Kronborg O, Ugstad M, Fuglerud P, Johne B, Hardcastle J, Scholefield J H, Vellacott K, Moshakis V, Reynolds J R
Odense University Hospital, Denmark.
Gut. 2000 Jun;46(6):795-800. doi: 10.1136/gut.46.6.795.
Faecal concentrations of the protein calprotectin have been found to be elevated in patients with colorectal neoplasia, suggesting that it might be used as a screening tool for colorectal cancer as well as adenomas.
To measure the sensitivity and specificity of faecal calprotectin for the detection of adenomas in high risk individuals undergoing colonoscopy. Also, to investigate between and within stool variability of calprotectin concentrations.
A total of 814 patients planned for colonoscopy were included for the following indications: positive faecal occult blood test, 25; neoplasia surveillance, 605; newly detected polyp, 130; and family risk, 54.
Two faecal samples from each of two stools were analysed using the PhiCal ELISA test device (Nycomed Pharma AS).
Adenoma patients had significantly higher calprotectin levels than normal subjects (median 9.1 (95% confidence interval 7.5-10.1) v 6.6 (5.6-7.4)mg/l). There was no significant decrease in calprotectin levels after polypectomy. Levels in cancer patients were significantly higher than those in all other subgroups (median 17.6 mg/l (11.5-31.0)). With a cut off limit of 10 mg/l, the sensitivity for cancer was 74% and for adenoma 43%. Corresponding specificity values were 64% for no cancer and 67% for no neoplasia (cancer+adenoma). Specificity varied from 71% for one stool sample to 63% for four samples. Stool variability was small, suggesting that two spots from one stool were as discriminative as two spots from each of two stools.
The sensitivity and specificity of faecal calprotectin levels as a marker for colorectal adenoma and carcinoma justifies its use in high risk groups, but specificity is too low for screening of average risk persons. Lack of a decrease in levels after polypectomy may be due to a more widespread leucocyte migration into the intestinal lumen than that at the polyp site, and needs further investigation.
已发现结直肠肿瘤患者粪便中钙卫蛋白的浓度升高，这表明它可能用作结直肠癌以及腺瘤的筛查工具。
测量粪便钙卫蛋白在接受结肠镜检查的高危个体中检测腺瘤的敏感性和特异性。此外，研究钙卫蛋白浓度在不同粪便之间以及同一粪便内的变异性。
共有814例计划进行结肠镜检查的患者因以下指征被纳入研究：粪便潜血试验阳性25例；肿瘤监测605例；新发现息肉130例；家族风险54例。
使用PhiCal ELISA检测设备（Nycomed Pharma AS）对两份粪便中的每份粪便的两份样本进行分析。
腺瘤患者的钙卫蛋白水平显著高于正常受试者（中位数9.1（95%置信区间7.5 - 10.1）对6.6（5.6 - 7.4）mg/l）。息肉切除术后钙卫蛋白水平没有显著下降。癌症患者的水平显著高于所有其他亚组（中位数17.6 mg/l（11.5 - 31.0））。截断值为10 mg/l时，癌症的敏感性为74%，腺瘤的敏感性为43%。无癌症的相应特异性值为64%，无肿瘤（癌症 + 腺瘤）的特异性值为67%。特异性从一份粪便样本的71%到四份样本的63%不等。粪便变异性较小，这表明来自一份粪便的两个样本点与来自两份粪便的各两个样本点具有相同的判别能力。
粪便钙卫蛋白水平作为结直肠腺瘤和癌的标志物，其敏感性和特异性证明了它在高危人群中的应用价值，但特异性对于筛查平均风险人群来说过低。息肉切除术后水平未下降可能是由于白细胞向肠腔的迁移比息肉部位更广泛，这需要进一步研究。
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