Article(id=1323941360864211239, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202502025, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1738425600000, receivedDateStr=2025-02-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793581818070, onlineDateStr=2026-11-02, pubDate=1765296000000, pubDateStr=2025-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793581818070, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793581818070, creator=13701087609, updateTime=1793581818070, updator=13701087609, issue=Issue{id=1323941237702668764, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='23', pageStart='4225', pageEnd='4416', issueExtLink='null', onlineDate='null', pubDate='1765296000000', pubDateStr='2025-12-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793581788707, creator='13701087609', updateTime=1793581887795, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1323941653374959780, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1323941653374959781, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4332, endPage=4338, ext={EN=ArticleExt(id=1323941362755842344, articleId=1323941360864211239, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Colorectal cancer screening results and colonoscopy compliance among rural residents in Sichuan Province, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the colorectal cancer(CRC) screening results and colonoscopy compliance among rural residents in Sichuan Province, providing evidence for optimizing CRC screening strategies.

Methods

From January to December 2023, through cluster sampling, residents aged 40 to 74 from rural areas of 8 districts/counties in Sichuan Province were selected to participate in CRC screening. The high-risk rate, colonoscopy compliance rate, and lesion detection rate were calculated. The χ2 test and multivariable logistic regression model were used to analyze factors influencing colonoscopy compliance.

Results

A total of 26 134 residents participated in the initial screening, with 5 483 identified as high-risk individuals, yielding a high-risk rate of 20.98%. Among them, 3 901 individuals underwent colonoscopy, resulting in a compliance rate of 71.15%. Multivariable logistic regression analysis showed that the compliance was significantly lower in the 70-74 age group(OR=0.55, 95% CI: 0.41-0.74) compared to the 40-44 age group. Higher education levels were associated with increased compliance. Self-employed individuals (OR=2.28, 95% CI: 1.59-3.26), those with a history of intestinal polyps (OR=3.40, 95% CI: 2.55-4.53), and those who were double-positive in both the high-risk factor questionnaire (HRFQ) and the fecal occult blood test (FOBT) (OR=3.03, 95% CI: 2.52-3.65) had higher compliance rates. Colonoscopy detected 230 cases of lesions, with a detection rate of 5.90%. Males had a higher lesion detection rate than females across all age groups.

Conclusion

The CRC screening program in rural areas of Sichuan Province has achieved positive results, but the compliance with colonoscopy still needs improvement, particularly among males, the elderly, and those with lower education levels. Efforts should be intensified to deliver targeted health education to these key populations, with the aim of further improving the overall compliance with colonoscopy and early detection rates.

, authors=Jing MA, Liang QIAO, Zhi-gang ZHONG, Xiao-xia LIU, Li-na LI, Jia-hao XU, authorsList=Jing MA, Liang QIAO, Zhi-gang ZHONG, Xiao-xia LIU, Li-na LI, Jia-hao XU, authorCompany=null, correspAuthors=Liang QIAO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1323941364160934190, articleId=1323941360864211239, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性分析, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

分析四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性,为优化筛查策略提供参考。

方法

通过整群抽样法,于2023年1—12月选取四川省8个市(区)农村40~74岁居民参与结直肠癌筛查,计算高危率、结肠镜依从性及病变检出率,采用χ2检验和多因素logistic回归模型分析结肠镜依从性影响因素。

结果

26 134名居民参与初筛,评估出高危人群5 483人,高危率为20.98%。其中3 901人接受结肠镜检查,依从率为71.15%。多因素logistic回归分析显示,70~74岁组肠镜依从性显著低于40~44岁组(OR=0.55,95% CI:0.41~0.74);教育程度越高,依从性更高;个体户(OR=2.28,95% CI:1.59~3.26)、有肠道息肉史(OR=3.40,95% CI:2.55~4.53)、问卷调查和便潜血检测双阳性者(OR=3.03,95% CI:2.52~3.65)依从性更高。结肠镜共检出230例病变,检出率为5.90%,男性各个年龄段病变检出率均高于女性。

结论

四川省农村地区结直肠癌筛查项目取得了一定成效,但结肠镜检查依从性仍有待提高,尤其应关注男性、年长及低教育程度的人群。未来应加强重点人群的健康宣教,以进一步提高肠镜依从性和早期病变检出率。

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马婧(1990—),女,硕士,主治医师,研究方向:疾病预防与控制

