血清肿瘤标志物检测在放化疗后结直肠癌患者复发评估中的临床价值

目的探索血清肿瘤标志物在结直肠癌患者预后评估中的临床价值。方法对结直肠癌患者肿瘤标志物进行测定,并采用拟合优度检验方法筛选能够预测复发的肿瘤标志物组合。结果单项检测肿瘤标志物敏感性较差,CEA、CA19-9、CA24-2阳性水平影响复发。最佳预测预后组合方案为CEA、CA19-9。结论血清肿瘤标志物联合检测可以作为结直肠癌患者预后评价的依据。     

血清肿瘤标志物联合检测对结直肠癌患者手术预后的评估价值

目的 探讨血清肿瘤标志物联合检测对结直肠癌患者手术预后的评估价值。方法 选取2018年2月至2019年5月本院收治的结直肠癌患者81例。结直肠切除术治疗前采集患者空腹外周静脉血4 ml,蛋白芯片检测试剂盒测定血清癌胚抗原、糖类抗原199(CA199)、糖类抗原242(CA242)水平。术后进行为期3年的随访,记录患者肿瘤转移情况和生存情况,根据肿瘤转移情况分为未转移组和转移组。结果 81例结直肠癌患者术前血清癌胚抗原水平为(13.95±3.71)μg/L,癌胚抗原阳性率为64.20%(52/81);血清CA199水平为(40.62±6.48)kU/L,CA199阳性率为30.86%(25/81);血清CA242水平为(55.17±6.05)kU/L,CA242阳性率为53.09%(43/81)。随访期间,81例结直肠癌患者中38例(46.91%,转移组)发生转移,其余43例未发生转移患者归入未转移组。转移组患者血清癌胚抗原、CA199、CA242水平明显高于未转移组患者,差异均有统计学意义(均P<0.01)。ROC曲线分析显示,血清癌胚抗原、CA199、CA242单独和联合检测对...     

双酚A暴露与结直肠癌肿瘤组织神经酰胺及血清肿瘤标志物相关性

目的  探讨双酚A(bisphenol A, BPA)暴露与结直肠癌(colorectal cancer, CRC)肿瘤组织神经酰胺(ceramide, Cer)及血清肿瘤标志物的相关性。 方法  收集84例CRC患者的晨尿、CRC肿瘤组织, 使用液相色谱-质谱联法(liquid chromatography mass spectrometer, LC-MS)检测尿液BPA浓度, 尿BPA浓度用尿肌酐(creatinine, Cr)进行校正(BPAcr)。酶联免疫吸附(enzyme-linked immunosorbent assay, ELISA)法检测肿瘤组织Cer浓度, 分析尿BPAcr与肿瘤组织Cer、血清肿瘤标志物之间的相关性。 结果  CRC肿瘤组织Cer与BPAcr呈正相关(r=0.784, P < 0.001), 回归分析显示肿瘤组织Cer与BPAcr的回归系数为0.218(95%CI:0.18~0.26), 具有统计学意义(P < 0.001);血清CEA阳性和阴性、CA125阳性和阴性、CA19-9阳性和阴性组之间CRC肿瘤组织Cer和尿BPAcr差异均有统计学意义(均有P < 0.05), 而AFP阳性和阴性组间肿瘤组织Cer和尿BPAcr差异无统计学意义(P=0.247)。血清CEA、CA125和CA19-9水平与尿BPAcr(r值分别为0.348, 0.251, 0.281, 均有P < 0.05)和CRC肿瘤组织Cer(r值分别为0.265, 0.309, 0.263, 均有P < 0.05)均呈正相关。 结论  BPA暴露可能会引起CRC肿瘤组织内Cer增加以及血清肿瘤标志物的异常, 提示BPA暴露可能通过影响CRC肿瘤组织Cer代谢参与CRC的发生发展。     

结直肠癌患者血清肿瘤标志物与临床分期的相关性分析

目的探讨血清肿瘤标志物CEA、CA199、CA242及CA50在结直肠癌患者中的表达情况以及与临床分期的相关性。方法回顾性分析55例结直肠癌患者血清CEA、CA199、CA242和CAS0的水平与其性别、年龄、肿瘤部位及cTNM分期的关系。结果cTNM分期对血清CEA、CA199、CA242及CA50水平有影响,差异有显著统计学意义（P〈0．05）;不同性别、年龄、肿瘤部位患者,上述血清肿瘤标志物表达比较差异无统计学意义（P〉0．05）。血清CEA、CA199、CA242及CA50的水平与cTNM分期的Pearson相关系数分别为0．282、0．332、0．305、0．301,比较差异均有统计学意义（P〈0．05）。结论CEA、CA199、CA242及CAS0的阳性表达水平与结直肠癌分期呈正相关,可反映肿瘤进展程度及判断预后。     

