;Jia Kangmei;Wang Xin;Jin Peng;Sheng Jianqiu(Department of Gastroenterology,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第10期767-770,共4页
National Medical Journal of China
基金
北京市科技计划课题(D171100002617001)。
关键词
伺机性筛查
结直肠癌
定量粪便免疫化学试验
Opportunistic screening
Colorectal cancer
Quantitative fecal immunochemical test