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Study on compliance rate of colonoscopy among High-Risk population of colorectal cancer in Jiangsu province [J]. China Cancer, 2023, 32 (3): 202-208. (In Chinese), articleTitle=Study on compliance rate of colonoscopy among High-Risk population of colorectal cancer in Jiangsu province, refAbstract=null), Reference(id=1323941377490432388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=3, pageStart=E143, pageEnd=E153, url=null, language=null, rfNumber=[18], rfOrder=30, authorNames=Shokar NK, Calderón-Mora J, Salaiz R, journalName=Journal of Public Health Management and Practice : JPHMP, refType=null, unstructuredReference=Shokar NK, Calderón-Mora J, Salaiz R, et al. Implementation and evaluation of a large Community-Based colorectal cancer screening program [J]. 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(In Chinese), articleTitle=Compliance and influencing factors of colonoscopy in high-risk population of colorectal cancer among community residents in Shenzhen, refAbstract=null), Reference(id=1323941377712730503, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=10, pageStart=811, pageEnd=816, url=null, language=null, rfNumber=[20], rfOrder=33, authorNames=金海朋, 应荣彪, 姚俊, journalName=肿瘤学杂志, refType=null, unstructuredReference=金海朋,应荣彪,姚俊, 等. 2020—2023年浙江省温岭市结直肠癌早诊早治筛查结果分析 [J]. 肿瘤学杂志, 2024, 30 (10): 811-816., articleTitle=2020—2023年浙江省温岭市结直肠癌早诊早治筛查结果分析, refAbstract=null), Reference(id=1323941377775645064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=10, pageStart=811, pageEnd=816, url=null, language=null, rfNumber=[20], rfOrder=34, authorNames=Jin HP, Ying RB, Yao J, journalName=Journal of Chinese Oncology, refType=null, unstructuredReference=Jin HP, Ying RB, Yao J, et al. 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(In Chinese), articleTitle=Results of colorectal cancer screening in Wenling city of Zhejiang province from 2020 to 2023, refAbstract=null)], funds=[Fund(id=1323941373019304291, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, awardId=2023YFG0148, language=CN, fundingSource=四川省科技厅重点研发项目(2023YFG0148), fundOrder=null, country=null), Fund(id=1323941373073830244, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, awardId=2024JDKP0121, language=CN, fundingSource=四川省科技厅科普培训项目(2024JDKP0121), fundOrder=null, country=null), Fund(id=1323941373145133413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, awardId=S22004, language=CN, fundingSource=四川省医学会科研课题(S22004), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1323941365129818416, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, xref=null, ext=[AuthorCompanyExt(id=1323941365167567153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, companyId=1323941365129818416, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Office of Cancer Prevention and Treatment, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute,Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1323941365175955762, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, companyId=1323941365129818416, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院四川省癌症防治中心办公室(预防部),四川 成都 610041)])], figs=[ArticleFig(id=1323941369571586395, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=EN, label=Figure 1, caption=Detection rates of abnormal colonoscopy findings by age and gender groups, figureFileSmall=qPKR7pZHTE9bRFeQsENqww==, figureFileBig=XpXKHP1OIlB8/iFfY4sJ0Q==, tableContent=null), ArticleFig(id=1323941369663861084, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=CN, label=图1, caption=不同年龄和性别组的结肠镜异常结果检出率, figureFileSmall=qPKR7pZHTE9bRFeQsENqww==, figureFileBig=XpXKHP1OIlB8/iFfY4sJ0Q==, tableContent=null), ArticleFig(id=1323941371710681437, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=EN, label=Table 1, caption=

Colonoscopy compliance among high-risk individuals with different characteristics in Sichuan Province [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人数结直肠癌高危接受肠镜检查χ2值P值
性别0.1420.707
男性11 258(43.08)2 198(19.52)1 570(71.43)
女性14 876(56.92)3 285(22.08)2 331(70.96)
年龄组(岁)130.64<0.001
40~441 852(7.09)471(25.43)349(74.10)
45~493 407(13.04)772(22.66)583(75.52)
50~545 128(19.62)1 290(25.16)978(75.81)
55~594 497(17.21)1 102(24.51)818(74.23)
60~642 714(10.38)624(22.99)450(72.12)
65~694 523(17.31)746(16.49)471(63.14)
70~744 013(15.36)478(11.91)252(52.72)
婚姻状况8.44<0.05
未婚156(0.60)29(18.59)22(75.86)
已婚25 097(96.03)5 220(20.80)3 726(71.38)
离异399(1.53)133(33.33)94(70.68)
丧偶482(1.84)101(20.95)59(58.42)
教育程度108.592<0.001
未上过学1 147(4.39)110(9.59)50(45.45)
小学11 927(45.64)2 051(17.20)1 371(66.85)
初中7 553(28.90)1 778(23.54)1 261(70.92)
高中3 463(13.25)723(20.88)548(75.80)
大专1 514(5.79)523(34.54)418(79.92)
本科及以上530(2.03)298(56.23)253(84.90)
职业116.799<0.001
农民14 479(55.40)2 339(16.15)1 512(64.64)
工人1 807(6.91)461(25.51)307(66.59)
个体户1 077(4.12)257(23.86)216(84.05)
各类专业技术人员1 166(4.46)528(45.28)424(80.30)
其它7 605(29.10)1 898(24.96)1 442(75.97)
是否吸烟4.523<0.05
否23 855(91.28)4 835(20.27)3 463(71.62)
是2 279(8.72)648(28.43)438(67.59)
是否饮酒0.0270.87
否24 404(93.38)4 867(19.94)3 461(71.11)
是1 730(6.62)616(35.61)440(71.43)
是否饮茶0.6690.413
否24 544(93.92)4 800(19.56)3 406(70.96)
是1 590(6.08)683(42.96)495(72.47)
本人有无肠息肉史73.942<0.001
无25 635(98.09)4 984(19.44)3 463(69.48)
有499(1.91)499(100.00)438(87.78)
一级亲属肠癌史11.064<0.01
无25 779(98.64)5 181(20.10)3 677(70.97)
有252(0.96)252(100.00)196(77.78)
不详103(0.39)50(48.54)28(56.00)
初筛阳性结果分类141.782<0.001
仅HRFQ阳性1 783(64.91)
仅FOBT阳性1 208(73.12)
HRFQ和FOBT双阳性910(83.95)
合计26 134(100.00)5 483(20.98)3 901(71.15)
), ArticleFig(id=1323941371815539038, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=CN, label=表1, caption=

