多靶点粪便基因检测在社区结直肠癌筛查中的应用价值研究

发布时间：2018-10-21 13:23

【摘要】：目的探讨多靶点粪便基因检测在社区结直肠癌(CRC)筛查中的应用价值。方法于2014年8月—2016年7月对浦东新区陆家嘴社区、三林社区、迎博社区居民进行筛查,包括采用《上海市社区居民大肠癌筛查危险度评估表》进行的危险度评估以及2次粪便隐血试验(FOBT)。以危险度评估阳性且2次FOBT中任1次阳性为初筛阳性,纳入试验组(n=294);以危险度评估阴性且2次FOBT均阴性为初筛阴性,纳入对照组(n=102)。入组居民在完成社区筛查后2周内至同济大学附属东方医院行肠镜检查并取病理活检,行肠镜检查前提取粪便DNA,检测异常甲基化BMP3、NDRG4启动子区域、KRAS突变。以肠镜和病理检查结果为"金标准",评价多靶点粪便基因检测在试验组和对照组中的诊断价值。结果在试验组居民中,多靶点粪便基因检测对CRC、癌前病变的灵敏度分别为85.7%[95%CI(59.8%,100.0%)]、75.0%[95%CI(32.6%,100.0%)],对普通息肉和完全阴性人群的特异度为84.0%[95%CI(79.7%,88.3%)]。在对照组患者中,多靶点粪便基因检测对普通息肉和完全阴性人群的特异度为83.8%[95%CI(76.7%,89.2%)]。结论多靶点粪便基因检测与FOBT联合应用于社区CRC筛查,可以提高社区CRC筛查的准确性。
[Abstract]:Objective to investigate the value of multi-target fecal gene detection in (CRC) screening of colorectal cancer in community. Methods from August 2014 to July 2016, residents of Lujiazui, Sanlin and Yingbo communities in Pudong New area were screened. Including the risk assessment of colorectal cancer screening for community residents in Shanghai and two fecal occult blood tests (FOBT).) The risk assessment was positive and any one of the two times of FOBT was positive, which was included in the test group (nnn294), and the risk assessment was negative and the FOBT was negative for the first screening, and the control group was included (nnn102). The residents of the group underwent colonoscopy and biopsy within 2 weeks after the completion of community screening. The fecal DNA, was extracted to detect abnormal methylated BMP3,NDRG4 promoter region and KRAS mutation was detected before colonoscopy. To evaluate the diagnostic value of multiple target fecal gene detection in the experimental group and control group, the results of colonoscopy and pathology were taken as the "golden standard". Results the sensitivity of multitarget fecal gene detection for precancerous lesions of CRC, was 85.7% [95%CI (59.8U 100.0%)], 75.0% [95%CI (32.6% 100.0%)] and 84.0% (95%CI (79.788.3%). In the control group, the specificity of multitarget fecal gene detection was 83.8% for normal polyps and completely negative individuals [95%CI (76.789. 2%)]. Conclusion multiple target fecal gene detection combined with FOBT can improve the accuracy of community CRC screening.
【作者单位】：上海市浦东新区陆家嘴社区卫生服务中心;同济大学附属东方医院消化中心;
【基金】：浦东新区科技发展基金创新资金(医疗卫生)项目(PKJ2014-Y39)
【分类号】：R735.34

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