粪便转铁蛋白试验在提高消化道出血检出率中的作用

目的研究粪便转铁蛋白试验（TFPT）与免疫粪隐血试验（IFOBT）互补的可行性,以提高消化道出血的检出率。方法连续性收集接受胃镜或结肠镜检查患者的粪便,其中上消化道出血性疾病27例,上消化道非出血性疾病31例;下消化道出血性疾病30例,下消化道非出血性疾病16例。分别计算IFOBT和TFPT的敏感性、特异性、阳性预示值、阴性预示值,再计算转铁蛋白试验与粪隐血试验的互补率。结果在上消化道出血性疾病中,TFPT的敏感性（8/27）显著高于IFOBT（2/27）（P〈0.05）。在下消化道出血性疾病中,TFPT的敏感性（25/30）也显著高于IFOBT（16/30）（P〈0.05）。两个试验结合互补后,将上、下消化道出血检出率分别提高到29.6%和83.3%。结论无论是上消化道出血还是下消化道出血,转铁蛋白试验的敏感性均高于免疫粪隐血试验。两个试验结合互补可明显提高消化道出血的检出效率。     

"序贯粪隐血大肠肿瘤筛检方案"应用价值的再探讨

目的 通过自然人群大肠肿瘤普查了解近年北京市大肠癌发病情况，进一步探讨“序贯粪便隐血大肠癌筛检方案”的有效性和可行性。方法 选定15家医院医疗责任区内48100自然人群为本次普查靶人群。对其中30岁以上的社区或企业职工26827人进行普查登记，并连续进行3d序贯粪隐血检查。隐血阳性者接受结肠镜检查。符合高危条件者，全部接受隐血和肠镜检查。结果 预计普查人为26827人，实际普查人数为19852人，普查率为74％。男女比例为1．05：1。中位年龄50岁。序贯粪隐血阳性率为5．6％，检出大肠癌12例，其中DukesA期4例，B期7例，C期1例。Dukes A B共11例，占全部检出癌的91．66％。40岁以下人群未检出大肠癌，50岁以上人群中，检出大肠癌的比例随年龄升高而逐渐增加。高危人群中检出2例大肠癌，占该人群的0．28％，一般危险人群中检出10例大肠癌，占该人群的0．05％。结论 普查靶人群的大肠癌患病率为36．57／10^5，提示北京市城区有较高的患病率。采用“序贯粪隐血筛检方案”检出了91．66％的早期和较早期癌。提示该方案的有效性和可行性。高危人群和50岁以上的一般危险人群为大肠癌的重点普查对象。     

自然人群序贯粪隐血试验连续性结直肠癌普查的队列研究：19年结果分析

筛查是早期发现结直肠癌（CRC）的重要手段。目的：评价自然人群序贯粪隐血试验（SFOBT）连续性CRC普查在提高早期CRC检出率、患者长期生存率和降低CRC发生率方面的作用。方法：于1987～2005年，应用SFOBT对一组基本固定的中老年人群（初次普查人群3002例）行连续性CRC普查。每1～2年接受一次普查者计入普查组，连续3年或3年以上未接受普查者计入未普查组。FOBT阳性者行结肠镜检查。于北京军区总医院行手术治疗的1033例CRC患者作为对照组。结果：19年中普查人群共发生CRC52例，总CRC发生率为90．4／10万人·年。普查组共检出CRC25例，漏诊7例，CRC检出率为57．6／10万人·年，发生率为73．8／10万人·年；未普查组发生CRC20例，发生率为141．4／10万人·年。普查组DukesA／B期患者比例（95．5％对31．2％和43．9％，P〈0．05）和5年生存率（77．8％对33．3％和39．8％，P〈0．05）显著高于未普查组和对照组。SFOBT筛查CRC的19年总敏感性为90．6％，特异性为98．0％，阳性预测值为3．2％，阴性预测值为99．99％。结论：SFOBT应用于自然人群连续性普查可提高早期CRC检出率和患者5年生存率。切除普查中发现的腺瘤可明显降低CRC发生率。该筛查方案具有较高的敏感性和特异性，但仍需高度关注其结肠镜检查的依从性.     