四川省不同特征结直肠癌高危人群结肠镜依从性情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人数结直肠癌高危接受肠镜检查χ2值P值
性别0.1420.707
男性11 258(43.08)2 198(19.52)1 570(71.43)
女性14 876(56.92)3 285(22.08)2 331(70.96)
年龄组(岁)130.64<0.001
40~441 852(7.09)471(25.43)349(74.10)
45~493 407(13.04)772(22.66)583(75.52)
50~545 128(19.62)1 290(25.16)978(75.81)
55~594 497(17.21)1 102(24.51)818(74.23)
60~642 714(10.38)624(22.99)450(72.12)
65~694 523(17.31)746(16.49)471(63.14)
70~744 013(15.36)478(11.91)252(52.72)
婚姻状况8.44<0.05
未婚156(0.60)29(18.59)22(75.86)
已婚25 097(96.03)5 220(20.80)3 726(71.38)
离异399(1.53)133(33.33)94(70.68)
丧偶482(1.84)101(20.95)59(58.42)
教育程度108.592<0.001
未上过学1 147(4.39)110(9.59)50(45.45)
小学11 927(45.64)2 051(17.20)1 371(66.85)
初中7 553(28.90)1 778(23.54)1 261(70.92)
高中3 463(13.25)723(20.88)548(75.80)
大专1 514(5.79)523(34.54)418(79.92)
本科及以上530(2.03)298(56.23)253(84.90)
职业116.799<0.001
农民14 479(55.40)2 339(16.15)1 512(64.64)
工人1 807(6.91)461(25.51)307(66.59)
个体户1 077(4.12)257(23.86)216(84.05)
各类专业技术人员1 166(4.46)528(45.28)424(80.30)
其它7 605(29.10)1 898(24.96)1 442(75.97)
是否吸烟4.523<0.05
否23 855(91.28)4 835(20.27)3 463(71.62)
是2 279(8.72)648(28.43)438(67.59)
是否饮酒0.0270.87
否24 404(93.38)4 867(19.94)3 461(71.11)
是1 730(6.62)616(35.61)440(71.43)
是否饮茶0.6690.413
否24 544(93.92)4 800(19.56)3 406(70.96)
是1 590(6.08)683(42.96)495(72.47)
本人有无肠息肉史73.942<0.001
无25 635(98.09)4 984(19.44)3 463(69.48)
有499(1.91)499(100.00)438(87.78)
一级亲属肠癌史11.064<0.01
无25 779(98.64)5 181(20.10)3 677(70.97)
有252(0.96)252(100.00)196(77.78)
不详103(0.39)50(48.54)28(56.00)
初筛阳性结果分类141.782<0.001
仅HRFQ阳性1 783(64.91)
仅FOBT阳性1 208(73.12)
HRFQ和FOBT双阳性910(83.95)
合计26 134(100.00)5 483(20.98)3 901(71.15)
), ArticleFig(id=1323941372167860575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=EN, label=Table 2, caption=

Multivariable analysis of factors associated with colonoscopy compliance among high-risk individuals in Sichuan Province

