免疫法粪便隐血试验和血癌胚抗原检测对大肠癌早期诊断的意义

目的探讨以免疫法粪便隐血试验与血癌胚抗原(CEA)检测为主要方法提高早期大肠癌的诊断率。方法应用问卷调查,按易感因素将研究对象分组,进行免疫法粪便隐血试验(iFOBT)、CEA、肠镜及病理检查。结果依据问卷调查将6997例研究对象分为大肠癌低度危险组(n=4551)、可疑组(n=2085)、高度危险组(n=361)。3组iFOBT阳性率依次升高,差异具有统计学意义(P<0.05,P<0.01)。共检出早期大肠癌6例,其中高度危险组5例,可疑组1例。根据结肠镜检查结果分为结肠癌、结肠息肉、结肠炎、正常组,结肠癌组iFOBT、CEA结果明显高于其他组,差异有统计学意义(P<0.05)。结论 iFOBT可以作为早期大肠癌筛查的主要方法,iFOBT和CEA联合检测可以提高早期结肠癌的检出率。     

检测粪便隐血的金免疫渗滤法的初步研究

目的建立以人白蛋白为靶抗原的检测人粪便隐血的金免疫渗滤法试剂,并作临床初步应用。方法应用自制的2株抗人白蛋白单克隆抗体,其中1株包被在硝酸纤维素膜上,另1株与胶体金结合,组成金免疫渗滤试剂,并用研制的试剂与商品化便隐血免疫层析法试剂对比检测69例临床粪便标本。结果本研究建立的方法检测范围为10～10 000 mg/L,与免疫层析法试剂条临床比对结果显示,69例标本中除1例本法为（＋）,而免疫层析法为（-）外,其余全部符合。结论本研究研制的金免疫渗滤法粪便隐血试验方法简便、结果可靠,进一步研究后可应用于临床。     

检测粪便隐血的金免疫渗滤法的初步研究

目的建立以人白蛋白为靶抗原的检测人粪便隐血的金免疫渗滤法试剂,并作临床初步应用。方法应用自制的2株抗人白蛋白单克隆抗体,其中1株包被在硝酸纤维素膜上,另1株与胶体金结合,组成金免疫渗滤试剂,并用研制的试剂与商品化便隐血免疫层析法试剂对比检测69例临床粪便标本。结果本研究建立的方法检测范围为10～10 000 mg/L,与免疫层析法试剂条临床比对结果显示,69例标本中除1例本法为(+),而免疫层析法为(-)外,其余全部符合。结论本研究研制的金免疫渗滤法粪便隐血试验方法简便、结果可靠,进一步研究后可应用于临床。     

临床粪便隐血试验方法的选择

粪便隐血试验临床上主要用于消化道出血、肠道肿瘤等疾患的筛查。目前较常用的方法大致有两种，即免疫胶体金法和化学法（联苯胺）。化学法灵敏度较好，测定范围广，但易受药物、动物血等影响造成假阳性。免疫胶体金法虽然具有高灵敏度，高特异性的特点，但上消化道出血病人的Hb易变性及由于抗原抗体比例不相合产生假阴性结果。我们对免疫胶体金法、化学法及免疫胶体金稀释法进行了临床结果比较，报告如下。     

胶体金法与邻联甲苯胺法检测粪便隐血试验的比较

目的 对比胶体金法和邻联甲苯胺法隐血实验的灵敏性、特异性及抗干扰性；探讨两种方法的优缺点及适用范围，避免假阳性和假阴性结果，使检测结果更准确，可靠。方法 在相同条件下应用胶体金法和邻联甲苯胺法进行对比研究。结果 胶体金法的灵敏度、特异性和抗干扰能力均明显高于邻联甲苯胺法。结论 胶体金法优于邻联甲苯胺法，值得在临床检测中推广使用。     

