摘要
目的 探讨具核梭杆菌(Fn)在结直肠癌筛查中的临床价值.方法 前瞻性纳入于2022年7月至2023年12月期间在首都医科大学附属北京友谊医院行结肠镜检查者.于结肠镜检查前3 d内留取粪便样本,采用定量聚合酶链反应(qPCR)法检测粪便中菌群Fn的相对丰度,同时行粪便隐血试验(FOBT).采用受试者操作特征(ROC)曲线评估Fn对结直肠癌的诊断效能.结果 共纳入271例受试者,其中诊断结直肠癌58例(21.40％).结直肠癌组患者粪便中的Fn相对丰度显著高于非结直肠癌组[6.602(3.716,8.997)vs.1.665(0.593,4.752)],差异有统计学意义(P＜0.05).Fn诊断结直肠癌的曲线下面积(AUC)为0.750(95％CI:0.680～0.820,P＜0.05),对应敏感度、特异度和阴性预测值分别为0.724、0.742和0.908.在FOBT结果阴性者中,Fn诊断结直肠癌的敏感度、特异度和阴性预测值分别为 0.714、0.730 和 0.983.Fn 联合 FOBT 诊断结直肠癌的 AUC 为 0.894(95％CI:0.848～0.940,P＜0.05),对应敏感度、特异度和阴性预测值分别为0.897、0.765和0.964,诊断效能显著优于单独检测Fn(P＜0.05).结论 粪便Fn在结直肠癌筛查中具有较高的敏感性、特异性和阴性预测值,与FOBT联合应用可进一步提升结直肠癌检出率.因此,粪便Fn是结直肠癌筛查有价值的无创生物标志物,可有效避免FOBT阴性者中结直肠癌的漏诊.粪便Fn丰度升高者应尽快行结肠镜检查,若Fn与FOBT均阴性,则可基本排除结直肠癌.
Abstract
Objective To investigate the value of Fusobacterium nucleatum(Fn)in colorectal cancer(CRC)screening.Methods This study prospectively included participants who underwent colonoscopy at Beijing Friendship Hospital,Capital Medical University from July 2022 to December 2023.Fecal samples collected within 3 days before colonoscopy were assessed for the relative abundance of Fn using quantitative polymerase chain reaction(qPCR).Additionally,fecal occult blood tests(FOBT)were performed.Diagnostic performance for CRC was evalua-ted using receiver operating characteristic(ROC)curves.Results A total of the 271 participants,58 were diagnosed with CRC(21.40％).The relative abundance of Fn in the feces of CRC patients significantly exceeded that in non-CRC individuals[6.602(3.716,8.997)vs.1.665(0.593,4.752)],and the difference was statistically significant(P＜0.05).The area under the curve(AUC)of Fn for diagnosing CRC was 0.750(95％CI:0.680-0.820,P＜0.05),with corresponding sensitivity,specificity,and negative predictive value(NPV)of 0.724,0.742 and 0.908,respectively.Among individuals with negative fecal occult blood test(FOBT)results,Fn exhibited sensitivity,specificity,and NPV of 0.714,0.730 and 0.983,respectively,for diagnosing CRC.The combined use of Fn and FOBT resulted in an AUC of 0.894(95％CI:0.848-0.940,P＜0.05)for the diagnosis of CRC,significantly outperforming Fn alone(P＜0.05).The corresponding sensitivity,specificity,and NPV were 0.897,0.765,and 0.964,respectively.Conclusion Fecal Fn demonstrates high sensitivity,specificity,and NPV in CRC screen-ing.Its combined application with FOBT improves the detection rate for CRC.Fecal Fn is a valuable non-invasive biomarker for CRC screening and can effectively avoid avoid missed diagnosis of CRC in FOBT negative individuals.Elevated fecal Fn abundance warrants prompt colonoscopy,and in cases where both Fn and FOBT are negative,CRC can be largely ruled out.
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