, figureFileSmall=null, figureFileBig=null, tableContent=
因素β Wald χ2值P值OR值(95% CI)
年龄组(岁)
40~441.00
45~490.1550.1411.2240.2691.17(0.89~1.54)
50~540.2660.1314.1130.0431.30(1.01~1.69)
55~590.1820.1341.8430.1751.20(0.92~1.56)
60~640.0970.1480.4330.5101.10(0.83~1.47)
65~69-0.2580.1403.3840.0660.77(0.59~1.02)
70~74-0.5950.15315.218<0.0010.55(0.41~0.74)
婚姻状况
未婚1.00
已婚-0.1380.4640.0890.7660.87(0.35~2.16)
离异-0.1880.5040.1390.7090.83(0.31~2.23)
丧偶-0.4090.5120.6370.4250.66(0.24~1.81)
教育程度
未上过学1.00
小学0.7160.21111.497<0.0012.05(1.35~3.09)
初中0.7820.21513.292<0.0012.19(1.44~3.33)
高中1.0370.22920.545<0.0012.82(1.80~4.42)
大专1.1820.24523.198<0.0013.26(2.02~5.27)
本科及以上1.5280.28329.231<0.0014.61(2.65~8.02)
职业
农民1.00
工人-0.1610.1181.8460.1740.85(0.68~1.07)
个体户0.8230.18320.128<0.0012.28(1.59~3.26)
各类专业技术人员0.2580.1463.1100.0781.29(0.97~1.73)
其它0.3990.07528.248<0.0011.49(1.29~1.73)
是否吸烟
否1.00
是-0.2480.0976.5750.0100.78(0.65~0.94)
本人有无肠息肉史
无1.00
有1.2240.14769.559<0.0013.40(2.55~4.53)
一级亲属肠癌史
无1.00
有0.2760.1642.8200.0931.32(0.95~1.82)
不详-0.8490.3047.7740.0050.43(0.24~0.78)
初筛阳性结果分类
仅HRFQ阳性1.00
仅FOBT阳性0.5760.07362.647<0.0011.78(1.54~2.05)
HRFQ和FOBT双阳性1.1090.095135.769<0.0013.03(2.52~3.65)
), ArticleFig(id=1323941372562125152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=CN, label=表2, caption=

四川省结直肠癌高危人群结肠镜依从性多因素分析

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因素β Wald χ2值P值OR值(95% CI)
年龄组(岁)
40~441.00
45~490.1550.1411.2240.2691.17(0.89~1.54)
50~540.2660.1314.1130.0431.30(1.01~1.69)
55~590.1820.1341.8430.1751.20(0.92~1.56)
60~640.0970.1480.4330.5101.10(0.83~1.47)
65~69-0.2580.1403.3840.0660.77(0.59~1.02)
70~74-0.5950.15315.218<0.0010.55(0.41~0.74)
婚姻状况
未婚1.00
已婚-0.1380.4640.0890.7660.87(0.35~2.16)
离异-0.1880.5040.1390.7090.83(0.31~2.23)
丧偶-0.4090.5120.6370.4250.66(0.24~1.81)
教育程度
未上过学1.00
小学0.7160.21111.497<0.0012.05(1.35~3.09)
初中0.7820.21513.292<0.0012.19(1.44~3.33)
高中1.0370.22920.545<0.0012.82(1.80~4.42)
大专1.1820.24523.198<0.0013.26(2.02~5.27)
本科及以上1.5280.28329.231<0.0014.61(2.65~8.02)
职业
农民1.00
工人-0.1610.1181.8460.1740.85(0.68~1.07)
个体户0.8230.18320.128<0.0012.28(1.59~3.26)
各类专业技术人员0.2580.1463.1100.0781.29(0.97~1.73)
其它0.3990.07528.248<0.0011.49(1.29~1.73)
是否吸烟
否1.00
是-0.2480.0976.5750.0100.78(0.65~0.94)
本人有无肠息肉史
无1.00
有1.2240.14769.559<0.0013.40(2.55~4.53)
一级亲属肠癌史
无1.00
有0.2760.1642.8200.0931.32(0.95~1.82)
不详-0.8490.3047.7740.0050.43(0.24~0.78)
初筛阳性结果分类
仅HRFQ阳性1.00
仅FOBT阳性0.5760.07362.647<0.0011.78(1.54~2.05)
HRFQ和FOBT双阳性1.1090.095135.769<0.0013.03(2.52~3.65)
), ArticleFig(id=1323941372671177057, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=EN, label=Table 3, caption=

The detection rates of colonoscopy by age and gender groups

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组(岁)肠镜检查对象进展期腺瘤及癌[n(%)]非进展期腺瘤[n(%)]
男性女性男性女性χ2值P值男性女性χ2值P值
40~441352148(5.93)4(1.87)2.9720.0850(0.00)3(1.40)0.6180.432
45~492003838(4.00)10(2.61)0.8470.3577(3.50)6(1.57)1.4530.228
50~5438259627(7.07)26(4.36)3.3250.06824(6.28)14(2.35)9.646<0.05
55~5931150725(8.04)18(3.55)7.797<0.0523(7.40)21(4.14)4.009<0.05
60~6419125918(9.42)17(6.56)1.2540.26316(8.38)10(3.86)4.118<0.05
65~6922424727(12.05)11(4.45)9.148<0.0516(7.14)7(2.83)4.696<0.05
70~7412712524(18.90)7(5.60)10.325<0.057(5.51)5(4.00)0.3170.573
), ArticleFig(id=1323941372746674530, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360864211239, language=CN, label=表3, caption=

