粪便潜血和钙卫蛋白检测优先考虑结肠镜检查转诊的初级保健患者：优势研究。
Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study.
发表日期：2023 Aug 23
作者：
Ángel Lanas, Francesc Balaguer, Marta Sánchez-Luengo, Gonzalo Hijos-Mallada, Goretti Hernández-Mesa, Melisa Piñero, Joaquin Castillo, Teresa Ocaña, Joaquín Cubiella, Anais Crespo, Águeda Iglesias, Isabel Medeiros, Guillermo Cacho, Rodrigo Jover-Martínez, Miren Alustiza, José Diaz-Tasende, Carmen Poves, Guilherme Macedo, Enrique Quintero,
来源：
United European Gastroenterology Journal
摘要：
结肠镜检查是结直肠癌（CRC）诊断和筛查的金标准，但内窥镜服务通常过于负担沉重。本研究旨在调查粪便血红蛋白（fHb）和钙卡钓蛋白（FC）对需要紧急转诊的高概率CRC患者的识别的有效性。在一项多中心前瞻性研究中，我们纳入了来自初级保健机构转诊进行结肠镜检查的症状性患者。在肠准备前，进行了fHb和FC定量检测。评估了每个生物标志物/组合的诊断性能。我们基于Logistic回归建立了多变量预测模型，将其转换为示意图和风险计算器，以协助临床医生进行决策过程。本研究纳入了1224名患者，其中69名（5.6%）患有CRC。在fHb截断值>0和10 μg/g的情况下，CRC的阴性预测值分别为98.8%（95%置信区间97.8%-99.3%）和98.6%（95%CI 97.7%-99.1%），敏感性分别为85.5%（95%CI 75.0%-92.8%）和79.7%（95%CI 68.3%-88.4%）。当我们在两个fHb阈值上加入FC 150 μg/g的截断值时，粪便检查的敏感性得到了改善。在多变量Logistic回归模型中，fHb浓度是CRC的独立预测因子；年龄和性别也与CRC独立相关。fHb和FC作为筛选工具的一部分，可用于确定那些高概率CRC的症状性患者。临床医生可以轻松应用此工具来优先考虑高风险患者进行紧急结肠镜检查。© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
Colonoscopy is the gold standard for colorectal cancer (CRC) diagnosis and screening, but endoscopy services are usually overburdened. This study aims to investigate the usefulness of fecal hemoglobin (fHb) and calprotectin (FC) for the identification of patients with high probability of CRC who need urgent referral.In a multicenter prospective study, we enrolled symptomatic patients referred from primary care for colonoscopy. Prior to bowel preparation, fHb and FC quantitative tests were performed. The diagnostic performance was estimated for each biomarker/combination. We built a multivariable predictive model based on logistic regression, translated to a nomogram and a risk calculator to assist clinicians in the decision-making process.The study included 1224 patients, of whom 69 (5.6%) had CRC. At the fHb cut-offs of >0 and 10 μg/g, the negative predictive values for CRC were 98.8% (95% confidence interval 97.8%-99.3%) and 98.6% (95%CI 97.7%-99.1%), and the sensitivities were 85.5% (95%CI 75.0%-92.8%) and 79.7% (95%CI 68.3%-88.4%), respectively. When we added the cut-off of 150 μg/g of FC to both fHb thresholds, the sensitivity of fecal tests improved. In the multivariate logistic regression model, the concentration of fHb was an independent predictor for CRC; age and gender were also independently associated with CRC.fHb and FC are useful as part of a triage tool to identify those symptomatic patients with high probability of CRC. This can be easily applied by physicians to prioritize high-risk patients for urgent colonoscopy.© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.