两种粪隐血试验在消化道出血诊断中的意义

目的 探讨并比较化学和免疫两种粪隐血试验方法 在消化道出血诊断中的意义.方法 对4474例门诊、住院及常规体检人群同时采用联苯胺化学法(CFOBT)及免疫层析法(IFOBT)进行粪隐血试验,对结果 阳性者复查2次并询问病史及行胃镜、结肠镜等检查,明确消化道出血部位及原因.结果 共检出粪便隐血阳性患者390例(8.22%),其中CFOBT阳性163例(41.8%),IFOBT阳性100例(25.6%),双项阳性127例(32.6%).经临床、内镜、腹部多普勒彩色超声及其他检查证实为上消化道出血235例(60.3%),下消化道出血136例(34.9%).CFOBT法与IFOBT法对上消化道出血和下消化道出血的检出率分别为90.2%、67.6%和42.5%、93.4%.消化道显性出血可呈双项检查法阳性.消化道出血相关疾病的主要病因为消化性溃疡、急性胃黏膜病变、胃癌、结肠息肉、结肠癌及内痔等.结论 粪隐血试验对消化道出血性疾病的筛选和诊断仍有非常重要的临床意义,诊断上消化道出血CFOBT优于IFOBT,而诊断下消化道出血则IFOBT优于CFOBT.

The clinical significance of two fecal occult blood tests in diagnosis of gastrointestinal hemorrhage

Objective To assess and compare chemical and immunochemical fecal occult blood tests (FOBTs) in diagnosis of gastrointestinal hemorrhage and their clinical significance. Methods The FOBT was carried out in 4474 in-patients, out-patients or subjects who had annual physical examination using both hemoccult Ⅱ (CFOBT) and colloidal gold chromagraphy (IFOBT) methods.Those who was positive for FOBTs would be re-tested for 2 times and followed by gastroscopy and colonoscopy as well as other examinations in order to find the reason and location of gastrointestinal hemorrhage. Results FOBT was positive in 390 (8.22%) patients, of which 163 (41.8%) were detected by CFOBT, 100(25.6%) by IFOBT, and 127(32.6%) by both CFOBT and IFOBT. The clinical, endoscopic and other examinations revealed that upper and lower gastrointestinal bleeding were found in 235 (60.3%) and 136 (34.9%) patients, respectively. The detective rates of upper and lower gastrointestinal bleeding were 90.2% and 67.6% by CFOBT respectively, and 42.5% and 93.4% by IFOBT, respectively. The obvious gastrointestinal bleeding could be detected by both CFOBT and IFOBT. The diseases related to gastrointestinal bleeding involved acute gastric mucosal lesion, peptic ulcer, gastric cancer and colonic polyp,colorectal cancer and piles, etc. Conclusions It is demonstrated that FOBT is still important in screening and diagnosis of gastrointestinal hemorrhage.The CFOBT is superior to IFOBT in detecting upper gastrointestinal bleeding, whereas the IFOBT is superior to CFOBT in detecting lower gastrointestinal bleeding.