按年龄和性别分组的结肠镜检查检出率

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组(岁)肠镜检查对象进展期腺瘤及癌[n(%)]非进展期腺瘤[n(%)]
男性女性男性女性χ2值P值男性女性χ2值P值
40~441352148(5.93)4(1.87)2.9720.0850(0.00)3(1.40)0.6180.432
45~492003838(4.00)10(2.61)0.8470.3577(3.50)6(1.57)1.4530.228
50~5438259627(7.07)26(4.36)3.3250.06824(6.28)14(2.35)9.646<0.05
55~5931150725(8.04)18(3.55)7.797<0.0523(7.40)21(4.14)4.009<0.05
60~6419125918(9.42)17(6.56)1.2540.26316(8.38)10(3.86)4.118<0.05
65~6922424727(12.05)11(4.45)9.148<0.0516(7.14)7(2.83)4.696<0.05
70~7412712524(18.90)7(5.60)10.325<0.057(5.51)5(4.00)0.3170.573
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四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性分析
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马婧 , 乔良 , 钟志刚 , 刘潇霞 , 李丽娜 , 许佳豪
现代预防医学 | 基层卫生服务 2025,52(23): 4332-4338
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现代预防医学 |基层卫生服务 2025 , 52 (23) : 4332 -4338
四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性分析
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马婧, 乔良 , 钟志刚, 刘潇霞, 李丽娜, 许佳豪
作者信息
  • 四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院四川省癌症防治中心办公室(预防部),四川 成都 610041
通讯作者:
乔良,E-mail:
作者简介:

马婧(1990—),女,硕士,主治医师,研究方向:疾病预防与控制

Colorectal cancer screening results and colonoscopy compliance among rural residents in Sichuan Province
Jing MA, Liang QIAO , Zhi-gang ZHONG, Xiao-xia LIU, Li-na LI, Jia-hao XU
Affiliations
  • Office of Cancer Prevention and Treatment, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute,Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, China
出版时间: 2025-12-10 doi: 10.20043/j.cnki.MPM.202502025
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目的

分析四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性,为优化筛查策略提供参考。

方法

通过整群抽样法,于2023年1—12月选取四川省8个市(区)农村40~74岁居民参与结直肠癌筛查,计算高危率、结肠镜依从性及病变检出率,采用χ2检验和多因素logistic回归模型分析结肠镜依从性影响因素。

结果

26 134名居民参与初筛,评估出高危人群5 483人,高危率为20.98%。其中3 901人接受结肠镜检查,依从率为71.15%。多因素logistic回归分析显示,70~74岁组肠镜依从性显著低于40~44岁组(OR=0.55,95% CI:0.41~0.74);教育程度越高,依从性更高;个体户(OR=2.28,95% CI:1.59~3.26)、有肠道息肉史(OR=3.40,95% CI:2.55~4.53)、问卷调查和便潜血检测双阳性者(OR=3.03,95% CI:2.52~3.65)依从性更高。结肠镜共检出230例病变,检出率为5.90%,男性各个年龄段病变检出率均高于女性。

结论

四川省农村地区结直肠癌筛查项目取得了一定成效,但结肠镜检查依从性仍有待提高,尤其应关注男性、年长及低教育程度的人群。未来应加强重点人群的健康宣教,以进一步提高肠镜依从性和早期病变检出率。

结直肠癌  /  筛查  /  肠镜检查依从性  /  检出率  /  四川
Objective

To analyze the colorectal cancer(CRC) screening results and colonoscopy compliance among rural residents in Sichuan Province, providing evidence for optimizing CRC screening strategies.

Methods

From January to December 2023, through cluster sampling, residents aged 40 to 74 from rural areas of 8 districts/counties in Sichuan Province were selected to participate in CRC screening. The high-risk rate, colonoscopy compliance rate, and lesion detection rate were calculated. The χ2 test and multivariable logistic regression model were used to analyze factors influencing colonoscopy compliance.

Results

A total of 26 134 residents participated in the initial screening, with 5 483 identified as high-risk individuals, yielding a high-risk rate of 20.98%. Among them, 3 901 individuals underwent colonoscopy, resulting in a compliance rate of 71.15%. Multivariable logistic regression analysis showed that the compliance was significantly lower in the 70-74 age group(OR=0.55, 95% CI: 0.41-0.74) compared to the 40-44 age group. Higher education levels were associated with increased compliance. Self-employed individuals (OR=2.28, 95% CI: 1.59-3.26), those with a history of intestinal polyps (OR=3.40, 95% CI: 2.55-4.53), and those who were double-positive in both the high-risk factor questionnaire (HRFQ) and the fecal occult blood test (FOBT) (OR=3.03, 95% CI: 2.52-3.65) had higher compliance rates. Colonoscopy detected 230 cases of lesions, with a detection rate of 5.90%. Males had a higher lesion detection rate than females across all age groups.

Conclusion

The CRC screening program in rural areas of Sichuan Province has achieved positive results, but the compliance with colonoscopy still needs improvement, particularly among males, the elderly, and those with lower education levels. Efforts should be intensified to deliver targeted health education to these key populations, with the aim of further improving the overall compliance with colonoscopy and early detection rates.

