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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (5): 576-581.doi: 10.3969/j.issn.1674-5671.2025.05.08

• 论著 • 上一篇    下一篇

高危因素量化问卷及免疫粪便隐血试验在结直肠肿瘤筛查中的效能

  

  1. 北京市垂杨柳医院消化内科；北京市垂杨柳医院检验科；首都医科大学附属北京安贞医院
  • 出版日期:2025-10-25 发布日期:2025-12-03
  • 通讯作者: 黎俊 E-mail：dalizijunjun@126.com
  • 基金资助:
    首都卫生发展科研专项项目（首发2024?3?7037）

Efficacy of a high-risk factor quantitative questionnaire and immune fecal occult blood test in colorectal cancer screening

  • Online:2025-10-25 Published:2025-12-03

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摘要： 目的 比较高危因素量化问卷（high⁃risk factor questionnaire，HRFQ）与免疫化学粪便隐血试验（immune fecal occult blood test，iFOBT）在结直肠肿瘤筛查中的效果，为优化早期筛查策略提供依据。方法 采用横断面研究设计， 于2024年6月至2025年3月纳入在北京市招募拟行肠镜检查的受试者。以结肠镜及病理结果为金标准，分析HRFQ与iFOBT单独及联合检测对结直肠肿瘤的诊断效能。结果 共纳入920名目标人群，655人完成HRFQ问卷，高危率为41.98%（275/655）；其中557人经结肠镜检查验证，结直肠肿瘤总检出率为47.22% (263/557)，HRFQ高危组（n=243例）较低危组（n=314例）的结直肠肿瘤检出率高（54.73% vs 41.40%，P=0.002），非进展期腺瘤检出率也高于低危组（35.80% vs 27.07，P=0.027），但进展期腺瘤及结直肠癌检出率差异均无统计学意义（P>0.05）。完成iFOBT检测571人，阳性率为25.74%（147/571）；其中517人经结肠镜检查验证，iFOBT阳性组（n=133例）结直肠肿瘤（60.90% vs 42.96%，P<0.001）、进展期腺瘤（22.56% vs 8.60%，P<0.001）和结直肠癌（18.05% vs 0.78%，P<0.001）检出率均显著高于阴性组（n=384例）。串联分析中，HRFQ高危且iFOBT阳性筛查模式的结直肠癌检出率较高，为16.92%（11/65）；并联分析中，HRFQ高危或iFOBT阳性筛查模式的结直肠癌和非进展腺瘤检出率均较HRFQ低危或iFOBT阴性筛查模式升高（8.94% vs 0，31.79% vs 9.77%，P<0.001），而非肿瘤性病变检出率下降（45.36% vs 80.46%，P<0.001）。HRFQ诊断结直肠肿瘤的敏感度、特异度和总体准确率分别为50.57% 、62.59%和 56.91%，iFOBT分别为32.93%、80.81%和50.03%，两者并联筛查（HRFQ高危或iFOBT阳性）分别为79.71%、55.81%和65.38%。HRFQ或iFOBT单独以及两者并联（HRFQ高危或iFOBT阳性）筛查结直肠癌的灵敏度分别为50.00%、88.89%和100.00%。结论 HRFQ适用于非进展期腺瘤初筛，iFOBT对进展期肿瘤更具优势，二者联合检测可显著提升结直肠肿瘤，尤其进展期肿瘤的筛查灵敏度，优化筛查效率，为结直肠癌早期筛查提供新策略。

关键词: 结直肠肿瘤, 进展期腺瘤, 筛查, 高危因素量化问卷, 免疫化学粪便隐血试验

Abstract: Objective To compare the efficacy of the high⁃risk factor questionnaire (HRFQ) and the immune fecal occult blood test (iFOBT) in colorectal cancer screening, and to provide evidence for optimizing early screening strategies. Methods A cross⁃sectional study design was adopted, involving participants scheduled for colonoscopy from Beijing between June 2024 and March 2025. The diagnostic efficacy of HRFQ and iFOBT, both individually and in combination, for detecting colorectal tumors was assessed, using colonoscopy and pathological results serving as the gold standard for evaluation.  Results A total of  920 participants were recruited, with 655 completing the HRFQ，and the high⁃risk rate was 41.98% (275/655). Among these, 557 underwent colonoscopy, resulting in an overall colorectal tumor detection rate of 47.22% (263/557). The HRFQ high⁃risk group (n=243) demonstrated a higher colorectal tumor detection rate than the low⁃risk group (n=314) (54.73% vs 41.40%, P=0.002), the non⁃advanced adenoma detection rate was also higher in the high⁃risk group (35.80% vs 27.07%， P=0.027), whereas no significant differences were observed in the detection rates of advanced adenoma or colorectal cancer. Among the 571 participants who completed iFOBT testing, the positive rate was 25.74% (147/571). Among these, 517 underwent colonoscopy，and the iFOBT⁃positive group （n=133） showed significantly higher detection rates for overall colorectal tumor (60.90% vs 42.96%，  P<0.001) , advanced adenoma （22.56% vs 8.60% ， P<0.001） and colorectal cancer （18.05% vs 0.78%， P<0.001） compared to the iFOBT⁃negative group （n=384）. In serial testing (HRFQ high⁃risk and iFOBT positive), the colorectal cancer detection rate reached 16.92%（11/65）. In parallel testing , the detection rates for both colorectal cancer and non⁃advanced adenoma in the HRFQ high⁃risk or iFOBT positive screening mode were elevated compared to the HRFQ low⁃risk or iFOBT negative screening mode (8.94% vs 0， 31.79% vs 9.77%， P<0.001), while the detection rate of non⁃neoplastic lesions decreased (45.36% vs 80.46%, P<0.001). The sensitivity, specificity and overall accuracy of HRFQ in the diagnosis of colorectal tumors were 50.57%, 62.59% and 56.91%, respectively; and those of iFOBT were 32.93%, 80.81% and 50.03%, respectively; the parallel screening (HRFQ high⁃risk or iFOBT positive) yielded 79.71%, 55.81% and 65.38%, respectively. The sensitivity of HRFQ or iFOBT individually and in combination (HRFQ high⁃risk or iFOBT positive) for colorectal cancer screening was 50.00%, 88.89% and 100.00%, respectively. Conclusions HRFQ is suitable for initial screening of non⁃advanced adenomas, while iFOBT demonstrates greater advantage in detecting advanced lesions. The integration  of both methods significantly enhances the sensitivity of colorectal tumor screening, particularly for advanced lesions, thereby optimizing optimizes screening efficiency and providing a new strategy for early colorectal cancer screening.

Key words: Colorectal neoplasms, Advanced adenomas, Screening, High?risk factor questionnaire, Immune fecal occult blood test

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