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目的探讨免疫法便隐血试验(IFOBT)在诊断大肠良恶性疾病中的诊断价值,提高大肠癌癌前疾病的早期筛查水平。方法对332例行结肠镜检查者进行免疫法便隐血试验,应用OC-MICRO全自动便隐血分析仪对便隐血结果进行分析,分别计算不同阳性阈值下的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。应用ELISA法检测外周血CEA、CA19-9水平及其敏感性、特异性、PPV、NPV。结果共纳入研究332例,其中男176例(53.0%),女156例(47.0%),分为结肠镜正常组183例,炎症性肠病(IBD)组34例,大肠息肉组79例(其中腺瘤型息肉25例,高危腺瘤12例)和大肠癌组36例。当便隐血试验阳性阈值为200ng/mL时,各组特异度为94.5%,各组敏感度分别为88.2%(IBD组)、86.1%(大肠癌组)、52.0%(腺瘤型息肉组)、50.0%(高危腺瘤组)和34.2%(大肠息肉组),与阳性阈值为100 ng/mL和150 ng/mL时相比较均无显著差异(P>0.05)。外周血CEA在正常组、IBD组和大肠息肉组之间无显著差异(P>0.05),大肠癌组和正常组之间有显著差异(P=0.006)。外周血CA19-9在正常组、IBD组和大肠癌组之间无显著差异(P>0.05)。CEA、CA19-9及二者联合检测其特异度均为100%,与免疫法便隐血无显著差异(P=1.000),其敏感度在IBD组、大肠息肉组、腺瘤型息肉组、高危腺瘤组和大肠癌组分别为:CEA(0、6.7%、0、8.3%、36.7%)、CA19-9(0、0、0、0、16.7%)、二者联合(0、3.3%、0、8.3%、40.0%)。CEA、CA19-9在诊断大肠癌时敏感度均低于免疫法便隐血(P=0.000),其PPV与免疫法便隐血无显著差异(P>0.05),NPV明显低于免疫法便隐血(P=0.000)。在诊断高危腺瘤时,免疫法便隐血NPV明显高于肿瘤标志物(P=0.000),敏感度、特异度和PPV均与肿瘤标志物无显著差异(P均>0.05)。结论免疫法便隐血在IBD、大肠腺瘤型息肉和大肠癌的诊断方面具有较高的敏感性和特异性,在大肠癌的诊断中比CEA、CA19-9具有更高的敏感度,该方法是较好的大肠良恶性疾病筛查和诊断的指标。
Objective To investigate the diagnostic value of IFOBT in diagnosis of benign and malignant colorectal diseases and to improve the early screening of precancerous lesions in colorectal cancer. Methods A total of 332 colonoscopy patients underwent occult blood tests. The OC-MICRO automatic occult blood analyzer was used to analyze the occult blood samples, and the sensitivity, specificity and positive predictive value were calculated under different positive thresholds PPV), negative predictive value (NPV). The levels of CEA and CA19-9 in peripheral blood and their sensitivity, specificity, PPV, NPV were detected by ELISA. Results A total of 332 cases were included in the study, including 176 males (53.0%) and 156 females (47.0%), divided into normal colonoscopy group of 183 cases, inflammatory bowel disease (IBD) group of 34 cases, colorectal polyps group of 79 cases Among them, 25 cases were adenomatous polyps, 12 cases were high-risk adenomas and 36 cases were colorectal carcinomas. The sensitivity of each group was 88.2% (IBD group), 86.1% (colorectal cancer group), 52.0% (adenoma polyp group) when the positive threshold of occult blood test was 200ng / mL. , 50.0% (high-risk adenoma group) and 34.2% (colorectal polyp group), respectively. There was no significant difference (P> 0.05) when compared with 100 ng / mL and 150 ng / mL. CEA in peripheral blood showed no significant difference between normal group, IBD group and colorectal polyp group (P> 0.05), but significant difference between colorectal cancer group and normal group (P = 0.006). Peripheral blood CA19-9 showed no significant difference between normal group, IBD group and colorectal cancer group (P> 0.05). CEA, CA19-9 and their combined detection of 100% specificity, and immunohistochemical occult blood no significant difference (P = 1.000), the sensitivity in IBD group, colorectal polyps, adenomatous polyps group, high risk Adenoma group and colorectal cancer group were: CEA (0,6.7%, 0,8.3%, 36.7%), CA19-9 (0,0,0,0,16.7%), the two combined (0,3.3% , 0,8.3%, 40.0%). The sensitivity of CEA and CA19-9 in the diagnosis of colorectal cancer were lower than that of immunohistochemical concealed blood (P = 0.000), there was no significant difference between PPV and immunohistochemical method in occult blood (P> 0.05), NPV was significantly lower than that of immune occult blood P = 0.000). In the diagnosis of high-risk adenoma, NPV of occult blood was significantly higher than that of tumor markers (P = 0.000). The sensitivity, specificity and PPV had no significant difference with tumor markers (all P> 0.05). Conclusion Immune occult blood in IBD, colorectal adenomatous polyps and colorectal cancer diagnosis has a high sensitivity and specificity in the diagnosis of colorectal cancer than CEA, CA19-9 has a higher sensitivity, the method Is a good screening of benign and malignant colorectal disease and diagnosis of indicators.