Colorectal cancer  /  Screening  /  Colonoscopy compliance  /  Detection rate  /  Sichuan
马婧, 乔良, 钟志刚, 刘潇霞, 李丽娜, 许佳豪. 四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性分析. 现代预防医学, 2025 , 52 (23) : 4332 -4338 . DOI: 10.20043/j.cnki.MPM.202502025
Jing MA, Liang QIAO, Zhi-gang ZHONG, Xiao-xia LIU, Li-na LI, Jia-hao XU. Colorectal cancer screening results and colonoscopy compliance among rural residents in Sichuan Province[J]. Modern Preventive Medicine, 2025 , 52 (23) : 4332 -4338 . DOI: 10.20043/j.cnki.MPM.202502025
结直肠癌是常见的消化道恶性肿瘤之一。据国家癌症中心报告,2022年我国结直肠癌新发病例约51.71万,死亡约24万,造成沉重的社会负担[1]。结直肠癌的发展存在明确的癌前病变阶段,由癌前病变发展成癌一般需要5~10年的时间[2-3]。因此,通过筛查及早诊早治,及早发现癌前病变并干预,是结直肠癌防控的有效手段[4]。
《健康中国行动—癌症防治行动实施方案(2023—2030年)》强调推广癌症早诊早治,在癌症高发地区和高风险人群中持续开展组织性筛查[5]。近年来,我国通过中央财政转移支付项目,在农村高发区开展以人群为基础的结直肠癌筛查和早诊早治工作。该项目依据全国癌症早诊早治专家委员会发布的《癌症早诊早治项目技术方案》(2011年版)(简称《技术方案》),采用高危因素问卷调查(high-risk factor questionnaire,HRFQ)和便潜血检测(fecal occult blood test, FOBT)为初筛,肠镜为精筛的序贯筛查方案,在全国16个省(自治区、直辖市)农村地区开展[6-7]。四川省作为该项目试点省份之一,由四川省癌症防治中心组织实施。四川省农村地区具有多民族聚居(如彝族、藏族等)、医疗资源相对不足、居民健康意识较为薄弱等特点,这些因素可能影响筛查依从性和早诊效果。然而,目前尚未见针对四川省农村居民结直肠癌筛查项目结果的相关报道。因此,本研究基于四川省结直肠癌筛查数据,分析四川省农村地区居民结直肠癌筛查结果及结肠镜检查依从性,以期为优化四川省结直肠癌筛查策略,提升癌症防控水平提供科学依据。
采用整群抽样的方法,在四川省8个县(区)(成都市武侯区、青白江区、简阳市、都江堰市、遂宁市船山区、乐山市五通桥区、宜宾市翠屏区、阆中市)确定筛查村/居委会。选择2023年1—12月在筛查村/居委会内参与农村结直肠癌筛查项目的人群作为研究对象。纳入标准为年龄40~74岁的四川省常住居民(在本地居住满三年以上),知情且自愿签署知情同意书者。排除已确诊恶性肿瘤、未控制精神病、严重心肺脑肝肾功能障碍及妊娠期妇女。研究通过四川省肿瘤医院医学伦理委员会审批(审批号:SCCHEC-02-2019-027)。
初筛工作遵循知情、同意、免费的原则,由经过统一培训的社区工作人员对纳入对象进行一次面对面的HRFQ及二次FOBT。
HRFQ问卷由全国癌症早诊早治专家委员会[7]统一制定,包含一般人口学特征(如性别、年龄、婚姻状况和教育水平等)及九个结直肠癌危险因素(涵盖生活方式、疾病史、肿瘤家族史、既往肠病史及一级亲属肠癌史等)。FOBT检测采用免疫法,参与者需检测二次,二次间隔一周,粪便样本收集可与问卷调查同步进行。
初筛阳性的判定标准为满足以下任一条件:(1)一级亲属结直肠癌史;(2)本人肠道息肉史;(3)同时存在以下两项及以上情况(慢性便秘、慢性腹泻、黏液血便、不良生活事件史、慢性阑尾炎或阑尾切除史、慢性胆道疾病史或胆囊切除史);(4)至少一次FOBT检测阳性。对于初筛阳性的高危人群,建议进一步行结肠镜检查。
社区工作人员通知初筛阳性者及时到定点筛查医院接受结肠镜检查。检查由成都市武侯区第三人民医院、简阳市人民医院、青白江区人民医院、都江堰市人民医院、遂宁市中心医院、乐山市人民医院、宜宾市第二人民医院、阆中市人民医院八家医院承担,所有医院均严格执行技术规范以保障质量。居民需自愿签署结肠镜检查知情同意书,随后由具有五年以上内镜检查经验的医师操作,使用具备电子染色功能及放大内镜功能的高清内镜系统,确保首次检查回盲部到达率≥95%,退镜时间≥6 min。镜下若发现可疑病变,均取活检明确病理诊断。
