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Three Consecutive Qualitative Fecal Occult Blood Tests to Diagnose Colorectal Polyps and Cancer
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摘要:
目的 评估3次粪便潜血定性检查对结直肠息肉和结直肠癌的诊断价值, 并探讨其影响因素。 方法 回顾性纳入2006年8月至2013年4月北京协和医院消化内科行结肠镜检查并在检查前1周内完成3次非同日的定性粪便潜血检查的患者, 分析患者连续3次粪便潜血检查结果, 并与结肠镜及病理检查相比较。评估粪便潜血阳性次数对结直肠新生物的诊断价值, 并分析出现粪便潜血阳性结果的影响因素。 结果 共303例患者纳入研究, 其中男性154例, 女性149例; 平均年龄(59.5±15.0)岁。其中结直肠息肉119例, 结直肠癌46例。粪便潜血诊断结直肠息肉的敏感度和特异度:至少1次阳性为71.4%和52.7%, 至少2次阳性为41.2%和67.4%;3次全部阳性为22.7%和79.9%。诊断结直肠癌的敏感度和特异度:至少1次阳性为91.3%和49.4%;至少2次阳性为80.4%和72.0%;3次全部阳性为54.3%和84.8%。新生物位于左半结肠及进展期新生物与粪便潜血阳性结果均显著相关(P=0.001)。 结论 连续3次粪便潜血检查对结直肠息肉和结直肠癌有一定的诊断意义, 息肉的位置和分化程度对粪便潜血结果产生影响。 Abstract:Objective To evaluate the diagnostic value of three consecutive qualitative fecal occult blood tests (FOBTs) for colorectal polyps and cancer. Methods We retrospectively reviewed patients who underwent three consecutive FOBTs in one week before a standard colonoscopy from August 2006 to April 2013 in Peking Union Medical College Hospital.The sensitivity and specificity of positive FOBT(1, 2, or 3 times) for diagnosing colorectal neoplasms(including polyps and cancer)were calculated. The impacts of colorectal neoplasm's location, amount, size, and histological features on FOBT results were also evaluated. Results A total of 303 patients[154 males and 149 females, aged (59.5±15.0)years] were enrolled in this study. Colorectal neoplasms were recognized in 165 patients, in whom 119 patients were diagnosed with colorectal polyps and 46 with cancer. As for colorectal polyps, the sensitivity and specificity of positive FOBT were 71.4% and 52.7% for one time, 41.2% and 67.4% for two times, and 22.7% and 79.9% for three times. As for colorectal cancer, the sensitivity and specificity were 91.3% and 49.4% for one time, 80.4% and 72.0% for two times, and 54.3% and 84.8% for three times. Neoplasms in the left half colon and advanced neoplasms were significantly related to positive FOBTs (P=0.001). Conclusions Three consecutive qualitative FOBTs can be used as a screening tool for colorectal polyps and cancer. Location and histological features of polyps may influence FOBT results. -
Key words:
- fecal occult blood test /
- colorectal polyps /
- colorectal cancer
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表 1 患者结肠镜检查结果及性别和年龄分布
结肠镜检查结果 例(%) 男/女(例) 年龄(岁，$ \overline x \pm s$) 正常 115(50.8) 49/66 54.9±15.5 异常 188(49.2) 105/83 62.4±13.9 结直肠新生物 165(54.5) 96/69 63.5±13.4 结直肠癌 46(15.2) 25/21 63.0±15.8 结直肠息肉 119(39.3) 71/48 63.7±12.4 进展期腺瘤 16(5.3) 11/5 65.2±13.5 炎症性病变 18(5.9) 9/9 55.1±12.7 其他异常 5(1.7) 0/5 50.4±24.3 总计 303(100) 154/149 59.5±15.0 
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表 2 FOBT对结直肠新生物的诊断价值(%)
病变性质 FOBT阳性
次数≥1的
敏感度/
特异度FOBT阳性
次数≥2的
敏感度/
特异度FOBT阳性
次数=3的
敏感度/
特异度结直肠新生物 77.0/67.4 52.1/83.3 31.5/91.3 结直肠息肉 71.4/52.7 41.2/67.4 22.7/79.9 结直肠腺瘤 71.0/49.5 37.6/64.8 20.4/78.6 结直肠进展期新生物 91.9/52.3 75.8/74.3 50.0/86.3 结直肠进展期腺瘤 93.7/45.3 62.5/65.5 37.5/79.8 结直肠癌 91.3/49.4 80.4/72.0 54.3/84.8 FOBT：粪便潜血检查
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