粪便潜血阳性后行结肠镜检查的时间和粪便血红蛋白浓度与结直肠高级别瘤变风险的关系。
Association of time to colonoscopy after a positive fecal test result and fecal hemoglobin concentration with risk of advanced colorectal neoplasia.
机构信息
Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
出版信息
Dig Liver Dis. 2019 Apr;51(4):589-594. doi: 10.1016/j.dld.2018.12.008. Epub 2018 Dec 23.
BACKGROUND
We evaluated the risk of advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) according to time to colonoscopy after positive fecal immunochemical test (FIT), fecal hemoglobin concentration, and combination of both.
METHODS
We analyzed the records of 2362 patients aged ≥50 years who underwent colonoscopy because of a positive FIT result through the National Cancer Screening Program of Korea.
RESULTS
ACRN risk increased with increasing time to colonoscopy after a positive FIT (17.2%, 18.6%, 19.1%, 21.4%, and 27.2% in <30, 30-59, 60-149, 150-179, and ≥180 days; P = 0.034), and ACRN and CRC risk increased with increasing fecal hemoglobin concentration (ACRN, 13.2%, 16.9%, 18.5%, 23.2%, and 26.6%; CRC, 1.3%, 1.7%, 4.7%, 5.7%, and 12.8% with 100-200, 200-300, 300-500, 500-1000, and ≥1000 ng Hb/mL; both P < 0.001). Even after adjusting for confounders, follow-up after 180 days tended to be associated with a higher ACRN risk (adjusted odds ratio, 1.73; 95% confidence interval [CI], 0.91-3.27), compared with follow-up colonoscopy at <30 days, and fecal hemoglobin 500-1000, and ≥1000 ng Hb/mL were associated with a significantly higher ACRN and CRC risk, compared with 100-200 ng Hb/mL. Moreover, the group with ≥180 days and ≥1000 ng Hb/mL had a much higher CRC risk compared with the group with <180 days and <1000 ng Hb/mL (12.45-fold; 95% CI, 3.73-41.57).
CONCLUSIONS
Patients with positive FIT results, especially those with higher fecal hemoglobin levels, should undergo timely follow-up colonoscopy.
背景
我们根据粪便免疫化学检测（FIT）阳性后行结肠镜检查的时间、粪便血红蛋白浓度以及两者的组合，评估了进展期结直肠腺瘤（ACRN）和结直肠癌（CRC）的风险。
方法
我们分析了韩国国家癌症筛查计划中因 FIT 阳性而接受结肠镜检查的 2362 名年龄≥50 岁患者的记录。
结果
FIT 阳性后行结肠镜检查的时间延长（<30、30-59、60-149、150-179 和≥180 天的 ACRN 风险分别为 17.2%、18.6%、19.1%、21.4%和 27.2%；P=0.034），以及粪便血红蛋白浓度升高（ACRN，13.2%、16.9%、18.5%、23.2%和 26.6%；CRC，1.3%、1.7%、4.7%、5.7%和 12.8%，粪便血红蛋白水平分别为 100-200、200-300、300-500、500-1000 和≥1000ng/mL；均 P<0.001）时，ACRN 和 CRC 的风险增加。即使在调整混杂因素后，与<30 天内进行结肠镜检查相比，随访时间为 180 天及以上的患者发生 ACRN 的风险更高（调整优势比，1.73；95%置信区间[CI]，0.91-3.27），粪便血红蛋白水平为 500-1000 和≥1000ng/mL 与 100-200ng/mL 相比，ACRN 和 CRC 的风险显著更高。此外，与<180 天和<1000ngHb/mL 相比，≥180 天和≥1000ngHb/mL 的患者 CRC 风险更高（12.45 倍；95%CI，3.73-41.57）。
结论
阳性 FIT 结果的患者，尤其是粪便血红蛋白水平较高的患者，应及时行结肠镜检查。
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