新型免疫学法检测人粪便血红蛋白和白蛋白在结直肠肿瘤检测中的有效性——一项内镜对照研究

Validity of new immunological human fecal hemoglobin and albumin tests in detecting colorectal neoplasms--an endoscopy-controlled study.

作者信息

Sieg A, Scheida M, John M R, Hertel A, Schröter M, Lüthgens K, Schmidt-Gayk H

机构信息

Practice for Gastroenterology, Ostringen, Germany.

出版信息

Z Gastroenterol. 1998 Jun;36(6):485-90.

PMID:9675833

Abstract

BACKGROUND

Screening for occult blood by means of guaiac tests has an unsatisfactory sensitivity for the detection of colorectal neoplasms. To increase sensitivity and specificity the immunological determination of human hemoglobin and albumin in feces has been developed. The validity of analyzing only two samples from one bowel movement of either test is not known.

METHODS

An immunological determination of human fecal hemoglobin and albumin using luminescence immunoassays (LIA) was performed in 739 patients with gastrointestinal complaints before scheduled colonoscopy. Each patient collected two 1 ml samples from one stool. There were no dietary restrictions.

RESULTS

The sensitivity for detecting colorectal carcinomas was 95.3% (95% confidence interval 84.2-99.4%) with hemoglobin and 67.4% (95% confidence interval 51.2-80.9%) with albumin. The sensitivity for detecting large adenomatous polyps was 62.9% (95% confidence interval 50.5-74.1%) with hemoglobin and 32.9% (95% confidence interval 22.1-45.1%) with albumin. The specificity was 97% for hemoglobin, 96% for albumin and 94% for the combined test.

CONCLUSIONS

The immunological determination of fecal hemoglobin is superior to albumin and has a better sensitivity for the detection of colorectal neoplasms than that reported for guaiac tests, even if two samples from one bowel movement are examined. The immunological determination of fecal hemoglobin should therefore be evaluated for use in colorectal cancer screening.

摘要

背景

通过愈创木脂试验筛查潜血对结直肠肿瘤的检测敏感性不尽人意。为提高敏感性和特异性，已开发出粪便中人血红蛋白和白蛋白的免疫测定法。尚不清楚对每次排便仅分析两种检测样本的有效性。

方法

对739例有胃肠道不适症状且计划进行结肠镜检查的患者，采用发光免疫分析法（LIA）对人粪便血红蛋白和白蛋白进行免疫测定。每位患者从一次粪便中采集两份1毫升的样本。无饮食限制。

结果

检测结直肠癌时，血红蛋白检测的敏感性为95.3%（95%置信区间84.2 - 99.4%），白蛋白检测的敏感性为67.4%（95%置信区间51.2 - 80.9%）。检测大腺瘤性息肉时，血红蛋白检测的敏感性为62.9%（95%置信区间50.5 - 74.1%），白蛋白检测的敏感性为32.9%（95%置信区间22.1 - 45.1%）。血红蛋白检测的特异性为97%，白蛋白检测的特异性为96%，联合检测的特异性为94%。