粪便转铁蛋白和免疫粪隐血试验在结直肠癌筛查中效能的比较

目的评估粪便转铁蛋白(TF)和免疫粪隐血试验(IFOBT)在筛查结直肠癌中的效能。方法筛查对象为1 943例无症状受试者。收集1次粪便标本,同时用于TF和IFOBT检测。两者任一结果为阳性,即通知受试者行结肠镜检查。分别计算TF、IF-OBT和两者联合检测的性能指标。结果共有1 737例受试者接受TF和IFOBT检查,其中251例(14.5%)至少1项结果为阳性。共有193例接受结肠镜检查,共发现3例结直肠癌和43例进展期腺瘤。与单独使用IFOBT相比,TF和IFOBT联合检测(并联)明显提高了结直肠癌和进展期腺瘤的检出率(2.6%vs 1.6%,P=0.034)。结论 TF和IFOBT联合检测能提高筛查时结直肠癌和进展期腺瘤的检出率。     

免疫法和化学法粪便隐血试验对下消化道易出血疾病筛查价值的对照研究

目的 探讨免疫法粪便隐血试验(IFOBT)和化学法粪便隐血试验(FOBT)对下消化道易出血疾病的筛查价值.方法 对经大肠镜明确诊断的260例下消化道易出血疾病及50例正常对照者分别进行IFOBT及FOBT检查,并结合临床资料分析其相应结果.结果 IFOBT检测大肠癌、大肠息肉、炎症性肠病的阳性率均高于FOBT(前者为100%,41%,100%,后者为87%,11%,52%)(P《0.05),假阳性率则低于FOBT(2%与18%)(P《0.05).IFOBT和FOBT均与大肠癌解剖部位无关(P》0.05);与Dukes分期呈正相关(r=0.30,P《0.05),即阳性病例主要分布在Dukes B和C期;阳性率均高于癌胚抗原阳性率(P《0.05).IFOBT和FOBT其结果与息肉的最大长径呈正相关(r=0.66.P《0.05),且随着腺瘤性息肉中具有癌前病变性质的绒毛成分的增多而增加(P《0.05).结论 IFOBT对于筛查结直肠癌和腺瘤性息肉等肠道易出血疾病具有良好的临床应用价值,并显著优于FOBT.     

免疫法和化学法粪便隐血试验在上消化道出血性疾病中阳性率的比较

目的:比较免疫法粪便隐血试验(immune fecal occult blood test,IFOBT)和化学法粪便隐血试验(chemical fecal occult blood test.CFOBT)在上消化道出血性疾病中的阳性率,以验证IFOBT筛查上消化道出血不具特异性.方法:2006-07/2007-03间连续选择我院内镜中心进行胃镜检查的上消化道出血性疾病患者206例,利用邻甲苯胺CFOBT和IFOBT同时比较两种粪便隐血试验的阳性率,并结合临床资料分析其相应结果.结果:IFOBT和CFOBT结果均与食管癌、胃癌的解剖部位及食管癌浸润深度无关,两者均与胃癌浸润深度有关,与胃癌的最大长径呈正相关(IFOBT:r=0.30,P=0.02;CFOBT:r=0.20,P=0.04);IFOBT与食管癌的最大长径呈正相关(r=0.38,P=0.01);CFOBT在食管癌患者中的阳性率高于食管磷状细胞癌抗原(SCC)的阳性率(47.43% vs 20.45%,P＜0.05);两者在胃癌患者中的阳性率均高于CA125,CEA和CA199的阳性率.CFOBT检测胃癌、食管癌、返流性食管炎和消化性溃疡的阳性率均高于IFOBT(50.88% vs 35.09%,47.73% vs 29.55%,18.00% vs 6.00%,60.00% vs 41.82%,均P＜0.05).IFOBT在上消化道出血性疾病中的总阳性率低于CFOBT.结论:IFOBT粪便隐血试验不适合上消化道出血性疾病的筛查,可能对下消化道出血性疾病的筛查具有相对特异性.     

