钙视网膜蛋白在先天性巨结肠中的诊断价值

Diagnostic value of calretinin for Hirschsprung's disease

目的探讨钙视网膜蛋白(calretinin,CR)诊断先天性巨结肠(Hirschsprung's disease,HD)的概率及意义。方法收集我院2008年1月至2014年10月经病理检查确诊为HD病例共495例资料,包括钡剂灌肠(contrast enema,CE)、直肠肛管测压(anorectal manometry,ARM)、经直肠黏膜吸引活检(rectal suction biopsy,RSB)等结果,通过上述各项检查阳性率来比较其在诊断HD中的价值,并分析出现CR阴性结果原因。结果 495例HD患儿中,435例术前CE,265例术前ARM,254例CR检查,其中术前经RSB 112例,术后142例。CE、ARM及CR诊断阳性率分别为81.1%、90.6%、99.6%,其中CR阳性率术前为98.2%,术后达100%。结论诊断HD需依靠病史、典型的临床表现及辅助检查,特殊辅助检查中CR阳性率术前为98.2%,术后达100%,因此CR可广泛用于临床,作为术前HD诊断的重要指标。

Objective To determine the probability and significance of calretinin（ CR） in the clinical diagnosis of Hirschsprung’s disease（ HD）. Methods A total of 495 children with pathologically confirmed HD via hematoxylin-eosin staining who admitted in our hospital from January 2008 to August 2014 were enrolled in this study. They were 387 boys and 108 girls,178 of them were at an age o 0 to 3 months,and 317 older than 3 months,and at a mean age of 12 months and 14 d. Clinical data of contrast enema（ CE）,anorectal manometry（ ARM） and rectal suction biopsy（ RSB） were collected,and the clinical value of CR was analyzed with positive rates by above examinations. Results Among the 495 HD children,435 received CE preoperatively and 353 were diagnosed as HD,with a diagnostic rate of 81. 1%. There were 265 cases showing no rectoanal inhibitory reflex by ARM preoperatively,and the positive rate was 90. 6%. For the254 cases receiving CR staining after RSB（ 112 cases before and 142 cases after the surgery）,249 cases were negative to CR,with a diagnostic rate of 99. 6%. Its positive rate was 98. 2% before surgery,and 100% after surgery. Conclusion The clinical diagnosis of HD should be based on medical history,typical physical examination and auxiliary examination. Immunohistochemical assay for CR through RSB is of high diagnostic value,and should be widely used in clinical practice,and regarded as an important index in preoperative diagnosis of HD.