联合检测粪便癌胚抗原和钙卫蛋白诊断大肠癌的临床价值

目的联合检测粪便中癌胚抗原（CEA）及钙卫蛋白,探讨其诊断大肠癌的临床应用价值。方法收集北京军区总医院消化内镜中心接受肠镜检查病人的新鲜粪便标本共177例,其中大肠癌48例,结直肠息肉51例,功能性肠病78例。采用ELISA法半定量检测粪便中钙卫蛋白及癌胚抗原浓度,比较其在不同组中的差异;应用ROC曲线确定最佳临界值,并对两个检测指标进行综合评价。结果大肠癌组粪便钙卫蛋白及CEA含量的中位数分别为470（0．9—1380．61）μg,／g,19．42（0．46～109．78）μg／g,高于其余组,差异有统计学意义（P〈0．05）;肿瘤发生部位不同的患者粪便钙卫蛋白及CEA的水平无明显差异（P〉0．05）;ROC曲线分析提示：以12．09μg／g为临界点,CEA诊断大肠癌的灵敏度为73％,特异度为56％;以104．2μg／g为临界点,钙卫蛋白诊断大肠恶性肿瘤的灵敏度为90．1％,特异度为54．2％;钙卫蛋白联合CEA诊断大肠癌的灵敏度为97．3％,特异度为30．35％。结论粪便钙卫蛋白及CEA检测大肠癌有较高的敏感性,且不受肿瘤部位的影响,可以作为门诊筛查大肠癌的标志物。     

钙卫蛋白监测在炎症性肠病患者中的意义

目的探讨钙卫蛋白监测在炎症性肠病中的意义。方法选取炎症性肠病患者20例和健康对照者20例,采用ELISA方法测定粪便中钙卫蛋白的含量,与C反应蛋白(CRP)进行比较。结果炎症性肠病活动组粪便钙卫蛋白含量高于正常对照组,差异有统计学意义(P0.05)。炎症性肠病活动组中激素组和非激素组钙卫蛋白含量均高于对照组和缓解组。活动期组中激素组CRP降低与对照组和缓解组比较无明显差异,而活动期组中非激素组CRP继续维持较高水平,高于对照组和缓解期组,差异均有统计学意义(P0.01)。结论粪便中的钙卫蛋白在作为监测炎症性肠病患者的活动性及黏膜损伤的临床指标方面具有重要的意义。     

粪便钙卫蛋白在溃疡性结肠炎诊断中的作用价值

溃疡性结肠炎(ulcerative colitis,UC)是常见的肠道疾病。目前的诊断主要依靠肠镜,但是肠镜检查患者要承受一定的痛苦。本文对最新的检测指标钙卫蛋白(calprotectin,CP)在UC诊断中的作用作一综述。     

钙卫蛋白在炎症性肠病中的作用研究进展

钙卫蛋白（calprotectin）是近年发现的、与钙结合的、不均一复合蛋白，主要来源于中性粒细胞和单核细胞，分布于粒细胞、上皮细胞及各种组织和体液中，具有抗微生物、调节免疫、抗增殖、传递信号等多种生物学功能，在许多炎症情况下其含量增加。新近的研究显示，钙卫蛋白在炎症性肠病（IBD）患者肠粘膜及粪便中的含量明显高于正常对照者，不仅可以作为评价疾病活动性的指标，而且还可以作为预测疾病复发、评价药物疗效等作用的指标。     

