BJGP：隱性血尿或可發生膀胱癌

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　　導讀：新的研究發現隱形血尿可能是膀胱癌發生的早期警告信號，這或可對臨床醫生就診有參考價值。

　　埃克塞特大學醫學院的科學家發現，每60個人中就有一個人超過60歲就會產生隱性血尿(由醫生測試尿液確定)發生從而會得膀胱癌。這個數字是指大約一半的人出現顯性血尿-發生膀胱癌的黃金指標。然而，它仍高于其它膀胱癌潛在臨床癥狀的數據，這需要進一步的調查。

　　第一作者Sarah Price博士是埃克塞特大學醫學院的學生，他領導的第一個有影響力的研究就是調查隱形血尿是否能預示膀胱癌的發生。該研究結果發表在2014年9月1日《英國全科醫學期刊》雜志上，她說：眾所周知，如果你在你的尿液中看到血，你就應該聯系醫生，他可能會建議你做檢查。但是如果醫生在常規檢查中查出血尿陰性，這對他們沒有明確的指導能夠做什么。我們希望我們的發現會做出更好的指導作用，這需要更進一步的調查。早期診斷是對于成功治療膀胱癌至關重要。四分之三的診斷早期患者比那些診斷晚的疾病患者有更好的治療結果。我們可以做些什么來幫助提高早期發現的幾率以挽救生命。

　　超過26000人的匿名數據有助于臨床實踐研究數據鏈接，這是一個大型研究數據庫，也是埃克塞特的團隊在一些癌癥研究所使用的。研究小組發現，60歲以上的人有隱形血尿患膀胱癌的風險是1.6%。在英國每年大約有10000人被診斷為膀胱癌癥。老年人和男性相對于女性來說更常見，診斷的平均年齡在68歲。吸煙是主要原因之一。

　　doi:10.3399/bjgp14X681409

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　　PMID:

　　Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care

　　Sarah J Price, BSc, PhD student，University of Exeter Medical School, Exeter. Elizabeth A Shephard, PhD, Associate research fellow，University of Exeter Medical School, Exeter.Sally A Stapley, PhD, Associate research fellow，University of Exeter Medical School, Exeter.Kevin Barraclough, MA, FRCP, FRCGP, LLB, GP.Hoyland House General Practice, Painswick, Gloucestershire.William T Hamilton, MD, FRCP, FRCGP, Professor of primary care diagnostics

　　Background Diagnosis of bladder cancer relies on investigation of symptoms presented to primary care, notably visible haematuria. The importance of non-visible haematuria has never been estimated. Aim To estimate the risk of bladder cancer with non-visible haematuria. Design and setting A case-control study using UK electronic primary care medical records, including uncoded data to supplement coded records. Method A total of 4915 patients (aged ≥40 years) diagnosed with bladder cancer between January 2000 and December 2009 were selected from the Clinical Practice Research Datalink and matched to 21 718 controls for age, sex, and practice. Variables for visible and non-visible haematuria were derived from coded and uncoded data. Analyses used multivariable conditional logistic regression, followed by estimation of positive predictive values (PPVs) for bladder cancer using Bayes'' theorem. Results Non-visible haematuria (coded/uncoded data) was independently associated with bladder cancer: odds ratio (OR) 20 (95% confidence interval [CI] =12 to 33). The PPV of non-visible haematuria was 1.6% (95% CI = 1.2 to 2.1) in those aged ≥60 years and 0.8% (95% CI = 0.1 to 5.6) in 40-59-year-olds. The PPV of visible haematuria was 2.8% (95% CI = 2.5 to 3.1) and 1.2% (95% CI = 0.6 to 2.3) for the same age groups respectively, lower than those calculated using coded data alone. The proportion of records of visible haematuria in coded, rather than uncoded, format was higher in cases than in controls (P<0.002, χ2 test). There was no evidence for such differential recording of non-visible haematuria by case/control status (P = 0.78), although, overall, the uncoded format was preferred (P<0.001). Conclusion Both non-visible and visible haematuria are associated with bladder cancer, although the visible form confers nearly twice the risk of cancer compared with the non-visible form. GPs'' style of record keeping varies by symptom and possible diagnosis.

　　膀胱癌的治療藥物是什么？膀胱癌的藥物可以選擇：百士欣、意美、樞丹等藥物進行輔助治療的。

　　詳情請致電我們的客服垂詢：400-101-6868。如需購買百士欣、意美、樞丹，可到臨近門店。廣東省佛山市分店地址為：廣東省佛山市禪城區影蔭路玫瑰大街13號1鋪（醫保定點）。門店電話：0757-83103800。

　　腫瘤科藥師溫馨提醒：膀胱癌放射治療效果不理想，目前主要用于晚期腫瘤病人的姑息治療、或手術、化療病人的鋪助治療。

TAG：膀胱癌 腫瘤