不明原因消化道出血的诊断

消化道出血是一种常见症状，大部分消化道出血经胃镜或结肠镜检查均能明确病因，但仍有近5％的患者无法确诊，称之为不明原因消化道出血（obscure gastrointestinal bleeding，OGIB），即“经胃镜、结肠镜和（或）X线片小肠钡餐检查术能发现出血部位的间歇性或慢性消化道出血”。OGIB可分为不明原因隐性出血[反复缺铁性贫血和（或）反复粪便隐血试验阳性]和不明原因显性出血（反复血便）。     

粪弹性蛋白酶试验在慢性胰腺炎诊断中的意义

粪弹性蛋白酶试验是通过检测粪便中弹性蛋白酶-1的含量来反映胰腺外分泌情况的一项检查,是间接胰腺外分泌试验中较为简便的一种.此文就其临床研究及应用价值作一综述.     

消化道出血诊断与治疗研究近况

消化道出血是消化内科的常见急症之一，其诊断与治疗手段进展十分迅速，本就近年来消化道出血的病因、诊断、治疗等方面的研究作一综述。     

胶囊内镜在老年人不明原因消化道出血中的应用价值

目的 通过分析老年不明原因消化道出血(PGIB)患者的临床资料和胶囊内镜检查结果,探讨胶囊内镜在老年OGIB患者中的应用价值. 方法 分析比较2002年5月至2007年2月,因OGIB在我院行胶囊内镜检查的老年患者及非老年患者的一般资料、出血类型及检查结果.老年组97例,男性40例、女性57例,平均年龄(70.8±6.8)岁;非老年组99例,男性61例、女性38例,平均年龄(44.4±10.3)岁. 结果 老年组显性出血89例,隐性出血8例;非老年组分别为91例和8例.两组胃排空时间、全小肠检查完成率及胶囊延迟率,差异均无统计学意义,老年组小肠转运时间较非老年组显著延长(P<0.05).老年组2例因胶囊内镜滞留于食管未纳入诊断统计,老年组获阳性诊断62例(65.3%),血管病变为最常见病因;非老年组获阳性诊断67例(67.7%).小肠克罗恩病为最常见病因.两组获得阳性诊断率差异无统计学意义,阳性诊断构成比差异有统计学意义(P<0.01).老年组未发现并发症. 结论 胶囊内镜检查对老年OGIB患者是一项安全有效的检查手段,血管病变为老年OGIB患者最常见的病因.     

Diagnostic value of occult fecal blood testing for colorectal cancer screening

AIM: To evaluate the diagnostic value of occult fecal blood testing in mass colorectal cancer screening.METHODS: A reverse passive hemagglutination reaction fecal occult blood test (RPHA-FOBT) and colorectal cancer risk factor quantitative method were used as preliminary screening for colorectal cancer. A 60-cm fiber optic colonoscopy was used to validate the preliminary screen and was used to detect colorectal cancer in a community of 75813 subjects.RESULTS: Compared to the 60-cm fiber optic colonoscopy as a standard reference, FOBT has a sensitivity of 41.9%, specificity of 95.8%, Youden′s index of 0.38, and positive predictive value of 0.68%. These results increased with subject age from the first detection. A 3-year follow up in the target mass showed that all new cases had initially been FOBT-negative.CONCLUSION: The value of FOBT as an indicator of colorectal cancer in mass screening is limited.     

