尿液中5-氨基乙酰丙酸检测在结直肠癌和腺瘤性息肉筛查和鉴别中的应用

Application of urinary 5-aminolevulinic acid detection in screening and identification of colorectal cancer and adenomatous polyps

目的探讨尿液中5-氨基乙酰丙酸(5-ALA)检测在结直肠癌和腺瘤性息肉筛查和鉴别中的应用.方法收集2018年1—10月河北北方学院附属第一医院就诊患者中的500例高危患者(结直肠癌组22例、腺瘤性息肉组134例、其他组344例)作为筛查对象,留取尿液样本用高效液相色谱法检测5-ALA水平,取少量粪便用便潜血方法进行检测,比较两种方法的灵敏度和特异度.同时收集上述患者中的431例患者(结直肠癌组22例、腺瘤性息肉组134例、结直肠黏膜正常组275例),比较三组患者尿液中5-ALA水平的差异.结果用高效液相色谱法检测尿液中5-ALA水平的方法筛查结直肠癌的灵敏度为74.9%,特异度为72.5%,筛查腺瘤性息肉的灵敏度为70.1%,特异度为75.0%;便潜血筛查结直肠癌的灵敏度为63.6%,特异度为62.1%,筛查腺瘤性息肉的灵敏度为42.3%,特异度为62.5%.结直肠癌组尿液中5-ALA水平显著高于腺瘤性息肉组[(9.35±0.46)μmol/g比(7.24±0.64)μmol/g](P<0.05)和结直肠黏膜正常组[(9.35±0.46)μmol/g比(3.12±0.24)μmol/g](P<0.05),腺瘤性息肉组尿液中5-ALA水平显著高于结直肠黏膜正常组(P<0.05).结论用高效液相色谱法检测尿液中5-ALA的方法筛查结直肠癌和腺瘤性息肉患者的灵敏度和特异度均高于便潜血;且应用此方法对鉴别结直肠癌、腺瘤性息肉和结直肠正常黏膜有很大帮助.

Objective To study the application of urinary 5-aminolevulinic acid (5-ALA)detection in screening and identification of colorectal cancer and adenomatous polyps. Methods The clinical data of 500 high-risk patients(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps, and 344 cases with other patients) at the First Affiliated Hospital of Hebei North University from January 2018 to October 2018 were collected. High performance liquid chromatography(HPLC) was used to detect urinary 5-ALA and fecal occult blood test was used to detect faeces. Sensitivity and specificity of two methods was compared. At the same time, urine samples of 431 cases(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps and 275 cases with colorectal normal mucosa)were collected, and the difference of the content of urinary 5-ALA among three groups was compared. Results The sensitivity of urinary 5-ALA for the colorectal cancer screening was74.9%, and the specificity was 72.5%. The sensitivity of urinary 5-ALA for the adenomatous polyps screening was 70.1%, and the specificity was75.0%. The sensitivity of fecal occult blood test for the colorectal cancer screening was 63.6%, and the specificity was 62.1%. The sensitivity of fecal occult blood test for the adenomatous polyps screening was 42.3%, and the specificity was 62.5%. The content of urinary 5-ALA of the colorectal cancer group [(9.35 ± 0.46)μmol/g] was significantly higher than that of the adenomatous polyps group [(7.24 ± 0.64)μmol/g](P < 0.05) and normal colorectal mucosa group [(3.12 ± 0.24)μmol/g](P < 0.05), and the content of urinary 5-ALA of the adenomatous polyps group was significantly higher than that of colorectal normal mucosa group (P < 0.05). Conclusions For screening of colorectal cancer and adenomatous polyps, the content of urinary 5-ALA by HPLC is better than fecal occult blood test, and this approach can do great help to identify colorectal cancer, adenomatous polyps and normal colorectal mucosa.