肝肠钙粘连蛋白在胃癌组织中的表达及临床意义

目的探讨肝肠钙粘连蛋白在不同分化程度的胃癌、正常胃黏膜组织中的表达及其与胃癌生物学行为的关系。方法采用免疫组化S—P法,检测肝肠钙粘连蛋白在74例胃癌及其正常胃黏膜组织中的表达情况,并结合临床病理资料进行分析。结果74例胃癌组织中肝肠钙粘连蛋白样阳性表达58例,总阳性率为78．4％,而肝肠钙粘连蛋白在正常胃黏膜组织中没有表达。肝肠钙粘连蛋白的阳性表达与胃癌分化程度以及淋巴结是否转移有关（P〈0．05）;而与年龄、性别、TNM分期以及是否有幽门螺杆菌感染、肝转移、腹膜转移间无关（P〉0．05）。结论肝肠钙粘连蛋白在胃癌组织中的表达与胃癌细胞的转移、浸润、生长和粘附有关。肠钙粘连蛋白有助于胃癌分化程度的判断和预测胃癌淋巴结有无转移。     

粪便钙卫蛋白检测在肠道疾病诊断中的价值

钙卫蛋白(calprotectin)是近年来新发现的一种急性炎症标志物,最早于1980年从中性粒细胞中分离发现,是一种杂合性的钙结合蛋白,具有抗蛋白酶的活性,并因具有螯合锌离子的能力而具有抗热性。钙卫蛋白是中性粒细胞更新的标志物,具有抗微生物、调节免疫、抗增殖、传递信号等多种生物学功能,在许多炎症情况下升高。研究发现,炎症性肠病(IBD)患者粪便中的钙卫蛋白水平明显高于结肠癌患者及肠易激综合征(IBS)患者,并且同患者病变程度呈正相关。因此,可以作为一项诊断指标区分IBD、结肠癌、IBS,并用来监测IBD活动性,对疾病的复发、治疗效果具有重要指导意义。     

粪钙卫蛋白在溃疡性结肠炎诊断中的价值

目的:研究粪便钙卫蛋白检测作为一种无创性方法用于诊断溃疡性结肠炎(UC)活动性的价值.方法:UC患者82例,60例经结肠镜检查正常的患者作为对照,留取结肠镜检查1wk内的粪便样本10g,采用ELISA方法进行粪便钙卫蛋白检测.对23例活动期3级患者实施随访,监测粪便钙卫蛋白水平,用于指导临床治疗用药并观察疗效.结果:UC缓解期组粪便钙卫蛋白水平和正常对照组之间差异无统计学意义,活动期粪便钙卫蛋白水平与缓解期和正常对照组比均有统计学意义(603.2μg/g vs 8.2μg/g,6.6μg/g,P<0.01),活动期1级(103.5μg/g)、2级(582.9μg/g)和3级(1340.6μg/g)两两比较差异均有统计学意义(P<0.01).粪便钙卫蛋白水平与UC内镜分级显著相关(r=0.89,P<0.01).UC活动期3级患者23例经治疗后至缓解期,粪便钙卫蛋白水平显著下降,其治疗前后相比差异有统计学意义(1383.5μg/g vs 8.0μg/g,P<0.01).结论:粪便钙卫蛋白能较准确地诊断UC活动期和缓解期,用于指导临床治疗较好.     

粪便钙卫蛋白在结直肠癌中的研究进展

粪便钙卫蛋白(fecal calprotectin, FC)是一种由肠腔内炎性细胞分泌的生物活性蛋白,有抗微生物活性、抗感染等作用,通过其含量高低可反映肠道的炎症状态,其在炎性肠病中的作用已被应用于临床实践.近年来,关于FC在结直肠癌(colorectal cancer, CRC)中的应用研究逐渐增多,相关研究结果显示FC可用于CRC的筛查以及和其他肠道器质性疾病的鉴别,同时, FC的浓度与CRC的分期、发生部位以及手术可能有一定的相关性,但仍需要进一步通过高质量、大样本研究以明确.本文就FC在CRC中的研究进展作一综述.     