免疫法粪便潜血试验在结直肠癌筛查中的价值

目的 探讨免疫法粪便潜血试验(IFOBT)在大系列健康体检人群中筛查结直肠癌及其癌前病变的临床价值.方法 对2006年7月至2007年6月间在上海交通大学医学院附属仁济医院行健康体检的5919例采用IFOBT筛查结直肠癌及其癌前病变,对阳性病例进行结直肠镜检查或x线钡剂灌肠检查,结合临床及病理资料进行分析.结果 5919例体检人群中IFOBT阳性者314例,阳性率为5.30%,其中241例(76.75%)接受了结直肠镜检查,23例(7.32%)接受了X线钡剂灌肠检查,总随访率达84.08%,失访50例.剔除失访病例后,共发现结直肠癌16例,检出率为2.73‰(16/5869),其中Dukes A期8例(50.00%),Dukes B期7例(43.75%),Dukes C期1例(6.25%),IFOBT阳性者中的结直肠癌检出率为6.06%(16/264).共发现结直肠腺瘤样息肉94例,检出率为16.01‰(94/5869),包括管状腺瘤55例(58.51%),绒毛状-管状腺瘤23例(24.47%),绒毛状腺瘤16例(17.02%),其中单发者55例(58.51%),多发者39例(41.49%);另见活动期溃疡性结肠炎6例.IFOBT阳性者中共检出116例结直肠癌或癌前病变,检出率为43.94%(116/264).结论 IFOBT适合于大系列人群结直肠癌及其癌前病变的筛查,能发现较早期结直肠癌和癌前病变,使疾病在可治愈阶段得到根治,从而有望减少结直肠癌的发病率和死亡率.     

Use of fecal occult blood testing in hospitalized patients: Results of an audit

BACKGROUND:

The fecal occult blood test (FOBT), widely used as a colorectal cancer screening tool, continues to be used in hospitalized patients. However, the utility of this test for hospitalized patients is unclear.

OBJECTIVE:

To assess FOBT use in a large urban regional health authority.

METHODS:

Reports of all FOBTs performed between April 1, 2011 and March 30, 2012 from two academic and four community hospitals in Winnipeg (Manitoba) were extracted. Of 650 hospitalizations with a positive FOBT result and 1254 with a negative FOBT result, random samples of 230 and 97 charts, respectively, were reviewed. Information including demographics, admission diagnos(es), indication(s) for ordering the FOBT and clinical management was extracted.

RESULTS:

Thirty-four percent (650 of 1904) of hospitalizations with an FOBT had a positive FOBT result. Family medicine physicians ordered approximately one-half of the reviewed FOBTs. The most common indication for ordering an FOBT was anemia. Of those with a positive FOBT, 66% did not undergo further gastrointestinal investigations. Of those with a positive FOBT and overt gastrointestinal bleeding and/or melena who underwent endoscopy, 60% had their endoscopy performed before the FOBT result being reported while 38% underwent their endoscopy ≥3 days after the stool sample was collected. There were minimal differences in clinical practices between academic and community hospitals.

CONCLUSIONS:

The present study suggests that FOBT results in hospitalized patients may have little beneficial impact on clinical management. Hospital laboratories may be better served in directing resources to other tests.     

Detection of upper gastrointestinal blood with fecal occult blood tests

OBJECTIVE: Although fecal occult blood (FOB) tests have most often been used to detect occult bleeding from the lower gastrointestinal (GI) tract, their utility in detecting occult blood loss from the upper GI tract is less well understood. The aims of this study were to determine whether small amounts of blood from the upper GI tract can be detected by currently available FOB tests and, if so, to correlate FOB tests with semiquantitative GI blood. METHODS: Groups of 10 healthy volunteers without a history of GI disease drank 5, 10, or 20 ml of their own blood mixed with tomato juice for 5 or 3 consecutive days. Standard dietary and medication restrictions were observed. Consecutive stools were tested for 2 days before, as well as 4 days after, blood ingestion. Each stool was simultaneously tested for FOB with HemoQuant (HQ), Hemoccult II (HO II), Hemoccult II SENSA (SENSA), HemeSelect (HS), and FlexSure OBT (FS). RESULTS: The mean age and hemoglobin concentration of the study population were 29.3+/-0.5 yr and 14.3+/-0.3 g/dl, respectively. No subject noted GI symptoms during blood ingestion. Fecal blood levels (measured by HQ) were elevated within 2 days after initiation of blood ingestion and remained elevated until 2-3 days after cessation of blood ingestion. Mean fecal blood levels peaked at 2.1, 7.9, 8.0, and 13.5 (mg hemoglobin/g stool) in groups ingesting 5 ml/5 days, 10 ml/3 days, 10 ml/5 days, and 20 ml/3 days, respectively. The proportion of positive tests during and immediately after the period of blood ingestion was greatest in the 20 ml/3 day group; 16% of HO II samples were positive as were 64% of SENSA and 67% of HQ samples. SENSA was more sensitive than HO II in all blood ingestion groups. At least one positive SENSA test was present in 50% of subjects ingesting 10 ml of blood (each 3 and 5 day groups) and in all subjects ingesting 20 ml/day. Immunochemical tests did not detect upper GI blood in any blood ingestion group. CONCLUSION: Inasmuch as many upper GI tract lesions have been reported to bleed small quantities of blood such as that studied here, and this amount of blood is readily detected with widely used guaiac-based FOB tests including Hemoccult II SENSA, the data emphasize that caution is warranted before attributing positive guaiac tests only to sites in the lower GI tract. The data raise the possibility that a combination of a highly sensitive guaiac-based FOB test plus an immunochemical could help differentiate occult upper from lower GI bleeding.     

