隐血与肛周检查：小儿炎症性肠病筛查中的附加价值
Occult Blood and Perianal Examination: Value Added in Pediatric Inflammatory Bowel Disease Screening.
作者信息
Moran Christopher J, Kaplan Jess L, Winter Harland S, Masiakos Peter T
机构信息
Division of Pediatric Gastroenterology, Hepatology, & Nutrition, MassGeneral Hospital for Children.
Department of Pediatrics, Harvard Medical School.
出版信息
J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):52-55. doi: 10.1097/MPG.0000000000000754.
OBJECTIVES
Pediatric inflammatory bowel disease (IBD) often presents insidiously and standard blood tests are normal in 20% of patients. We hypothesize that fecal occult blood testing (FOBT) and the perianal examination in addition to blood tests provide important information during the screening process for IBD. The aim of the present study was to measure the diagnostic value of adding FOBT and perianal examination to standard screening laboratories in evaluating children and adolescents for IBD.
METHODS
The medical records of consecutive patients undergoing ileocolonoscopy for IBD were reviewed. Laboratory test results, FOBT, and perianal examination before the decision to perform the ileocolonoscopy were recorded. Standard limits of laboratory tests were used. Multivariate logistic regression was performed on a discovery cohort and applied to an independent validation cohort.
RESULTS
The discovery cohort included 335 patients (85 IBD and 250 non-IBD). A total of 61.2% had FOBT and perianal examination performed before the decision to perform the ileocolonoscopy. A total of 119 patients had complete blood testing, FOBT, and perianal examination available for full analysis. The sensitivity of the laboratory testing was 80.5% for IBD, and the sensitivity of FOBT with perianal examination was 66.9%. The combined sensitivity of laboratory testing and FOBT with perianal examination was, however, 97.6%. The most predictive model included C-reactive protein, platelet counts, and FOBT with perianal examination and was superior to the laboratory value-only model (P < 0.001) that was validated in a separate cohort.
CONCLUSIONS
Perianal examination and FOBT improve sensitivity in screening children for IBD.
目的
儿童炎症性肠病（IBD）通常起病隐匿，20%的患者标准血液检查结果正常。我们推测，除血液检查外，粪便潜血试验（FOBT）和肛周检查在IBD筛查过程中可提供重要信息。本研究的目的是评估在评估儿童和青少年IBD时，将FOBT和肛周检查添加到标准筛查实验室检查中的诊断价值。
方法
回顾了连续接受回结肠镜检查以诊断IBD的患者的病历。记录了在决定进行回结肠镜检查之前的实验室检查结果、FOBT和肛周检查情况。采用实验室检查的标准限值。在一个发现队列中进行多因素逻辑回归分析，并应用于一个独立的验证队列。
结果
发现队列包括335例患者（85例IBD患者和250例非IBD患者）。共有61.2%的患者在决定进行回结肠镜检查之前进行了FOBT和肛周检查。共有119例患者有完整的血液检查、FOBT和肛周检查结果可供全面分析。实验室检查对IBD的敏感性为80.5%，FOBT联合肛周检查的敏感性为66.9%。然而，实验室检查与FOBT联合肛周检查的综合敏感性为97.6%。最具预测性的模型包括C反应蛋白、血小板计数以及FOBT联合肛周检查，且优于仅采用实验室检查值的模型（P<0.001），该模型在另一个队列中得到了验证。
结论
肛周检查和FOBT可提高儿童IBD筛查的敏感性。
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