在中国人群中，用于结直肠癌筛查时，灵敏的愈创木脂粪便潜血试验不如免疫化学检测有用。
A sensitive guaiac faecal occult blood test is less useful than an immunochemical test for colorectal cancer screening in a Chinese population.
作者信息
Wong B C-Y, Wong W M, Cheung K L, Tong T S M, Rozen P, Young G P, Chu K W, Ho J, Law W L, Tung H M, Lai K C, Hu W H C, Chan C K, Lam S K
机构信息
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
出版信息
Aliment Pharmacol Ther. 2003 Nov 1;18(9):941-6. doi: 10.1046/j.1365-2036.2003.01783.x.
BACKGROUND
Colorectal cancer screening by guaiac faecal occult blood test has been shown to reduce the incidence and mortality of colorectal cancer in Western populations. The optimal faecal occult blood test, whether guaiac or immunochemical, for colorectal cancer screening in the Chinese population remains to be defined.
AIM
To compare the performance characteristics of a sensitive guaiac-based faecal occult blood test (Hemoccult SENSA) and an immunochemical faecal occult blood test (FlexSure OBT) in a Chinese population referred for colonoscopy.
METHODS
One hundred and thirty-five consecutive patients who were referred for colonoscopy and who met the study inclusion criteria took samples for the two faecal occult blood tests simultaneously from three successive stool specimens, with no dietary restrictions. All tests were developed and interpreted by a single experienced technician who was blind to the clinical diagnosis. The sensitivity, specificity and positive predictive value for the detection of colorectal adenomas and cancers were estimated for the two tests.
RESULTS
The sensitivity, specificity and positive predictive value for the detection of significant colorectal neoplasia (adenomas > or = 1.0 cm and cancers) were 91%, 70% and 18% for Hemoccult SENSA and 82%, 94% and 47% for FlexSure OBT. The specificity and positive predictive value were significantly higher for FlexSure OBT than for Hemoccult SENSA (P < 0.001 and P = 0.016, respectively). Combining the positive results from both faecal occult blood tests did not improve the accuracy.
CONCLUSION
The positive predictive value of the immunochemical faecal occult blood test for the detection of significant colorectal neoplasia was 29% better than that of the sensitive guaiac-based test. This may relate to the Chinese diet and requires further study. The poor specificity of the sensitive guaiac-based test, without dietary restriction, makes it less useful for colorectal cancer screening in a Chinese population.
背景
在西方人群中，通过愈创木脂粪便潜血试验进行结直肠癌筛查已被证明可降低结直肠癌的发病率和死亡率。对于中国人群的结直肠癌筛查而言，最佳的粪便潜血试验，无论是愈创木脂法还是免疫化学法，仍有待确定。
目的
比较一种基于愈创木脂的敏感粪便潜血试验（Hemoccult SENSA）和一种免疫化学粪便潜血试验（FlexSure OBT）在因结肠镜检查而就诊的中国人群中的性能特征。
方法
135例连续因结肠镜检查而就诊且符合研究纳入标准的患者，在无饮食限制的情况下，从连续三份粪便标本中同时采集样本进行两种粪便潜血试验。所有检测均由一名对临床诊断不知情的经验丰富的技术人员进行操作和判读。对两种检测方法检测结直肠腺瘤和癌症的敏感性、特异性和阳性预测值进行了评估。
结果
对于检测显著的结直肠肿瘤（腺瘤≥1.0 cm和癌症），Hemoccult SENSA的敏感性、特异性和阳性预测值分别为91%、70%和18%，FlexSure OBT分别为82%、94%和47%。FlexSure OBT的特异性和阳性预测值显著高于Hemoccult SENSA（分别为P<0.001和P = 0.016）。将两种粪便潜血试验的阳性结果相结合并未提高准确性。
结论
免疫化学粪便潜血试验检测显著结直肠肿瘤的阳性预测值比基于愈创木脂的敏感试验高29%。这可能与中国饮食有关，需要进一步研究。基于愈创木脂的敏感试验在无饮食限制时特异性较差，使其在中国人群的结直肠癌筛查中用处较小。
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