Fecal immunochemical tests compared with guaiac fecal occult blood tests for population-based colorectal cancer screening

Colorectal cancer (CRC) is the second most common cause of cancer deaths in Canadian men and women - accounting for almost 12% of all cancer deaths. In Ontario, it is estimated that 8100 persons were diagnosed with CRC in 2011, and 3250 died from the disease. CRC incidence and mortality rates in Ontario are among the highest in the world. Screening offers the best opportunity to reduce this burden of disease. The present report describes the findings and recommendations of Cancer Care Ontario's Fecal Immunochemical Tests (FIT) Guidelines Expert Panel, which was convened in September 2010 by the Program in Evidence-Based Care. The purpose of the present guideline is to evaluate the existing evidence concerning FIT to inform the decision on how to replace the current guaiac fecal occult blood test with FIT in the Ontario ColonCancerCheck Program. Eleven articles were included in the present guideline, comprising two systematic reviews, five articles reporting on three randomized controlled trials, and reports of four other studies. Additionally, one laboratory study was obtained that reported on several parameters of FIT tests that helped to inform the present recommendation. The performance of FIT is superior to the standard guaiac fecal occult blood test in terms of screening participation rates and the detection of CRC and advanced adenoma. Given greater specimen instability with the use of FIT, a pilot study should be undertaken to determine how to implement the FIT in Ontario.     

免疫学法与化学法大便潜血试验对老年人大肠病变筛选的价值

目的　比较免疫学OC hemodia法抗人血红蛋白单克隆抗体大便潜血试验与化学法大便潜血试验对老年人大肠病变筛选的价值。　方法　对在我院门诊就诊的 110 0例老年患者 ,于检查日采集粪便 ,同时送不同实验室分别做化学法和免疫学OC hemodia法大便潜血试验 ,两者试验分别进行结果分析。潜血阳性者进一步行纤维结肠镜、乙状结肠镜或钡剂灌肠造影检查。其中 10 4 6例获得 5年随访。　结果　 110 0例受检者中OC hemodia法大便潜血阳性者 2 31例 (2 1.0 % ) ,比化学法大便潜血阳性者 15 9例 (14 .5 % )为高 ,两者差异有显著性 (P <0 .0 5 )。OC hemodia法大便潜血阳性中的 10 9例再接受纤维结肠镜、乙状结肠镜或钡剂灌肠造影检查发现结肠病变者 70例 ,占6 4 2 % ;化学法阳性中的 71例发现结肠病变者 5 0例 ,占 70 4 %。 5年随访的结果显示 ,OC hemodia法假阴性率为 0 1% ,化学法假阴性率为 0 5 %。　结论　OC hemodia法在老年人大便潜血试验中敏感性、特异性及阳性检出率高 ,但费用较高 ;化学法仍有较高的敏感性 ,是经济实用的方法     

