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背景结直肠癌居世界常见癌症第三位,居欧洲常见癌症第二位。行结直肠癌筛查能早期发现该病,经其他检测方式做出诊断时常处于病变中晚期。目的本文旨在识别及描述社区医院接诊的非转移性结直肠癌患者临床特点,期望以此提高全科医师早期诊断结直肠癌的能力。设计与场所本研究为病例对照研究,使用的诊断标准来源于瑞典国家及地方医疗保健数据库。方法 2011年从瑞典癌症登记处数据库选取542例非转移性结直肠癌患者作为研究对象,并从瑞典地方医疗保健数据库选取2 139例相匹配的患者作为对照组。在癌症确诊日期(此项以瑞典癌症登记处的数据为准)前1年社区医院登记的所有患者的诊断标准(国际疾病分类2010年版)数据来源于瑞典地方医疗保健数据库。采用多因素Logistic回归分析与非转移性结直肠癌独立相关变量的比值比,计算各变量以及联合变量对非转移性结直肠癌的阳性预测值(PPV)。结果结直肠癌患者在确诊之前,往往有以下5种症状:(1)出血。包括直肠出血、黑便、胃肠出血〔PPV=3.9%,95%CI(2.3,6.3),P<0.05〕;(2)贫血〔PPV=1.4%,95%CI(1.1,1.8),P<0.05〕;(3)排便习惯的改变〔PPV=1.1%,95%CI(0.9,1.5),P<0.05〕;(4)腹痛〔PPV=0.9%,95%CI=(0.7,1.1),P<0.05〕;(5)体质量减轻〔PPV=1.0%,95%CI(0.3,3.0),P<0.05〕。如患者有出血且伴随排便习惯改变的症状,则PPV=13.7%,95%CI=(2.1,54.4);具有出血且伴随腹痛的症状,则PPV=12.2%,95%CI=(1.8,51.2)。此套结直肠癌风险评估工具的研制较成功。结论出血伴随腹泻、便秘、排便习惯的改变,或者腹部疼痛是提示可能患有非转移性结直肠癌的最有效因素,一旦患者发生以上情况,全科医师应及时安排患者行结直肠检查。
Background Colorectal cancer is the third most common cancer in the world, ranking second in common cancers in Europe. Colorectal cancer screening early detection of the disease, the diagnosis by other tests often in the late disease. Objective This paper aims to identify and describe the community hospital admissions of non-metastatic colorectal cancer clinical features, hoping to improve general practitioners early diagnosis of colorectal cancer. Design and Locations This study is a case-control study using diagnostic criteria derived from the Swedish National and Local Health Care Database. Methods A total of 542 patients with non-metastatic colorectal cancer were selected from the Swedish Cancer Registry database in 2011 and 2 139 matched patients were selected from the Swedish local health care database as a control group. The diagnostic criteria for all patients registered in the Community Hospital (International Classification of Diseases 2010) 1 year prior to the date of the diagnosis of cancer (this data is based on the Swedish Cancer Registry) are based on the Swedish local healthcare database. Multivariate logistic regression analysis was used to analyze the odds ratio (RR) of independent variables in non-metastatic colorectal cancer, and the positive predictive value (PPV) of each variable and co-variable in non-metastatic colorectal cancer was calculated. Results Colorectal cancer patients in the diagnosis before, often the following five kinds of symptoms: (1) bleeding. Including rectal bleeding, melena, gastrointestinal bleeding [PPV = 3.9%, 95% CI (2.3, 6.3), P < <0.05]; (3) changes in bowel habits [PPV = 1.1%, 95% CI (0.9,1.5), P < , P <0.05]. (5) Body mass reduction [PPV = 1.0%, 95% CI (0.3, 3.0), P <0.05〕. PPV = 13.7%, 95% CI = (2.1, 54.4); bleeding with concomitant abdominal pain, PPV = 12.2%, 95% CI = (1.8, 51.2 ). This set of colorectal cancer risk assessment tools developed more successful. Conclusions Hemorrhage with diarrhea, constipation, changes in bowel habits, or abdominal pain is the most effective factor that may indicate a possible non-metastatic colorectal cancer. Once the patient has the above condition, the GP should arrange for the patient to have a colorectal examination in time.