血清肿瘤标志物联合检测对结直肠癌的诊断价值

目的 分析结直肠癌(CRC)患者血清肿瘤标志物癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)水平及联合检测的价值.方法 选取2020年1月至2020年12月本院收治的54例CRC患者为CRC组,另取同期本院良性结直肠病变患者46例为良性组.比较2组血清CA125、CA199、CEA水平,...     

血清microRNA141表达对结直肠癌早期筛查的临床意义

目的探讨血清microRNA141(miR-141)表达在结直肠癌早期筛查及癌症转移中的临床意义。方法采用qRT-PCR(SYBR Green)法检测1∶1匹配的46对结直肠癌患者及健康对照者血清中miR-141的表达并比较差异,同时用logistic回归模型分析miR-141表达与结直肠癌临床病理特征的关系。结果结直肠癌患者血清中miR-141的相对表达量(M=5.61)高于健康对照(M=2.21,Z=-2.84,P=0.005);同时,logistic回归分析结果显示,miR-141高表达与结直肠癌患者的淋巴结转移相关(OR=5.17,P=0.035)。结论血清miR-141高表达可能与结直肠癌有关,但能否作为结直肠癌早期筛查的生物学指标,需进一步扩大样本量验证。     

基于神经网络的MSCT孤立肺小结节诊断模型的设计

目的构建基于神经网络模型(SVM)在MSCT孤立肺小结节(SPN)诊断系统的设计及应用。方法观察2000例经病理证实的SPN临床表现及影像学特征共17项相关指标,采用多因素回归分析,与SPN病理良恶性相关指标作为SVM分析参数,对1500例进行训练,另500例进行预测,对照病理结果分析。采用C/S(Client/Server)架构设计神经网络模型诊断系统。结果与病理对照,500例SVM的良性正确预测238例(98.5%),错误预测4例(1.5%);恶性正确预测250例(97%),错误预测8例(3%)。结论 SVM能有效地对SPN良恶性进行较精确的预测,该模型操作简单、方便、使用,可帮助医生提高SPN正确诊断率。     

结直肠癌术后感染的相关因素调查及病原菌分析

目的 探讨结直肠癌患者术后感染的相关因素,并分析其病原菌的分布特点,为防治术后感染提供参考.方法 回顾性调查分析2004年6月-2011年6月医院收治的364例结直肠癌患者发生手术部位感染情况,将发生感染61例为感染组,未发生感染303例为对照组,比较两组患者临床资料,并分析感染患者病原菌的分布特点.结果 发生手术部位感染61例,感染率为16.76％;共分离出73株病原菌,其中革兰阴性杆菌47株占64.38％,革兰阳性球菌20株占27.40％;体重指数≥23及合并糖尿病患者是结直肠癌术后手术部位感染的危险因素(P＜0.05).结论 肥胖和糖尿病是影响结直肠癌患者术后发生手术部位感染的重要危险因素,应予以高度重视.     

内镜黏膜下剥离术在早期结直肠癌及癌前病变治疗中的效果观察

目的探讨内镜黏膜下剥离术在早期结直肠癌及癌前病变治疗中的效果。方法选取2018年3月—2020年3月河南省某医院收治的138例早期结直肠癌及癌前病变患者为研究对象。采用随机数字表法将患者分为研究组(n=69例)与对照组(n=69例)。对照组患者接受内镜下黏膜切除术治疗,研究组患者接受内镜下黏膜剥离术治疗。比较2组患者手术时间(进入至离开手术室的时间)、术中失血量(称重法和容量法计算失血量)、卧床时间(离开手术室至首次自主下床活动的时间)及住院时间(办理入院至办理出院的时间)。比较2组患者术前、术后3 d时胃动素(MTL)、生长抑素(SS)及D-乳酸(D-LA)水平。比较2组患者在术后3个月随访期内并发症发生情况。结果研究组患者卧床时间及住院时间均短于对照组,差异有统计学意义(P<0.05),研究组患者术中失血量少于对照组,差异有统计学意义(P<0.05)。术前2组患者MTL、SS、D-LA水平比较,差异无统计学意义(P>0.05)。术后3 d时,2组患者MTL、SS水平均低于术前,而研究组MTL水平高于对照组,差异均有统计学意义(P<0.05);2组患者D-LA...     

