南部醫學中心健檢中心糞便潛血與大腸息肉相關性研究

The Relationship of Fecal Occult Blood and Colorectal Polyp in One Health Examination Center of Medical Center in Southern Taiwan

蔡宜璇(I-Hsuan Tsai) ； 謝依儒(Yi-Ju Hsieh)

《中華職業醫學雜誌》 27卷2期 (2020/04) Pp. 105-112

摘要

目的：糞便潛血檢查能早期發現大腸癌或息肉，也被我國國民健康署用來作為50至74歲民眾大腸癌篩檢工具；然而糞便潛血陽性有許多原因，國民健康署癌症篩檢資料庫顯示，篩檢結果陽性民眾（50至74歲）做後續確診60%是大腸息肉及大腸癌。而現今許多健檢中心及公司體檢項目都包含糞便潛血檢查，受檢者年齡不受限於50至74歲，針對此族群糞便潛血陽性者，是否代表大腸息肉機率也比較高，國內較少健檢族群的相關研究，因此本研究目的在探討健檢族群糞便潛血與大腸息肉的相關性。方法：本研究以南部某醫學中心的健康檢查中心為樣本所作的回溯性橫斷式分析。收集2016年10月至2017年2月期間曾至醫院健檢時同時接受糞便潛血及大腸鏡檢查之民眾為對象，以該次健康檢查紀錄資料為依據，使用多變項邏輯式迴歸分析糞便潛血和大腸息肉及各變項之相關性。結果：本次研究總共包含508位受檢者，男性佔323人（63.6%），女性佔185人（36.4%），平均年齡48.5±11.2歲；23人（4.5%）之糞便潛血呈現陽性反應。大腸息肉的比率在糞便潛血陽性者比糞便潛血陰性者高。收縮壓與舒張壓在糞便潛血陽性者也比糞便潛血陰性高。在單變項邏輯式迴歸分析中，發現大腸息肉（OR=8.37; 95% CI=3.36-20.90）、收縮壓（OR=1.04;95% CI=1.02-1.07）、舒張壓（OR=1.04; 95% CI=1.01-1.08）與糞便潛血陽性呈現正相關；進一步以多變項邏輯式迴歸分析校正後顯示，大腸息肉與糞便潛血陽性有顯著正相關性（AOR=7.27; 95% CI=2.82-18.76）。結論：本研究顯示針對健檢族群，糞便潛血陽性與大腸息肉有顯著正相關，臨床醫師遇到健檢糞便潛血陽性的受檢者，考量患有大腸息肉的風險較高，如果受檢者尚未做過大腸鏡或同時有大腸癌相關危險因子，則可以建議接受大腸鏡檢查。

關鍵字

糞便潛血 ； 大腸息肉

並列摘要

Background: Fecal occult blood test can detect colorectal cancer or polyp early and is used by the Health Promotion Administration as a screening tool for colorectal cancer in people aged 50 to 74. However, there are many etiologies of positive fecal occult blood. Health Promotion Administration Cancer Screening Database showed for people with positive fecal occult blood (aged 50 to 74), 60% of subsequent colonoscopy diagnoses were colorectal polyps or colorectal cancer. Today, many health examination centers and company physical examination programs include fecal occult blood tests. However, subjects are not limited to ages 50 to 74. For this group of people with positive occult blood test, whether they have higher risk of colorectal polyp. There are few related researches for group of health examination in Taiwan. Therefore, the purpose of this study is to explore the relationship of fecal occult blood and colorectal polyp for the group of health examination. Methods: This was a retrospective cross-sectional study in a health examination center of medical center in southern Taiwan. We collected subjects who received both fecal occult blood test and colonoscopy from October 2016 to February 2017.We analyzed the relationships between fecal occult blood, colorectal polyp and other factors by multivariate logistic regression, based on the data of the health examination record. Results: This study contained a total of 508 subjects of whom 323 were men (63.6%) and 185 were women (36.4%). Their mean age was 48.5 ±11.2 years. 23 subjects (4.5%) had positive occult blood test. The proportion of colorectal polyp was higher in subjects with positive fecal occult blood than subjects with negative fecal occult blood. Systolic and diastolic blood pressure were also higher in subjects with positive fecal occult blood than subjects with negative fecal occult blood. On univariate logistic regression analysis, we found colorectal polyp (OR=8.37; 95% CI=3.36-20.90), systolic blood pressure (OR=1.04; 95% CI=1.02-1.07) and diastolic blood pressure (OR=1.04; 95% CI=1.01-1.08) were positively associated with positive fecal occult blood. Further adjusted by multivariate logistic regression showed colorectal polyp was significantly positively associated with positive fecal occult blood (AOR=7.27; 95% CI=2.82-18.76). Conclusion: This study shows for the group of health examination, subjects with positive fecal occult blood are significantly positively associated with colorectal polyp. For subjects with fecal occult blood test, the clinician by considering higher risk of colorectal polyp to them can recommend them to receive colonoscopy if these subjects has not received colonoscopy or have risk factors of colorectal cancer.

並列關鍵字

fecal occult blood ； colon polyp