血清癌胚抗原及大便隐血试验诊断大肠癌价值

目的:评价大便隐血试验、血清癌胚抗原在早期大肠癌诊断中的价值.方法:回顾性分析173例大肠癌患者(大肠癌组),327例结肠息肉患者、126例胃癌患者、96例胃息肉患者、182例消化道溃疡患者及150例胃炎患者(对照组)的大便隐血试验及血清癌胚抗原检测结果,对上述指标在大肠癌筛查中的敏感度和特异度进行统计学分析.结果:在大肠癌诊断中,单独应用大便隐血试验的敏感度为50.9%,特异度为86.8%,Youden指数仅为37.7%;单独应用癌胚抗原的敏感度为39.3%,特异度为94.2%,Youden指数仅为33.5%.联合应用大便隐血试验+癌胚抗原的敏感度为69.9%,特异度为83.7%,Youden指数为53.6%.结论:血清癌胚抗原和大便隐血试验对晚期大肠癌的诊断有一定价值,但单项应用诊断早期大肠癌的准确率偏低.联合应用可提高大肠癌诊断敏感度,但总体检测效率仍偏低.     

粪便隐血试验硫酸甲氨基酚法

粪便隐血试验硫酸甲氨基酚法吴玉智刘文杰侯风琴（武警专科学校医院，山西夏县０４４４００）关键词粪便隐血试验硫酸甲氨基酚我们用硫酸甲氨基酚法做粪便隐血试验，用邻甲苯胺法做对照试验，观察了２００例病人，认为本法实验稳定，呈色反应灵敏，便于观察，结果较为满意...     

两种粪便隐血试验的方法学比较

目的对单克隆抗体法、联苯胺法检测粪便潜血的敏感性和特异性及抗干扰性进行比较。方法采取单克隆抗体法与联苯胺法,对随机抽取100份患者的粪便进行隐血检测。结果①联苯胺法粪潜血实验阳性占34.0%,在联苯胺法阴性标本中加5种动物血红蛋白,则均为阳性。②单克隆抗体法粪便潜血实验阳性占19.0%,在单克隆抗体法阴性标本中加5种动物血红蛋白,则均为阴性。③含不同浓度的维生素C加入约含血红蛋白（Hb）3.5μg/ml的粪便中,结果单抗法仍为阳性,而联苯胺法测得结果为阴性,再用铁剂及含过氧化物酶的蔬菜汁加入含Hb 3.5μg/ml粪便中做同样的隐血试验,单克隆抗体法所做的结果始终不变,而联苯胺法测得的结果为阴性。结论单克隆抗体法对粪便潜血实验有不可比拟的特异性、灵敏度和准确率,是一种实用且临床上值得推广应用的粪便潜血方法。     

大便隐血试验对大肠癌早期诊断的评价

目的探讨大肠癌的早期诊断.方法在2000～2005年,对3 437名55～84岁的自然人群进行大肠癌普查.结果该人群来2 856人接受普查为(A组),普查率83.10%,6年来共发现大肠癌19例,年平均大肠癌发生率92.23/105,A组检出大肠癌11例,漏检5例,发生率89.67/105,检出率61.65/105,早期为90.9%.2年或2年以上未参加普查者为B组,B组检出大肠癌3例,早期诊断率为33.3%.结论高龄自然人群大便隐血试验普查,可检出大部分早期大肠癌,大大提高患者生存率.     

粪便隐血胶体金法和氨基比林法的对比及意义

目的通过对黑色柏油样粪便同时使用胶体金免疫法和氨基比林半定量法(化学法)测定并分析结果,了解粪便隐血试验的最佳方法及意义。从而给临床提供可靠依据。方法随机选取我院2013年1月至2014年12月间的住院及门诊确诊为上消化道出血患者的黑色柏油样粪便100例,同时取正常外观黄色软粪便100例(健康体检者提供)作为对照,每份标本用两种方法测定。结果正常外观黄色软便胶体金免疫法阳性率为8%,氨基比林半定量法阳性率为2%,两种方法同时阳性为0;黑色柏油样便胶体金免疫法阳性率为77%,氨基比林半定量法阳性率100%。结论用于临床筛查早期消化道肿瘤及胃肠道微量出血和鉴定出血部位时胶体金免疫法较适用;用于上消化道出血和判断出血量时则氨基比林半定量法(化学法)较适用。     

