结肠癌筛检的新方法:转铁蛋白试验与免疫粪隐血试验的对照研究

Transferrin dipstick as a potential novel test for colorectal cancer screening:a comparative study with immuno fecal occult blood test

目的分析转铁蛋白试验(Tf)检测结肠癌及癌前病变的效率,并与免疫粪隐血试验(IFOBT)对比。方法收集接受结肠镜检查的110例患者的粪便标本,包括40例结肠癌,36例癌前病变(16例高危腺瘤、20例溃疡性结肠炎),34例低危病变,分别进行IFOBT、Tf和两者联合检测(IFOBT+Tf)。结果对于结肠癌和癌前病变,转铁蛋白检测的阳性率(76%)明显高于免疫粪隐血试验(61%)(2χ=4.38;P<0.05);尤其在癌前病变的检测中,两种试验阳性率的差异更为显著(Tf:72%,IFOBT:44%;2χ=5.71;P<0.05);而在低危组,两者的阳性率无显著差异(P>0.05)。转铁蛋白试验和免疫粪隐血试验联合检测,肿瘤检测的阳性率可达90%,癌前病变为78%,低危组为29%。Tf和IFOBT检测结肠癌和癌前病变的准确率分别为69.0%和76.4%。结论转铁蛋白试验敏感性高,可用于检测肿瘤及癌前病变,为结肠癌的筛检提供了新的途径。

Objective To examine the efficacy of the newly developed Tf dipstick for detecting colorectal cancer,premalignant lesions,and to compare that with immuno fecal occult blood test（IFOBT）.Methods Fecal samples from 110 patients including 40 colorectal cancer,36 premalignant subjects（16 with high-risk adenomas and 20 with ulcerative colitis）,and 34 low-risk subjects were collected before colonoscopic examination.Then Tf and IFOBT were performed on these samples.Results Compared with IFOBT,Tf had a significantly higher positive rate in patients with colorectal cancer and premalignant lesions（76% for Tf vs 61% for IFOBT,respectively;χ2=4.38;P0.05）.The difference of positivity was mainly observed in patients with premalignant lesions（72% for Tf vs 44% for IFOBT;χ2= 5.71;P0.05）.The positive rates of If and IFOBT in low-risk group were similar（P0.05）.Combining Tf with IFOBT together（either/or） had 90% positive rate in cancer patients,78% in premalignant subjects,and 29% in low-risk subjects.The overall accuracy of IFOBT and Tf tests for detecting colorectal cancer and premalignant lesions were 69.0% and 76.4%,respectively.Conclusion Tf dipstick test seems to be a highly sensitive test for detecting not only cancer,but also premalignant lesions,and provides an additional tool for colorectal cancer screening.