一种快速粪便乳胶凝集试验检测中性粒细胞蛋白乳铁蛋白在诊断慢性腹泻炎症原因中的应用。

Utility of a rapid fecal latex agglutination test detecting the neutrophil protein, lactoferrin, for diagnosing inflammatory causes of chronic diarrhea.

作者信息

Fine K D, Ogunji F, George J, Niehaus M D, Guerrant R L

机构信息

Division of Gastrointestinal Research, Baylor University Medical Center, Dallas, Texas 75246, USA.

出版信息

Am J Gastroenterol. 1998 Aug;93(8):1300-5. doi: 10.1111/j.1572-0241.1998.413_l.x.

DOI:10.1111/j.1572-0241.1998.413_l.x

PMID:9707055

Abstract

OBJECTIVE

The utility of tests for fecal neutrophils in the setting of chronic diarrhea has not been established. The purpose of this study was to determine the causes of chronic diarrhea associated with fecal neutrophils.

METHODS

One fecal specimen from each of 10 normal subjects, 26 patients with known microscopic colitis, 13 with celiac sprue, eight with Crohn's disease, four with ulcerative colitis, and 103 with chronic diarrhea of unknown origin, as well as 10 fecal specimens from a patient with chronic nongranulomatous enterocolitis were analyzed blindly for the presence of a neutrophil granule protein called lactoferrin using a commercial latex agglutination kit. Diagnostic evaluation of the 103 patients with chronic diarrhea was carried out to determine the diagnostic accuracy of this test for chronic inflammatory bowel disease.

RESULTS

None of the normal control subjects, three of 39 patients with microscopic colitis or celiac sprue, all 10 specimens from the patient with enterocolitis, and all 12 control patients with ulcerative colitis or Crohn's disease had a positive fecal lactoferrin test. Eleven of 103 patients with chronic diarrhea presenting without a diagnosis had a positive test, and all were diagnosed with an inflammatory condition of the colon (five-, ulcerative colitis; four-, Crohn's disease; one-, ischemic colitis; and one-, microscopic colitis). Only one patient with inflammatory bowel disease had a negative lactoferrin test. The sensitivity, specificity, and positive and negative predictive values of the fecal lactoferrin test for ulcerative or Crohn's colitis were 90%, 98%, 82%, and 99%, respectively.

CONCLUSION

The major cause of fecal neutrophils in patients with chronic diarrhea is chronic inflammatory bowel disease of the colon. The latex agglutination test for fecal lactoferrin offers a highly sensitive, specific, and simple means for detection of fecal neutrophils in these patients.

摘要

目的

尚未确定粪便中性粒细胞检测在慢性腹泻诊断中的作用。本研究旨在确定与粪便中性粒细胞相关的慢性腹泻病因。

方法

使用商用乳胶凝集试剂盒，对10名正常受试者、26名已知显微镜下结肠炎患者、13名乳糜泻患者、8名克罗恩病患者、4名溃疡性结肠炎患者、103名不明原因慢性腹泻患者的各一份粪便标本，以及1名慢性非肉芽肿性小肠结肠炎患者的10份粪便标本进行盲法检测，以确定是否存在一种名为乳铁蛋白的中性粒细胞颗粒蛋白。对103名慢性腹泻患者进行诊断评估，以确定该检测对慢性炎症性肠病的诊断准确性。

结果

正常对照受试者、39名显微镜下结肠炎或乳糜泻患者中的3名、小肠结肠炎患者的所有10份标本，以及所有12名溃疡性结肠炎或克罗恩病对照患者的粪便乳铁蛋白检测均为阴性。103名未确诊的慢性腹泻患者中有11名检测呈阳性，且均被诊断为结肠炎症性疾病（5例为溃疡性结肠炎；4例为克罗恩病；1例为缺血性结肠炎；1例为显微镜下结肠炎）。只有1名炎症性肠病患者的乳铁蛋白检测为阴性。粪便乳铁蛋白检测对溃疡性或克罗恩性结肠炎的敏感性、特异性、阳性和阴性预测值分别为90%、98%、82%和99%。