大肠癌高危人群筛查研究
Screening of high-risk group with colorectal cancer
目的 了解社区自然人群中大肠癌高危人群和大肠癌的检出率,探讨大肠癌的筛查成本,为大肠癌普查和高危人群筛查制定方案提供科学依据.方法 对广东省惠州地区自然人群用"高危问卷联合免疫法粪便隐血试验(FOBT)方案"进行普查,以符合高危条件人群和FOBT阳性人群为大肠癌高危人群.对高危人群行全结肠镜检查,对发现病变者取活组织行病理学检查以筛出大肠癌.按直接花费计算筛查成本并进行比较.结果 社区自然人群接受调查者68 953人,问卷调查符合高危条件者940人(1.36%),FOBT阳性者3118人(4.52%),二者合并筛出大肠癌高危人群3870人(5.61%).符合高危条件人群、FOBT阳性人群、大肠癌高危人群和社区自然人群大肠癌检出率分别为506.3/10万、314.3/10万、315.9/10万和17.7/10万."高危问卷一肠镜筛查方案"和"FOBT-肠镜筛查方案"检出大肠癌的阳性预测值分别为0.43%和0.22%,每筛查出1例大肠癌的直接成本分别为47 834.5元和82 303.6元,后者是前者的1.7倍.结论 "高危问卷联合FOBT方案"用于大肠癌普查效果较好,"高危问卷-肠镜筛查方案"比"FOBT-肠镜筛查方案"具有更好的效价关系,可作为大肠癌高危人群机会性筛查的首选方法.
更多Objective To measure the rate of high-risk group and the detection rate of colorectal cancer (CRC) in communities in Guangdong province and to provide scientific rationales for formulating mass screening plans in high-risk group. Methods Mass survey was conducted by questionnaire combined fecal occult blood test (FOBT) in Huizhou region, Guangdong Province, to sort out the high-risk population of CRC. Then the high-risk population was screened by colonoscopy and pathology to identify CRC. The differences were compared by direct expenditure which was used to calculate screening cost. Results A total of 68 953 people were surveyed. There were 940 people in high-risk group (detection rate: 1.36% ), 3118 in immunity FOBT positive group (detection rate: 4. 52% ), Merging aforementioned two groups, there were 3870 in population at risk (detection rate: 5.61% ). The CRC detection rate in high-risk group, immunity FOBT positive group, population at risk and average-risk group was 506. 3/10~5, 314. 3/10~5, 315.9/10~5 and 17.7/10~5 respectively. The positive predictive value of CRC screening scheme by high-risk group questionnaire-colonoscopy was 0. 43% while CRC screening scheme by FOBT-colonoscopy 0. 22%. In terms of direct expenditure of CRC per case in high-risk group and immunity FOBT positive group was 47 834. 5 yuan and 82 303.6 yuan. The latter was 1.7 times than that of the former. Conclusions The scheme of questionnaire combined FOBT for CRC is an effective way in mass survey. The scheme by high-risk group questionnaire-colonoscopy has a much better cost-effectiveness than that of the scheme by FOBT-colonoscopy so that it should be one of the preferred methods for individual screening in high-risk group.
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