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目的建立苏南地区大肠癌平均风险人群大肠进展期肿瘤发生风险评分系统,并评价其筛查效能。方法以接受结肠镜检查的苏南地区籍大肠癌平均风险人群为研究对象,通过问卷调查获取其人口学特征、既往疾病史、吸烟史、饮酒史、饮食习惯等信息。采用多元logistic回归分析方法建立大肠进展期肿瘤发生风险预测模型。根据模型中各变量的β值赋予分值,建立大肠进展期肿瘤发生风险评分系统,并进行内部人群验证。通过预测一致性、区分能力和筛查准确度评价评分系统的筛查效能。结果共纳入905例合格研究对象。所建立的评分系统由年龄、性别、冠心病、蛋类摄入、排便频率等5个变量组成,分值范围为0~10分,其预测的一致性好(P=0.205),区分能力良好(受试者工作特性曲线下面积为0.75,95%CI:0.69~0.82)。以2.5分作为筛查界值,其敏感度、特异度、准确率、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为93.8%、47.6%、50.1%、9.1%、99.3%、1.79和0.13。大肠进展期肿瘤在高风险人群(>2分)中的比例(9.1%)显著高于低风险人群(0~2分)中的比例(0.7%,P<0.001)。如果仅对高风险人群进行结肠镜筛查,则在减少45.4%结肠镜检查例数的情况下,可以筛查出93.8%的进展期肿瘤病例。结论所建立的大肠进展期肿瘤发生风险评分系统具有良好的筛查效能,可以作为大肠癌初筛工具,应用于苏南地区无症状平均风险人群的大肠癌筛查。
Objective To establish a risk assessment system for colorectal cancer progression in colorectal cancer of average risk population in southern Jiangsu and evaluate its screening efficacy. Methods Taking the average risk population of colorectal cancer in southern Jiangsu Province who underwent colonoscopy as the research object, the demographic characteristics, past disease history, smoking history, drinking history, eating habits and other information were obtained by questionnaire survey. Multivariate logistic regression analysis was used to establish the risk prediction model of advanced colorectal cancer. According to the β value of each variable in the model, the scoring system was established and the internal population was validated. The screening performance of the scoring system was evaluated by predicting consistency, discerning ability and screening accuracy. Results A total of 905 eligible subjects were enrolled. The scoring system established by the age, gender, coronary heart disease, egg intake, frequency of defecation and other 5 variables, score range of 0 to 10 points, the consistency of its prediction is good (P = 0.205), the ability to distinguish good (Area under the receiver operating characteristic curve was 0.75, 95% CI: 0.69 to 0.82). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 93.8%, 47.6%, 50.1%, 9.1%, respectively, 99.3%, 1.79 and 0.13. The proportion of advanced colorectal cancers in the high-risk population (> 2 points) (9.1%) was significantly higher than in the low-risk population (0-2) (0.7%, P <0.001). If colonoscopy screening is only for high-risk groups, then 93.8% of advanced cancer cases can be screened at a 45.4% reduction in the number of colonoscopy. Conclusion The established risk score system for advanced colorectal tumor progression has a good screening performance and can be used as a screening tool for colorectal cancer in colorectal cancer screening of asymptomatic mean risk population in southern Jiangsu.