分子诊断和粪便隐血试验在结直肠癌诊断中的意义

Significance of molecular markers and fecal occult blood test in the diagnosis of colorectal cancer

目的探讨联合检测粪便中肿瘤分子标志物和粪便隐血试验对结直肠癌早期诊断的敏感度和特异度。方法检测68例不同结直肠癌患者的粪便标本的粪便隐血和 APC、K-ras 及 p533种肿瘤相关分子标记物的突变。同时检测43名健康体检者的粪便标本。结果 35例癌症患者粪便隐血试验呈现阳性[51%;95%可信区间(95%CI)为37%～64%]。45例标本肿瘤分子标志物发生改变(66%;95%CI 为51%～77%)。两种方式检测的一致性较弱(Kappa 值为0.023),其联合应用的敏感度为94%(95%CI 为83%～97%);特异度为90%(95%CI 为76%～95%)。结论粪便隐血试验和分子诊断联合应用的敏感度高于任何一种单独的非创伤性诊断方式,有利于对结直肠癌患者的早期诊断。

Objective To explore the sensitivity and specificity of associated detection of tumor molecular markers in stool with fecal occult blood test （FOBT） in the early diagnosis of colorectal cancer. Methods FOBT and three molecular markers （APC, K-ras and p53 ） were detected in 68 stool samples from patients with colorectal cancer, and stool samples from 43 health persons. Results FOBT were positive in 35 stool samples from patients with colorectal cancer[51% ; 95% confidence interval （95% CI） ： 37%-64% ]. At least one molecular marker in 45 samples has been determined （66% ;95 % CI：51%-77% ） . The results of the two assays did not show consistent （ Kappa value = 0. 023 ）. Sensitivity of combination of both methods is 94% （ 95% CI： 83% -97% ） and specificity is 90% （ 95% CI. 76% -95% ）. Conclusion Sensitivity of combination of FOBT and molecular marker is superior to any one marker of non-invasive diagnostic methods and useful for early diagnosis of colorectal cancer.