粪便钙卫蛋白检测在炎症性肠病患者中的意义

<正>炎症性肠病(inflammatory bowel diseases,IBD)包括克罗恩病(Crohn’s disease,CD)和溃疡性结肠炎(ulceralive colitis,UC),是一种慢性非特异性肠道炎症性疾病,以反复复发为特点,对于IBD疾病的管理,一直是临床医生面临的难题,目前临床上常用的评估病情手段有内镜、血清学指标、影像     

粪便钙卫蛋白在IBS与IBD鉴别诊断中的意义

目的:研究粪钙卫蛋白在炎症性肠病(inflammatory bowel disease,IBD)与肠易激综合征(irritable bowel syndrome,IBS)鉴别诊断中的意义.方法:收集中国人民解放军北京军区总医院消化内镜中心接受肠镜检查患者的新鲜粪便标本共92例,其中溃疡性结肠炎(UC)23例、克罗恩病(CD)4例、IBS 55例、健康人20例.采用ELISA法半定量检测粪便中钙卫蛋白浓度.结果:健康人粪钙卫蛋白浓度为77.15±160.9μg/g,IBS患者为46.08±131.97 μg/g,IBD患者为851.34±522.19 μg/g.IBS患者和健康人粪钙卫蛋白浓度差异无显著差异(P>0.05); IBD与IBS和健康人粪钙卫蛋白水平有显著差异(P<0.001).以60 μg/g为临界值时鉴别IBD与IBS的敏感性86.7%,特异性为96.3%.结论:粪便钙卫蛋白含量检测作为一种非侵入性筛选试验,为临床鉴别IBD和IBS提供了手段.     

Fecal calprotectin concentration in patients with colorectal carcinoma

PURPOSE: The study contained herein was undertaken to investigate fecal calprotectin excretion in a series of patients with colorectal carcinoma and to determine whether the excretion was influenced by localization or stage of the tumor. Furthermore, the effect of surgical treatment on the concentrations was studied. Fecal calprotectin was also compared with plasma concentrations of calprotectin, carcinoembryonic antigen, and C-reactive protein. METHODS: Fecal calprotectin was measured in 119 consecutive patients admitted for treatment of colorectal carcinoma. In 116 (97.5 percent) patients, resectional surgery was performed. Plasma calprotectin was measured in 90 (76 percent) patients, carcinoembryonic antigen in 88 (74 percent) patients, and C-reactive protein in 82 (69 percent) patients. RESULTS: Median fecal calprotectin concentration in the 119 patients was 50 (range, 2-950) mg/l, which was significantly (P<0.0001) higher than in 125 control patients (median, 5.2 mg/l). In 23 patients studied also after resection, the excretion fell greatly. There were no significant differences in fecal calprotectin concentration among patients with different tumor stages. Elevated plasma calprotectin concentrations were found in 67 of 90 (73.3 percent) patients with colorectal carcinoma, compared with elevated fecal calprotectin in 111 of 119 (93.3 percent) patients, and there was no significant correlation between plasma and fecal calprotectin concentrations. Plasma calprotectin concentrations were significantly lower in patients with T1 or T2 tumors than in those with more advanced stages (P=0.0025). CONCLUSION: Measurement of fecal calprotectin may become a diagnostic tool in detecting colorectal carcinoma. The specificity in relation to colorectal carcinoma has not, however, been completely investigated. Both neoplastic and inflammatory conditions may be associated with elevated values; therefore, it is unlikely that calprotectin can predict specific colonic disorders.     