上消化道出血时D-二聚体的变化及临床意义

目的 研究上消化道出血患者D-二聚体水平的变化及临床意义.方法选取2012年3月～ 2013年2月在我院住院的上消化道出血的131例患者的临床资料,分析D-二聚体水平在不同临床特征中的变化及其与实验室检查指标的相关性.结果 131例上消化道出血患者D-二聚体平均水平为(1.41±2.57)mg/L,阳性率为48.1％ (63/131);不同病因导致的上消化道出血患者血清D-二聚体水平不同,其中食管胃底静脉曲张破裂出血、恶性肿瘤及其它病因组患者D-二聚体阳性率显著增高(P＜0.01);周围循环衰竭、呕血及呕血伴全身症状组患者的D-二聚体阳性率较高,黑便组阳性率最低(P＜0.01);持续和再出血患者血清D-二聚体水平显著高于无再出血的患者(P＜0.01);死亡患者的D-二聚体阳性率显著高于好转组(P＜0.01),但与未愈组比较差异无统计学意义(P＞0.05);D-二聚体水平与休克指数有一定相关性(P＜0.01),与入院时收缩压、脉搏、血红蛋白、红细胞计数无相关性(P＞0.05).结论 上消化道出血患者存在纤溶活动异常增强,且不同病因患者D-二聚体阳性率不同.D-二聚体水平升高可能提示机体循环血容量不足,可作为预测再出血风险的指标之一,而且提示患者预后不良.     

Relationship between the number of positive fecal occult blood tests and the diagnostic yield of colonoscopy

BACKGROUND:

In 2007, Ontario launched a colon cancer screening program for average-risk individuals based on biennial fecal occult blood tests (FOBTs) on three fecal samples, followed by colonoscopy for individuals who tested positive.

OBJECTIVE:

To determine whether >1 positive screening FOBT was predictive of finding advanced neoplasia at colonoscopy.

METHODS:

A retrospective chart review of outpatient colonoscopic procedures performed at Hotel Dieu Hospital (Kingston, Ontario) in the first two years of the colon cancer screening program was conducted, focusing on endoscopic and pathological findings.

RESULTS:

Of 5556 individuals undergoing colonoscopy, 346 were referred for positive FOBT. Overall, 41 (11.8%) patients with a positive FOBT had colon cancer. In 16 (4.6%) cases, the number of positive FOBTs was not reported. For the 330 individuals in whom the number of positive tests was specified, 198, 71 and 61 cases had one, two and three positive results, respectively. Cancer was found at colonoscopy in 11 (5.6%), 11 (15.5%) and 18 (29.5%) of individuals with one, two and three positive FOBT results, respectively (OR 3.0 [95% CI 1.2 to 7.3] and 6.5 [95% CI 2.8 to 15.0] for two or three positive FOBTs compared with one; P=0.015 and P<0.001, respectively). High-risk adenomas (>1 cm in diameter, villous component and/or high-grade dysplasia) were found in 41 (20.8%), 29 (42.0%) and 25 (41.0%) individuals with one, two and three positive FOBTs, respectively (OR 2.8 [95% CI 1.5 to 5.0] and 2.4 [95% CI 1.3 to 4.5] for two or three positive FOBTs compared with one; P=0.001 and P=0.006, respectively).

CONCLUSIONS:

The diagnostic yield of colonoscopy varied directly with the number of positive FOBTs. This information may be useful in assigning scheduling priority for patients with positive FOBTs.     

Inverted Meckel's diverticulum as a cause of occult lower gastrointestinal hemorrhage

Meckel’s diverticulum is a common asymptomatic congenital gastrointestinal anomaly, but rarely it can present with hemorrhage. Over the last few years inverted Meckel’s diverticulum has been reported in the literature with increasing frequency as an occult source of lower gastrointestinal hemorrhage. Here, we report a case of a 54-year-old male, who was referred for surgical evaluation with persistent anemia and occult blood per rectum after a work up which failed to localize the source over 12 mo, including upper and capsule endoscopy, colonoscopy, enteroclysis, Meckel scan, and tagged nuclear red blood cell scan. An abdominal computed tomography scan showed a possible mid-ileal intussusception and intraluminal mass. During the abdominal exploration, inverted Meckel’s diverticulum was diagnosed and resected. We review the literature, discuss the forms in which the disease presents, the diagnostic modalities utilized, pathological findings, and treatment. Although less than 40 cases have been reported in the English literature from 1978 to 2005, 19 cases have been reported in the last 6 years alone (2006-2012) due to improved diagnostic modalities. Successful diagnosis and treatment of this disease requires a high index of clinical suspicion, which is becoming increasingly relevant to general gastroenterologists.