结直肠癌和结直肠腺瘤筛查方式的研究进展

doi:10.3969/j.issn.1674-8115.2022.05.017

摘要/Abstract

摘要：

近年来我国结直肠癌（colorectal cancer，CRC）发病率和死亡率呈上升趋势，严重威胁我国居民的生命健康，并造成了巨大的社会负担。筛查发现早期结直肠癌或腺瘤（癌前病变）可有效降低CRC发病率和死亡率。因此，在CRC的防治中，筛查的作用和意义重大。CRC和结直肠腺瘤的筛查技术包括以下4种类型。① 基于粪便的检查：粪便隐血试验（fecal occult based test，FOBT）、粪便DNA检测、粪便菌群标志物检测和粪便M2型丙酮酸激酶（M2 pruvate kinase，M2-PK）检测。② 影像学检查：计算机断层结肠成像（computed tomo-graphic colonography，CTC）、双对比钡灌肠（double-contrast barium enema，DCBE）和结肠胶囊内镜检查（colon capsule endoscopy，CCE）。③ 内窥镜检查：柔性乙状结肠镜（flexible sigmoidoscopy，FS）和结肠镜（colonoscopy，CS）。④ 液体活检：循环肿瘤细胞、循环肿瘤DNA（circulating tumor DNA，ctDNA）、循环肿瘤RNA（circulating tumor RNAs，ctRNAs）、蛋白质标志物、细胞外囊泡（extracellular vesicles，EVs）等。其中生物标志物DNA和RNA分子等可传达出丰富的人体健康状态信息，在筛查CRC中具有高敏感度和特异度，但在筛查腺瘤方面尚未广泛开展，需要对相关生物标志物开展更深入大规模的随机研究。该文对CRC和结直肠腺瘤筛查技术进行综述，介绍其原理、特点以及最新的研究进展，为CRC和结直肠腺瘤筛查技术在临床上的应用提供理论依据。

关键词: 结直肠癌, 结直肠腺瘤, 筛查

Abstract:

In recent years, the incidence and mortality of colorectal cancer (CRC) in China are on the rise, which seriously threatens the life and health of Chinese residents and causes a huge social burden. Screening to detect early colorectal cancer or adenoma (precancerous lesions) can effectively reduce the incidence and mortality of CRC. Therefore, the role and significance of screening in the prevention and treatment of CRC is significant. There are 4 types of screening techniques for CRC and colorectal adenoma. ① Stool-based tests: fecal occult based test (FOBT), fecal DNA test, fecal flora marker test, and fecal M2 pyruvate kinase (M2-PK) test. ② Imaging tests: computed tomo-graphic colonography (CTC), double-contrast barium enema (DCBE), and colon capsule endoscopy (CCE). ③ Endoscopy: flexible sigmoidoscopy (FS) and colonoscopy (CS). ④ Liquid biopsies: circulating tumor cells, circulating tumor DNA (ctDNA), circulating tumor RNAs (ctRNAs), protein markers, extracellular vesicles (EVs), etc. Among them, biomarkers DNA and RNA molecules can convey rich information about human health status and have high sensitivity and specificity in screening CRC, but they have not been widely carried out in screening adenomas, and more in-depth large-scale randomized studies of relevant biomarkers are needed. The review of CRC and colorectal adenoma screening technologies is present, introducing their principles, characteristics, and recent research advances to provide a theoretical basis for the clinical application of CRC and colorectal adenoma screening technologies.

Key words: colorectal cancer, colorectal adenoma, screening

中图分类号:

R735.3

赵敏, 褚以忞, 彭海霞. 结直肠癌和结直肠腺瘤筛查方式的研究进展[J]. 上海交通大学学报（医学版）, 2022, 42(5): 673-679.

ZHAO Min, CHU Yimin, PENG Haixia. Research advances in screening modalities for colorectal cancer and colorectal adenoma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 673-679.

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