Camilleri M, Zinsmeister A R
Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota.
Gastroenterology. 1992 Jul;103(1):36-42. doi: 10.1016/0016-5085(92)91092-i.
Currently available clinical tests of colonic transit, such as the radiopaque marker method, are useful to detect delayed transit but may be less sensitive for rapid transit. The aim of this study was to develop a relatively inexpensive, noninvasive, accurate test of colonic transit using selected scintigraphic observations within the first 24 hours after ingestion of a pH-sensitive, methacrylate-coated, delayed-release capsule containing 111In-labeled resin pellets. The authors' previously published colonic transit data on 22 healthy subjects, 9 patients with diarrhea-predominant irritable bowel syndrome, and 7 patients with idiopathic constipation and previously unpublished data on 4 patients with carcinoid diarrhea were analyzed. A logistic discriminant analysis was used to estimate the sensitivity and specificity of selected combinations or simple summaries of transit. Among combined transit summaries, the emptying rate of the proximal colon was significantly different between healthy and constipation groups; the geometric center of isotope in the colon at 4 hours was significantly greater in the diarrhea group than in healthy controls; the geometric center at 24 hours was significantly lower in the constipation group than in the other two groups. From the logistic discriminant analysis, simple summaries of transit also had significant discriminant value; these included the isotopic contents in the ascending, transverse, and descending colon at 4 hours and the counts in the ascending and transverse colon and stool at 24 hours. At 90% sensitivity, the specificity of the transverse colon counts at 4 hours was 79%, which is identical to the specificity of the proximal colon emptying rate, both adjusted for age. Thus, quantitation of isotopic counts in colonic regions on scans taken at 4 and 24 hours provides an accurate summary of colonic transit, with acceptable specificity at a high sensitivity in the detection of motility disorders of the colon.
目前可用的结肠传输临床测试，如不透X线标志物法，对于检测传输延迟是有用的，但对于快速传输可能不太敏感。本研究的目的是利用摄入含111In标记树脂颗粒的pH敏感、甲基丙烯酸酯包衣、缓释胶囊后24小时内的选定闪烁扫描观察结果，开发一种相对廉价、非侵入性且准确的结肠传输测试方法。分析了作者之前发表的22名健康受试者、9名腹泻型肠易激综合征患者和7名特发性便秘患者的结肠传输数据，以及之前未发表的4名类癌性腹泻患者的数据。采用逻辑判别分析来估计选定传输组合或简单汇总的敏感性和特异性。在组合传输汇总中，健康组和便秘组近端结肠的排空率有显著差异；腹泻组在4小时时结肠内同位素的几何中心明显大于健康对照组；便秘组在24小时时的几何中心明显低于其他两组。从逻辑判别分析来看，传输的简单汇总也具有显著的判别价值；这些包括4小时时升结肠、横结肠和降结肠的同位素含量，以及24小时时升结肠、横结肠和粪便中的计数。在敏感性为90%时，4小时时横结肠计数的特异性为79%，这与近端结肠排空率的特异性相同，两者均根据年龄进行了调整。因此，在4小时和24小时扫描时对结肠区域同位素计数进行定量，可提供结肠传输的准确汇总，在检测结肠动力障碍时，在高敏感性下具有可接受的特异性。