参照《技术方案》中病理相关指标定义[7],结肠镜检查结果分为非腺瘤性良性病变、非进展期腺瘤、进展期腺瘤、伴中/重度异型增生的其他病变及结直肠癌五类。本研究中癌前病变指非进展期腺瘤,肠镜检查检出病变包括进展性腺瘤、伴中/重度异型增生的其他病变和结直肠癌(合计简称“进展期腺瘤及癌”)。
高危率=(初筛阳性人数/参加筛查总人数)×100%。
依从率=(接受肠镜检查人数/初筛阳性人数)×100%。
病变检出率=(病变人数/肠镜检查人数)×100%。
研究实施前,对所有参与筛查的社区工作人员、内镜和病理医生等进行统一培训并考核,包括研究对象纳入排除标准、筛查流程、信息平台操作等。社区工作人员负责资料核查,将筛查结果录入“四川省结直肠癌早诊早治信息平台”;该平台具备验证机制,自动评估确定结直肠癌高危人群,并对问卷的完整性和逻辑性进行校验,以防止空项、漏项、逻辑错误等,确保信息的准确合理。
采用SPSS 26.0软件进行统计分析。计数资料采用频率或百分比表示,组间比较采用χ2检验。使用多因素logistic回归模型分析结直肠癌高危人群结肠镜依从性的影响因素。检验水准α=0.05。
共有26 134名四川省居民参与初筛调查,其中男性、女性分别为11 258人(43.08%)、14 876人(56.92%)。平均年龄为(58.19±9.33)岁,50~54岁组占比最高,为19.62%。婚姻状况以已婚为主,为96.03%。78.93%的居民是初中及以下文化程度。55.40%的居民是农民。91.28%的调查居民不吸烟;不饮酒、不饮茶的个体分别占调查总数的93.38%、93.92%。有肠道息肉史的人数为499人,占1.91%;有一级亲属肠癌史的人数为252人,占0.96%。共有5 483人评估为结直肠癌高危,高危率为20.98%,其中,仅HRFQ阳性2 747人,仅FOBT阳性1 652人,HRFQ和FOBT都阳性1 084人;女性占22.08%,高于男性的19.52%。见表1。
高危人群中,实际接受结肠镜检查3 901人,总体依从性为71.15%。不同性别组间肠镜依从性差异无统计学意义(P>0.05),但对于不同年龄组、婚姻状况、教育程度、职业、是否吸烟、本人有无肠息肉史、有无一级亲属肠癌史和初筛阳性结果不同分类,其高危人群结肠镜依从性差异均有统计学意义(均P<0.05)。见表1。
50~54岁组(OR=1.30,95% CI:1.01~1.69)相较于40~44岁组肠镜依从性更高,而70~74岁组(OR=0.55,95% CI:0.41~0.74)的依从性相比则更低;职业为个体户(OR=2.28,95% CI:1.59~3.26)、本人有肠道息肉史(OR=3.40,95% CI:2.55~4.53)的人群肠镜检查依从性更高;教育程度越高,依从性更高;单独FOBT阳性(OR=1.78,95% CI:1.54~2.05)和HRFQ与FOBT双阳性(OR=3.03,95% CI:2.52~3.65)相较于单独HRFQ阳性,肠镜检查依从性也更高;吸烟者相较于不吸烟者,其结肠镜检查依从性更低(OR=0.78,95% CI:0.65~0.94)。见表2。
结肠镜检查共检出病例230例,病变检出率为5.90%(230/3 901);其中检出27例进展性腺瘤、177例伴中/重度异型增生的其他病变、7例早期癌、19例中晚期癌,检出率分别为0.69%、4.54%、0.18%、0.49%。检出非进展期腺瘤159例,癌前病变检出率为4.08%。比较检出病变(进展期腺瘤及癌)和癌前病变(非进展期腺瘤)在不同性别和年龄组中的分布,结果发现:男性非进展期腺瘤的检出率在45岁以上各年龄段高于女性,且在50~54岁、55~59岁、60~64岁、65~69岁四个年龄组检出率的差异具有统计学意义(P<0.05)。男性进展期腺瘤及癌的检出率高于女性,且在55~59岁、65~69岁、70~74岁三个年龄组检出率的差异具有统计学意义(P<0.05)。随着年龄的增加,全人群和男性的进展期腺瘤及癌、非进展期腺瘤的检出率呈增长的趋势(P<0.05),女性检出率的差异无统计学意义(P>0.05)。见表3、图1。
四川省2019年结直肠癌发病率和死亡率分别位居恶性肿瘤第三位和第五位,严重威胁居民健康[8]。筛查能有效降低其发病率和死亡率,是结直肠癌防控的重要手段[9]。然而,四川省农村地区具有多民族聚居、风俗饮食文化差异、基层医疗资源相对匮乏及居民健康意识较为薄弱等特点,使得筛查实践面临独特挑战。本研究依据《癌症早诊早治项目技术方案》(2011年版),在四川省农村地区开展结直肠癌筛查,采用高危因素问卷调查联合便潜血检测进行初筛,并对初筛阳性者进一步行结肠镜检查以明确诊断。该方法既节约筛查成本,又提高筛查效率,为西部多民族及医疗资源欠发达地区的结直肠癌防控提供了实践依据,也为我国差异化防控策略的制定提供参考。研究结果显示,2023年四川省共26 134名居民参与筛查,其中5 483人被评估为高危,总体高危率为20.98%,该比例低于北京市(26.9%)[10]、广州市(22.49%)[11],但高于南昌市西湖区(20.44%)[12]、上海市闽行区(17.2%)[13]。这一差异提示结直肠癌高危人群的比例存在地域性差异,可能与不同地区的发病水平、生活习惯、环境因素及医疗资源分布等多种因素相关。