粪标本的综合检测在结直肠癌早期筛查中的意义

目的探索一种简便易行、无创的门诊早期筛查结直肠癌的有效方法。方法对2011年3月至2012年3月间从上海市闸北区9个社区医院选取150例结直肠癌高危人群以及40例健康体检者（对照组）分别进行粪标本的综合检测一粪潜血（FOBT）、粪钙卫蛋白（CPT）、粪微型染色体维持蛋白-2（MCM2）表达、粪K—ras基因突变并同时行结肠镜检查,评估粪标本的综合检测与早期诊断结直肠癌的关系。结果190例受检者中FOBT阳性者14例,阳性率为7．37％;CPT阳性者6例,阳性率为3．16％;K—ras均为阴性。共发现结直肠癌21例,检出率11．05％（21／190）,其中DukeA期11例（52．38％）,B期9例（42．86％）,C期1例（4．76％）;FOBT阳性者中结直肠癌检出率为78．57％（11／14）。其中发现病例组（21例）、高危组（129例）与对照组（40例）之间FOBT、MCM2表达差异显著（P〈0．01）,CPT均值没有显著差异（P〉0．05）。Logistic回归模型分析结果亦表明FOBT和MCM2对结直肠癌的筛查具有临床意义。结论联合检测粪FOBT、MCM2有助于在普查中发现结直肠癌高危人群,及早行结肠镜检查,有利于发现较早期结直肠癌,从而使疾病在可治愈的阶段得到根治。     

Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea

PurposeRepeated participation in fecal occult blood testing (FOBT) is one of the major factors affecting the long-term success of population-based colorectal cancer screening programs. The aim of this study is to explore strong factors linked to repeated participation in FOBT in the prior decade (2002–2011) among adults using the Health Belief Model (HBM) after controlling for other covariates.MethodsData were obtained from South Korean adults, aged 50 years and over, who visited a national health screening center within a magnet hospital (N = 237). A pilot test was conducted to investigate the internal consistency of the HBM instruments and the clarity of survey questions. Sample characteristics and rates of adherence to FOBT screening were examined using means and frequencies. Important factors associated with adherence to FOBT were examined using multivariate logistic regression analysis.ResultsAbout 44% of the respondents were adherent to FOBT screening over the prior decade. Four out of the six HBM-driven factors (perceived susceptibility, severity, and barriers, and health motivation) were statistically significant. Those with greater levels of susceptibility and health motivation and lower levels of severity and barriers were more likely to adhere to FOBT.ConclusionsHealth professionals should focus more on the four modifiable HBM-related factors to encourage adults to adhere to FOBT. Intervention programs, which lower perceived severity and barriers and increase susceptibility and health motivation, should be developed and implemented.     

Screening for colorectal cancer using the faecal occult blood test: a critical literature review

Colorectal cancer (CRC) is a major health problem whose outcome is crucially dependent on the stage of disease at the time of diagnosis. Consequently, early detection of CRC by mass population screening is the subject of much international research and debate. A critical literature review was undertaken to determine the effectiveness of faecal occult blood (FOB) testing in CRC screening. Four issues were addressed: an appraisal of available FOB tests, their impact on CRC mortality, the appropriate screening interval and the factors influencing public compliance with FOB screening. A computerized literature search was conducted, supplemented by cross-referencing and hand searching. Forty studies which fulfilled pre-defined inclusion and exclusion criteria were appraised. A thorough assessment of methodology, combined with an applied hierarchy of evidence, resulted in the selection of 22 studies for review. The evidence from this review is that no single (currently used) FOB test provides optimal screening performance, that biennial FOB screening reduces CRC mortality by between 6-18%, that there is a small advantage in annual screening and that better dissemination of information can improve compliance rates. An appreciation of the current evidence and issues surrounding CRC screening is important to nurses in their capacity as health promoters and educators. Definitive answers to many important questions regarding FOB screening for CRC do not currently exist. Before the concept of a national screening programme could be supported, further research is needed, the key elements of which must include the assessment of more sensitive and specific FOB tests and the promotion of population compliance.     