RRBP1在结直肠癌组织中的表达及临床意义

目的探讨核糖体结合蛋白1(RRBP1)在结直肠癌组织中的表达及临床意义。方法收集2016年7月-2018年7月于四川省某医院就诊的184例结直肠癌患者手术切除的结直肠癌组织及癌旁正常组织标本,采用免疫组织化学法检测RRBP1表达水平,分析RRBP1表达与患者临床病理参数和预后的关系。结果 RRBP1在结直肠癌中的阳性表达率为79.35%(146/184),明显高于癌旁正常组织的19.02%(35/184),差异有统计学意义(P0.05)。不同年龄、性别、肿瘤部位患者RRBP1阳性表达率比较,差异无统计学意义(P0.05);不同肿瘤大小、TNM分期、分化程度、淋巴结转移患者RRBP1阳性表达率比较,差异有统计学意义(P0.05)。Cox回归分析结果显示,RRBP1阳性、Ⅲ/Ⅳ分期、低分化、淋巴结转移是结直肠癌患者预后的危险因素(P0.05)。结论 RRBP1在结直肠癌组织中呈现高表达;RRBP1阳性为结肠癌患者预后危险因素;RRBP1作为分子标志物可以为结直肠癌的诊断及预后提供参考依据,值得临床参考。     

Mathematical Models for the Early Detection and Treatment of Colorectal Cancer

Colorectal cancer is a major cause of death for men and women in the Western world. When the cancer is detected through an awareness of the symptoms by a patient, typically it is at an advanced stage. It is possible to detect cancer at an early stage through screening and the marked differences in survival for early and late stages provide the incentive for the primary prevention or early detection of colorectal cancer. This paper considers mathematical models for colorectal cancer screening together with models for the treatment of patients. Illustrative results demonstrate that detailed attention to the processes involved in diseases, interventions and treatment enable us to combine data and expert knowledge from various sources. Thus a detailed operational model is a very useful tool in helping to make decisions about screening at national and local levels.     

大肠癌筛查策略和进展

大肠癌是目前世界上主要的恶性肿瘤之一,在我国的发病率和死亡率逐年上升。目前已证明对自然人群筛查可以有效降低大肠癌的发病率和死亡率,很多发达国家都开展了基于自然人群的大肠癌筛查工作,并取得了一定的成效。本文通过介绍目前常用的自然人群大肠癌筛查方法、目标人群的纳入标准以及筛查周期的制定,总结了国内外大肠癌筛查策略以及进展,对我国大肠癌筛查工作面临的挑战进行分析,为我国大肠癌筛查策略的制定提供建议。     

Critical Analysis of Markov Models Used for the Economic Evaluation of Colorectal Cancer Screening: A Systematic Review

Background

The economic evaluation of colorectal cancer screening is challenging because of the need to model the underlying unobservable natural history of the disease.

Prevalence of Colorectal Cancer Testing and Screening in a Multiethnic Primary Care Population

Colorectal cancer (CRC) screening is strongly supported by evidence and widely recommended, but remains underutilized. This study reports the prevalence of CRC diagnostic testing and CRC screening in three racial/ethnic groups attending the same primary care clinic. A cross-sectional survey was conducted to elicit past history of CRC testing, including test type, indication and timing. A comparable number of African American, Hispanic and non-Hispanic white patients aged 50–80 were recruited. 560 surveys were completed: mean age was 63.4 years, 64% reported minority race/ethnicity, and 96.8% had insurance. Overall, 62.5% [95% CI: 58.5%, 66.5%] of patients were current with any type of CRC test, when diagnostic and screening procedures were included. However, 48.6% [95% CI: 44.5%, 52.7%] of the sample was current with CRC screening, when only procedures performed for screening in asymptomatic patients were included. Patients least likely to be current with testing were those of minority race/ethnicity (48.2% of Hispanics, 56.7% of African Americans and 67.5% of non Hispanic whites, p < 0.05), younger age, (57.6% of those aged 50–64, and 71.4% of those aged 65–80, p < 0.005), and those with private insurance alone (56.0% private, 67.7% public and 68.1% mixed, p < 0.05). Our findings indicate that racial/ethnic and age related disparities in CRC screening exist even in a patient population that has the same source of health care and no differences in insurance status. These results underline the need for providers to emphasize CRC screening in their practices to minority patients and those younger than 65 years of age.     