结直肠癌筛查有利于降低其发病率和死亡率,然而筛查效能的实现必须以人群的依从性为前提[14-16]。本研究发现,初筛阳性者整体肠镜检查依从率达71.15%,该数据显著高于北京市(58.9%)[10]、广州市(27.03%)[11]、上海市闽行区(27.1%)[13]、江苏省[17],并接近美国水平[18]。分析原因:首先,本研究在农村地区实施免费结肠镜筛查,减轻了居民经济负担,这可能是导致肠镜依从性较高的直接原因之一;其次,本项目所有肠镜检查均在配备先进医疗设备和专业医疗团队的三级医院进行,增强了受检者信任,进而提升了居民检查意愿;再次,本项目积极倡导并推广无痛结肠镜技术,以解决结肠镜检查较痛苦、患者接受度低的问题;最后,四川省近年来持续开展多样化健康宣教,也提升了公众的筛查意识,增强了筛查积极性。需注意的是,人口学特征和样本量差异也可能对结果产生影响,未来研究制定筛查策略应综合考虑这些因素。
本研究显示,不同性别之间结肠镜检查依从性无明显差异,但40~59岁年龄组的个体相较于60~74岁年龄组,表现出更高的依从性,与既往研究相符[10]。提示在当前筛查策略下,应重点关注并提升60~74岁年长群体的筛查依从性。有肠道息肉病史者更倾向于接受结肠镜检查,可能与其对自身健康状况的更为关注有关。在初筛阳性的对象中,HRFQ与FOBT双阳性者依从率最高,仅FOBT阳性者次之,仅HRFQ阳性者最低,与既往研究结论一致[11,17]。此外,受教育程度越高人群的依从性更高,可能与其健康意识更强且资源获取能力更佳有关[19]。
研究显示,男性各个年龄段进展期腺瘤及癌的检出率均高于女性,与既往研究结论一致[20]。这一性别差异可能与男性更容易暴露在吸烟、饮酒及较高工作生活压力等结直肠癌危险因素有关。然而,值得注意的是,本研究中男性筛查参与率仅为43.08%,显著低于女性,提示需加强对男性的宣传力度,提高其筛查依从性。此外,无论是全人群还是男性群体,随着年龄的增长,进展期腺瘤及癌的检出率均呈上升趋势,与既往报道[10,13]相符,可能与致癌因子累积、免疫功能下降及肠道功能退化等有关。然而,本研究中65岁以上人群的结肠镜检查依从性低于年轻人群,需制定针对性策略其提高其筛查积极性。
本研究存在一定的局限性。一是,通过问卷收集数据可能导致一定的回忆偏倚。二是,未对评估为高危但拒绝接受肠镜检查的居民进行原因分析,未来研究可进一步收集相关数据,从心理(如风险感知、检查恐惧)、经济(如医疗费用负担、误工成本)及文化(如健康观念、社会支持)等多维度系统探究拒检原因,以优化干预策略。此外,卫生服务可及性与社区动员质量也会影响依从性,而本研究未纳入健康行为相关变量(如癌症知识认知或就医便利性),这些因素的缺失可能对结果的解释范围构成一定限制。综上,四川省农村地区结直肠癌筛查项目为当地居民带来了一定的健康保障,但结肠镜依从性仍有待提升,尤其应关注男性、年长以及教育程度较低的群体。未来应针对重点人群制定精准防控策略,加强健康宣教,以提高肠镜检查依从性和和早期病变检出率。
  • 四川省科技厅重点研发项目(2023YFG0148)
  • 四川省科技厅科普培训项目(2024JDKP0121)
  • 四川省医学会科研课题(S22004)
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2025年第52卷第23期
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doi: 10.20043/j.cnki.MPM.202502025
  • 接收时间:2025-02-02
  • 首发时间:2026-11-02
  • 出版时间:2025-12-10
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  • 收稿日期:2025-02-02
基金
四川省科技厅重点研发项目(2023YFG0148)
四川省科技厅科普培训项目(2024JDKP0121)
四川省医学会科研课题(S22004)
作者信息
    四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院四川省癌症防治中心办公室(预防部),四川 成都 610041

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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