FOBT阳性人群结肠镜二次筛查结直肠癌的效果分析

目的观察连续粪便隐血试验(FOBT)阳性人群应用结肠镜二次筛查结直肠癌的效果。方法选取FOBT阳性2 192例为目标人群,应用结肠镜进行二次筛查结直肠癌。发现息肉样病变即取活检或摘除,病理确诊。分析筛查数据,计算初筛阳性人群中不同年龄段和不同性别人群的结直肠肿瘤检出率。结果 2 048例完成结肠镜检查,检出结直肠肿瘤307例,检出率为14.99%(95%CI:12.89%~17.01%)。其中结直肠癌33例,检出率为1.61%(95%CI:0.91%~2.03%);进展期腺瘤92例,检出率为4.49%(95%CI:3.88%~5.12%);非进展期腺瘤182例,检出率为8.89%(95%CI:7.81%~10.01%)。结直肠癌发病率男性高于女性(P=0.013),年龄段越大结直肠癌发病率越高(P0.05)。结论 FOBT阳性人群应用结肠镜二次筛查结直肠癌效果显著,值得推广。     

联合免疫法和化学法检测粪便隐血的临床应用评价

目的评价转铁蛋白（Tf）/血红蛋白（Hb）联合免疫法和匹拉米洞化学法在检测消化道出血中的临床应用价值。方法用联合免疫法和化学法分别对122例消化道出血患者和76名阴性对照粪便标本进行检测,评价2种方法的特异性、敏感性、阴性预测值和阳性预测值并用稀释已知浓度人红细胞（RBC）悬液比较2种方法检测线性范围。结果化学法的特异性、敏感性、阴性预测值和阳性预测值分别是54.1%、97.4%、97.1%、56.9%,而联合免疫法分别为96.7%、98.7%、99.2%、94.9%,化学法检出限高于联合免疫法。结论Tf与Hb联合免疫法可有效提高上消化道出血及大肠肿瘤的阳性检出率。     

联合免疫法和化学法检测粪便隐血的临床应用评价

目的评价转铁蛋白(Tf)/血红蛋白(Hb)联合免疫法和匹拉米洞化学法在检测消化道出血中的临床应用价值。方法用联合免疫法和化学法分别对122例消化道出血患者和76名阴性对照粪便标本进行检测,评价2种方法的特异性、敏感性、阴性预测值和阳性预测值并用稀释已知浓度人红细胞(RBC)悬液比较2种方法检测线性范围。结果化学法的特异性、敏感性、阴性预测值和阳性预测值分别是54.1%、97.4%、97.1%、56.9%,而联合免疫法分别为96.7%、98.7%、99.2%、94.9%,化学法检出限高于联合免疫法。结论Tf与Hb联合免疫法可有效提高上消化道出血及大肠肿瘤的阳性检出率。     

Comparison of a peanut agglutinin test and an immunochemical faecal occult blood test in detecting colorectal neoplasia in symptomatic patients