Effectiveness of Community Health Workers in Providing Outreach and Education for Colorectal Cancer Screening in Appalachian Kentucky

The purpose of this study was to examine the effectiveness of a community health worker (CHW)–delivered cancer education program designed to increase knowledge and awareness of colorectal cancer screening options. The study population was an extremely vulnerable and medically underserved geographic region in Appalachian Kentucky. CHWs enrolled participants in face-to-face visits, obtained informed consent, and administered a baseline assessment of knowledge of colorectal cancer risks and the benefits of screening and screening history. An educational intervention was then provided and participants were re-contacted 6 months later when a posttest was administered. The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p < .001). Participants who reported asking their health care provider about colorectal cancer screening increased from 27.6% at baseline to 34.1% at follow-up (p?=?.013). Results suggest that CHWs were very effective at maintaining the study population; no loss to follow-up occurred. The results also showed increased knowledge and awareness about colorectal cancer screening education. Implications for social work practice, policy and research are discussed.     

上海市居民大肠癌早期发现知识和行为调查

[目的]了解上海市15岁及以上居民大肠癌早期发现的知识和行为现状,为开展大肠癌筛查和早期发现工作提供科学依据. [方法]利用2010年上海市慢性病及其危险因素监测调查数据,采用多阶段分层概率随机抽样方法,对15 732名常住居民进行问卷调查. [结果]获取有效问卷15663份.15岁及以上居民对大肠癌的早期异常体征和3项筛检方法,即每年1次主动肛指检查、每年1次主动大便隐血检查(FOBT)和50岁及以上每5年1次主动肠镜检查的知晓率分别为44.04％、22.62％、20.97％和16.83％.不同性别、区域、年龄和文化程度者对此的知晓率差异均有统计学意义(P＜0.05).50～74岁居民曾做过舡指检查、大便隐血检查和肠镜检查者的比例分别为12.07％、6.65％和4.82％.不同年龄(不包括15～17岁)和文化程度居民受检比例差异有统计学意义(P＜0.05);中心城区和非中心城区居民受检比例差异无统计学意义;除肛指检查外,男、女受检比例差异亦无统计学意义.在曾经做过相关检查的调查对象中,不同性别、年龄、地区和文化程度者最近一次接受肛指和肠镜检查的时间距调查时间间隔差异无统计学意义. [结论]上海市居民对大肠癌早期发现的认知较差,参加相关早期发现检查的比例较低.     

肠内营养用于术前肠道准备对结直肠癌患者腹腔和肠腔脱落癌细胞的影响

目的探讨术前肠内营养代替肠道准备对结直肠癌患者腹腔和肠腔脱落癌细胞的影响。方法将经病理确诊的60例结直肠癌患者随机分为两组,每组30人:A组于术前3天起每日口服30ml/kg瑞素,不进行灌肠,不口服泻药和抗生素;B组采用传统肠道准备,包括术前禁食、口服抗生素和清洁灌肠。两组患者均在开腹后用400ml生理盐水冲洗肿瘤所在的局部腹腔,抽取腹腔冲洗液200ml,迅速送检;手术切除肿瘤后作肠吻合之前,用1000ml生理盐水灌洗远端结直肠腔,收集肠腔冲洗液500ml,迅速送检。比较两组患者腹腔和肠腔内脱落的癌细胞阳性率,同时比较其肠道清洁度、术后肛门排气恢复时间和并发症发生率。结果A组患者腹腔和肠腔内脱落癌细胞阳性率分别为3.3%(1/30)和6.7%(2/30),明显低于B组患者的20.0%(6/30)和26.8%(8/30)(P均<0.05)。两组患者的肠道清洁度、术后肛门排气恢复时间和并发症发生率差异均无显著性(P均>0.05)。结论术前肠内营养可减少结直肠癌患者腹腔和肠腔脱落癌细胞的阳性率。