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背景 50岁以下人群的大肠癌和炎性肠病发病率呈上升趋势。目的本研究旨在调查50岁以下社区大肠癌/炎性肠病患者的临床特征,对其诊断价值进行量化评估,并探讨哪些有此临床特征的患者能从潜在的严重结直肠疾病调查中获益。设计与场所本研究为配比病例对照研究。使用的社区病历来源于英国临床研究数据库。方法本研究于2000-2013年选择50岁以下的大肠癌社区患者1 661例,50岁以下的炎性肠病社区患者9 578例。两组人群均以1:3的比例选择配比对照对象,大肠癌社区患者的对照人群为3 979例,炎性肠病社区患者的对照人群为22 947例。患者确诊之前,对大肠癌/炎性肠病的临床特征对该病诊断的价值进行评估。结果直肠出血、排便习惯改变、腹泻、炎性因子水平增高、血小板计数增多、腹痛、低平均红细胞体积、低血红蛋白、白细胞计数增多、肝酶水平增高是大肠癌/炎性肠病的独立影响因素(P<0.001)。直肠出血合并腹泻、血小板计数增多、低平均红细胞体积、低血红蛋白或炎性因子水平增高对大肠癌/炎性肠病的阳性预测值>3%;排便习惯改变合并低平均红细胞体积、血小板计数增多或低血红蛋白对大肠癌/炎性肠病的阳性预测值>3%;腹泻合并血小板计数增多对大肠癌/炎性肠病的阳性预测值>3%。结论本研究对50岁以下社区肠道疾病患者的临床特征对大肠癌/炎性肠病的诊断价值进行了量化评估。直肠出血和排便习惯改变合并血液学检查异常结果对大肠癌/炎症性肠病具有较高诊断价值。有助于医生优先安排有临床症状但未能及时确诊的患者进行结肠镜检查。
Background The incidence of colorectal cancer and inflammatory bowel disease in people under 50 years of age is on the rise. PURPOSE This study was designed to investigate the clinical features of patients with colorectal cancer / inflammatory bowel disease in a community under 50 years of age and to assess their diagnostic value quantitatively and to explore which patients with this clinical characteristic can benefit from a survey of potentially serious colorectal diseases beneficial. Design and Place This study was a matched case-control study. Community medical records were sourced from the UK clinical research database. Methods This study selected 1 661 patients with colorectal cancer under 50 years of age from 2000 to 2013 and 9 578 patients with inflammatory bowel disease under 50 years of age. In both groups, the ratio of 1: 3 was used to select the matched control subjects, 3 979 controls for colorectal cancer community, and 22 947 controls for inflammatory bowel disease community. Prior to diagnosis, the clinical features of colorectal cancer / inflammatory bowel disease are evaluated for the diagnostic value of the disease. Results Rectal bleeding, changes in bowel habits, diarrhea, increased levels of inflammatory cytokines, increased platelet count, abdominal pain, low mean erythrocyte volume, low hemoglobin, increased white blood cell count, and increased liver enzymes were independent predictors of colorectal cancer / inflammatory bowel disease (P <0.001). Rectal bleeding with diarrhea, increased platelet count, low average erythrocyte volume, low hemoglobin or elevated levels of inflammatory cytokines / colitis / inflammatory bowel disease positive predictive value of> 3%; defecation habits combined with low average erythrocyte volume, increased platelet count Or low hemoglobin on colorectal cancer / inflammatory bowel disease positive predictive value of> 3%; diarrhea with increased platelet count for colorectal cancer / inflammatory bowel disease positive predictive value> 3%. Conclusions This study provides a quantitative assessment of the diagnostic value of colorectal cancer / inflammatory bowel disease for the clinical features of patients with intestinal diseases under 50 years of age. Rectal bleeding and bowel habits to change the combined hematology abnormal results of colorectal cancer / inflammatory bowel disease has a high diagnostic value. Helps doctors prioritize colonoscopy in patients who have clinical signs but are not diagnosed promptly.