细胞周期蛋白E和生存素在结直肠癌中表达意义的探讨

目的研究结直肠癌中细胞周期蛋白E和生存素基因的表达,探讨其与结直肠癌的临床病理因素间的关系。方法采用免疫组织化学SP法检测67例结直肠癌组织石蜡切片中细胞周期蛋白E和生存素蛋白的表达情况。结果①细胞周期蛋白E和生存素蛋白在结直肠癌中阳性表达率分别为44.77%(30/67)和49.25%(33/67);②细胞周期蛋白E和生存素蛋白的表达率及表达强度均分别与结直肠癌的细胞分化和淋巴结转移密切相关(P均<0.05);③结直肠癌中细胞周期蛋白E和生存素蛋白的表达未见明显相关性(P>0.05)。结论①细胞周期蛋白E可能作为一种细胞周期调节蛋白在结直肠癌细胞中特异性表达,其高表达的癌细胞常分化差,进展快且易发生转移,常为TNM晚期,因此细胞周期蛋白E具有癌基因的性质;②生存素作为一种癌蛋白,特异性表达于结直肠癌细胞中,与肿瘤的分化和转移密切相关,其高表达的癌细胞常分化差,易转移,预后差;③结直肠癌形成发展多步骤过程是多因素协同作用的结果,癌基因生存素和细胞周期蛋白E激活并上调蛋白的表达;④生存素和细胞周期蛋白E表达强度间无显著相关性,细胞周期蛋白E过表达导致结直肠癌细胞的细胞周期从G1期转化为S期,DNA合成增加,而生存素过表达则使DNA合成后的细胞从G2期转化为M期,癌细胞分裂活跃,两者的协同作用反映在癌生长和浸润转移的生物学表型特征上。     

DR-nm23在大肠癌组织中的蛋白表达及意义

目的:探讨DR-nm23蛋白在大肠癌组织中的表达及其与大肠癌发生发展和转移的关系. 方法:应用SP免疫组织化学法检测98例大肠癌、57例大肠腺瘤及42例正常大肠黏膜组织中DR-nm23蛋白的表达,统计学分析比较DR-nm23蛋白表达差异与大肠癌的发生、进展、淋巴结转移以及大肠癌组织学分型、病理分级的相关性. 结果:DR-tnm23蛋白在正常组、腺瘤组和大肠癌组的表达逐渐下调,3组间表达差异具有显著性(71.4% vs 38.6%,35.7%,均P<0.01).腺瘤组中,高级别上皮内肿瘤的表达率低于低级别上皮内肿瘤(25.7% vs 59.1%,P<0.05);大肠癌无淋巴结转移组表达率高于淋巴结转移组,表达与淋巴结转移呈负相关(44.1% vs 23.1%,P<0.05);DR-nm23表达与组织学分型(χ2=13.731,P<0.01)及病理分级(χ2=12.198,P<0.01)均有相关性.转移组中,淋巴结转移癌DR-nm23蛋白表达率较原发癌高,但二者差异无显著性(P>.05). 结论:DR-nm23参与大肠癌细胞的分化,其表达下调与大肠癌发生发展转移密切相关,可作为反映大肠癌生物学行为和判断预后的潜在重要指征.     

TMEM16A在结肠癌组织中的表达及其意义

目的:探讨Ca2+激活的氯离子通道(Ca2+-activated Cl-channels,CaCC)蛋白TMEM16A在结肠癌中的表达和意义.方法:收集67例结肠癌标本,采用免疫组织化学SP法检测TMEM16A的表达,以癌旁结肠黏膜组织和6例结肠腺瘤组织作为对照,1例胃间质瘤组织作为阳性对照.结果:TMEM16A表达于结肠癌细胞胞膜和胞质内,在67例结肠癌中TMEM16A呈不同程度阳性表达,其中阴性占5.97%(4/67)、弱阳性占16.42%(11/67)、阳性占29.85%(20/67)、强阳性占47.76%(32/67);在癌旁结肠黏膜腺体内大多呈阴性和弱阳性表达,其中阴性占40.30%(27/67)、弱阳性占52.24%(35/67)、阳性占4.48%(3/67)、强阳性占2.99%(2/67);在6例结肠腺瘤中均呈阳性表达.将阴性和弱阳性表达分为阴性组,将阳性和强阳性表达分为阳性组进行分析,在67例结肠癌中TMEM16A表达的总阳性率("阳性"和"强阳性")占77.61%(52/67),而在相应的癌旁组织中TMEM16A表达的总阳性率("阳性"和"强阳性")仅占7.46%(5/67),两者之间差异显著(P<0.005).结论:TMEM16A可高表达于结肠癌组织,可作为结肠癌的分子诊断和靶向治疗的一个新的候选靶点.     