Background: Currently available methods for detection of early‐stage colorectal cancer are reliant on faecal occult blood (FOB) tests. Bleeding, however, is not specific for colorectal neoplasia. Enzymatically detected or peanut agglutinin (PNA)‐detectable galactose‐β1‐3‐N‐acetyl‐galactosamine residues found in rectal mucus have been used to detect colorectal cancer. Methods: The sensitivity and specificity of the PNA rectal mucus test were compared with those of an immunological test for faecal occult blood (Hemolex) in 199 symptomatic patients referred for colorectal investigations. All patients also underwent a colonoscopy. SDS‐PAGE and PNA‐overlay were used to characterize PNA‐binding proteins in normal and malignant colorectal tissue. Results: The PNA test had a similar sensitivity to that of Hemolex for colorectal carcinoma (83% vs. 72%), adenomas (55% vs. 50%), inflammatory bowel disease (52% vs. 48%) and hyperplastic polyps (48% vs. 25%). The sensitivity of the PNA test and Hemolex for colorectal neoplasia was 69% vs. 59% and specificity 68% vs. 86% (p=0.002). SDS‐PAGE and PNA‐overlay showed some commonly expressed PNA‐binding proteins in both normal mucosa and colorectal cancer and a higher and even selective expression of 160?kD PNA‐binding protein in colorectal cancer. Conclusions: A single PNA test in its present form is as sensitive an indicator of colorectal neoplasia as Hemolex completed over three days, but lacks specificity. The 160?kD cancer‐associated antigen we have identified is under further characterization for development of a more specific PNA test.     

A prospective study of a new immunochemical fecal occult blood test in Korean patients referred for colonoscopy

OBJECTIVES: The exquisite performance characteristics of an immunochemical fecal occult blood test (IFOBT) are well understood. We evaluated the diagnostic validity of a new IFOBT for colorectal neoplasia in patients undergoing colonoscopy and compared its results with two other commercially available IFOBTs. DESIGN AND METHODS: Eighty-five consecutive patients referred for colonoscopy were studied. We performed three different IFOBTs, namely, HM-Jack, Instant-View, and a newly developed OcculTech on each fecal specimen. RESULTS: OcculTech was easy to perform and had a sensitivity, specificity, and positive predictive value of 58.3%, 76.3%, and 27.9%, respectively, for the detection of colorectal cancers and >or=1 cm adenomas. OcculTech showed higher sensitivity than the automatic analyzer, HM-Jack. No improvement was obtained by combining tests. CONCLUSIONS: The OcculTech test had performance characteristics comparable to the two other IFOBTs. This study confirms the usefulness of the OcculTech test for colorectal neoplasia screening.     

胶体金法粪便隐血检测试剂的性能检测及初步临床应用评估

目的评价胶体金法粪便隐血检测试剂的性能及临床应用价值。方法随机选择150例住院患者粪便样本,分别用试验试剂[胶体金法,梅里埃(上海)生物制品有限公司生产]和对照试剂(胶体金法,上海凯创生物技术有限公司生产)对样本进行检测,并对结果进行统计。同时结合患者临床资料,对检测结果的符合程度进行综合分析,初步评估其临床应用价值。结果试验试剂敏感性可达到40 ng/mL,特异性和重复性均符合要求,与对照试剂结果基本相符,且检测结果与临床病情相符合。结论胶体金法粪便隐血检测试剂方法简便,结果可靠,可进一步应用于临床。     

小儿腹泻大便隐血试验的研究

目的 对腹泻患儿大便隐血试验阳性的发生率进行研究.方法 对2010年1～11月来本院就诊的589例腹泻患者的大便标本进行隐血检测.分为儿童组(0～6岁)489例,按照年龄划分为0～1岁组206例、1～3岁组247例、3～6岁组36例;成人组(>18岁)100例,并进行统计学分析.结果 儿童组与成人组腹泻患者比较,大便隐血试验阳性发生率儿童组高于成人组,差异有统计学意义(P＜0.05);根据儿童组年龄分段,其大便隐血试验阳性的发生率不同,差异有统计学意义(P＜0.05);儿童组隐血试验阳性大便标本镜下红细胞检出率高于成人组,差异有统计学意义(P＜0.05).结论 小儿腹泻时大便隐血检测易呈阳性,应及时与影像学、病原学检测结果相结合查找病因,进行相应治疗.