Clinical and histopathological correlations of fecal calprotectin release in colorectal carcinoma

AIM:To determine calprotectin release before and after colorectal cancer operation and compare it to tumor and histopathological parameters.METHODS:The study was performed on patients with diagnosed colorectal cancer admitted for operation.Calprotectin was measured in a single stool sample before and three months after the operation using an enzymelinked immunosorbent assay(ELISA).Calprotectin levels greater than or equal to 50μg/g were considered positive.The compliance for collecting stool samples was assessed and the value of calprotectin was correlated to tumor and histopathological parameters of intra-and peri-tumoral inflammation.Surgical specimens were fixed in neutral buffered formalin and stained with hematoxylin and eosin.Staging was performed according to the Dukes classification system and the 7th edition tumor node metastasis classification system.Intra-and peri-tumoral inflammation was graded according to the Klintrup criteria.Immunohistochemical quantification was performed for MPO,CD45R0,TIA-1,CD3,CD4,CD8,CD57,and granzyme B.Statistical significance was measured using Wilcoxon signed rank test,Kruskal Wallis test and Spearman’s rank correlation coefficient as appropriate.RESULTS:Between March 2009 and May 2011,80 patients with colorectal cancer(46 men and 34 women,with mean age of 71±11.7 years old)were enrolled in the study.Twenty-six patients had rectal carcinoma,29 had left-side tumors,23 had right-side tumors,and2 had bilateral carcinoma.In total,71.2%of the patients had increased levels of calprotectin before the operation(median 205μg/g,range 50-2405μg/g)and experienced a significant decrease three months after the operation(46μg/g,range 10-384μg/g,P<0001).The compliance for collecting stool samples was 89.5%.Patients with T3 and T4 tumors had significantly higher values than those with T1 and T2 cancers(P=0.022).For all other tumor parameters(N,M,G,L,V,Pn)and location,no significant difference in calprotectin concentration was found.Furthermore,the calprotectin levels and histological grading of both peri-and intra-tumoral inflammation was not correlated.Additional testing with specific markers for lymphocytes and neutrophils also revealed no statistically significant correlation.CONCLUSION:Fecal calprotectin decreases significantly after colorectal cancer operation.Its value depends exclusively on the individual T-stage,but not on other tumor or histopathological parameters.     

KLF6和WWOX蛋白在结直肠癌组织中的表达及意义

目的:探讨KLF6和WWOX蛋白在结直肠癌组织中的表达及其临床病理意义.方法:采用免疫组织化学法分别检测40例结直肠癌及40例正常结直肠黏膜组织中KLF6和WWOX蛋白的表达,并分析两者的表达水平与其,临床病理因素的关系.结果:结直肠癌组织中的KLF6和WWOX蛋白的阳性表达率明显低于正常结直肠黏膜组织(45.0% v...     

大肠癌组织中血管内皮生长因子的表达及意义

目的 探讨血管内皮生长因子（ＶＥＧＦ）在大肠癌组织中的表达及其与大砀癌发展的关系。方法 应用名单组织化学ＬＳＡＢ法检测５２你人大肠癌组织的ＶＥＧＦ表达,分析ＶＥＧＦ与大肠癌组织类类型、分化程度、Ｄｕｋｅｓ分期及淋巴结转移毕率随关大肠癌Ｋｕｋｅｓ分期的进展而增加,且Ｄｕｋｅｓ Ｃ期的ＶＥＧＦ表达率与ＤｕｋｅｓＡ期相比有显著性差异（Ｐ〈０．０５）,ＶＥＧＦ在有淋巴结转移组的４０．００％（Ｐ〈０．０１）     

Bmi-1和Mel-18基因在大肠癌组织中的表达及意义

目的:探讨Bmi-1和Mel-18基因在大肠癌中的表达及其临床意义.方法:收集我院68例大肠癌组织标本,68例癌旁正常组织作为对照.利用免疫组织化学的方法检测大肠癌及正常组织中的Bmi-1基因和Mel-18基因的表达,并结合临床资料,对该两种基因的表达与大肠癌患者临床表现的相关性进行分析.结果:(1)Bmi-l在大肠癌组织中的表达明显高于正常组织(73.5%vs23.5%,P<0.05),且与大肠癌的侵袭深度、淋巴结转移及临床分期有关(P<0.05);(2)Mel-18基因在大肠癌组织中的表达明显低于正常组织(41.2%vs66.2%,P<0.05),且与大肠癌的淋巴结转移及临床分期呈负相关(P<0.05);(3)相关性分析发现,Bmi-1和Mel-18基因在大肠癌组织中的表达呈负相关(r=-0.545,P<0.05).结论:Bmi-1和Mel-18基因与大肠癌的发展、转移关系密切,检测Bmi-1和Mel-18对大肠癌的诊断及判断预后可能有重要意义.     

Survivin在大肠癌组织中表达的意义及其与Bcl-2的关系

目的:探讨凋亡抑制蛋白Survivin在大肠癌组织中表达的意义并分析其与Bcl-2的关系.方法:用免疫组化方法检测52例大肠癌组织中Survivin和Bcl-2的表达,运用统计学方法分析Survivin表达与预后的关系以及Survivin在凋亡抑制机制方面与Bcl-2的关系.结果:Survivin在大肠癌组织中表达的阳性率为51.9%(27/52),Survivin表达与患者年龄、性别、生长部位、肿瘤病理类型、大小、淋巴结转移、组织分化程度等无关(P＞0.05).但是Survivin高表达患者的5 a生存率明显低于Survivin低表达患者,二者差别有统计学意义(52.94% vs 83.33%,P=0.0304).Survivin的表达与Bcl-2的表达无关(P=0.5524).结论:Survivin在大肠癌中的表达能强烈抑制凋亡,高表达者预后较差.Survivin的表达与Bcl-2的表达无关.     

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma

BACKGROUND AND AIMS: Testing for faecal occult blood has become an accepted technique of non-invasive screening for colorectal neoplasia but lack of sensitivity remains a problem. The aim of this study was to compare the sensitivity and specificity of faecal calprotectin and faecal occult blood in patients with colorectal cancer and colonic polyps. METHODS: Faecal calprotectin and occult blood were assessed in 62 patients with colorectal carcinoma and 233 patients referred for colonoscopy. The range of normality for faecal calprotectin (0.5-10.5 mg/l) was determined from 96 healthy subjects. RESULTS: Median faecal calprotectin concentration in the 62 patients with colorectal carcinoma (101 mg/l, 95% confidence interval (CI) 57-133) differed significantly from normal (2.3 mg/l, 95% CI 1.6-5.0) with 90% of patients having elevated levels (normal <10 mg/l) whereas only 36/62 (58%) had positive faecal occult bloods. There was no significant difference in faecal calprotectin levels when considering location or Dukes' staging of tumour. Percentage positivity of faecal occult bloods was significantly higher for Dukes' stage C and D cancers compared with Dukes' A and B. In the colonoscopy group, 29 patients with adenomatous polyps were detected in whom the median faecal calprotectin was 12 mg/l (95% CI 2.9-32). Sensitivity for detection of adenomatous polyps was 55% using the calprotectin method and 10% using faecal occult blood testing. The overall sensitivity and specificity of calprotectin for colorectal cancer and adenomatous polyps as a combined group was 79% and 72%, respectively, compared with a sensitivity and specificity of faecal occult blood of 43% and 92%. CONCLUSIONS: Faecal calprotectin is a simple and sensitive non-invasive marker of colorectal cancer and adenomatous polyps. It is more sensitive than faecal occult blood tests for detection of colorectal neoplasia at the cost of a somewhat lower specificity.