Usefulness of fecal lactoferrin and hemoglobin in diagnosis of colorectal diseases

AIM:To evaluate prospectively usefulness of fecal lactoferrin(Lf)and fecal hemoglobin(Hb)in the diagnosis of colorectal diseases.METHODS:Fecal Lf and Hb were measured using ELISA in 872 patients before they underwent colorectal endoscopy.RESULTS:Lf was positive in 18(50%)of 36 patients with colorectal cancer,25(15.9%)of 157 with colorectal polyps,29(46.8%)of 62 with ulcerative colitis,and 25(62.5%)of 40(62.5%)with Crohn's disease.The Hb-positive rates were 50%,12.1%,41.9% and 32.5%,respectively.Of the 318 patients free of abnormalities by colorectal endoscopy,Lf was positive in 29(9.1%)and Hb was positive in 15(4.7%).Among patients with Crohn's disease,the Lf-positive rate was significantly higher than the Hb-positive rate.If either high Lf or Hb levels were considered positive,the positive rates rose to 61.1%,51.6%,and 67.5% in the colorectal cancer group,ulcerative colitis group,and Crohn's disease group,respectively.If both high Lf and Hb levels were rated positive,the positive predictive values(PPV)were 21% for colorectal cancer,33% for ulcerative colitis,and 17% for Crohn's disease,and PPV of high Hb level alone was 18%,25% and 13%,respectively.CONCLUSION:Fecal Lf and Hb were found useful in the detection of colorectal diseases,and the combination of the two measurements appears to increase the sensitivity and efficacy of diagnosis.

Matrix metalloproteinase-2 as a superior biomarker for peritoneal deterioration in peritoneal dialysis

AIM: To investigate the efficacy of effluent biomarkers for peritoneal deterioration with functional decline in peritoneal dialysis(PD). METHODS: From January 2005 to March 2013, the subjects included 218 PD patients with end-stage renal disease at 18 centers. Matrix metalloproteinase-2(MMP-2), interleukin-6(IL-6), hyaluronan, and cancer antigen 125(CA125) in peritoneal effluent were quantified with enzyme-linked immunosorbent assay. Peritoneal solute transport rate was assessed by peritoneal equilibration test(PET) to estimate peritoneal deterioration. RESULTS: The ratio of the effluent level of creatinine(Cr) obtained 4 h after injection(D) to that of plasma was correlated with the effluent levels of MMP-2(ρ = 0.74, P < 0.001), IL-6(ρ = 0.46, P < 0.001), and hyaluronan(ρ = 0.27, P < 0.001), but not CA125(ρ = 0.13, P = 0.051). The area under receiver operating characteristic curve for the effluent levels of MMP-2, IL-6, and hyaluronan against high PET category were 0.90, 0.78, 0.62, and 0.51, respectively. No patient developed new-onset encapsulating peritoneal sclerosis for at least 1.5 years after peritoneal effluent sampling.CONCLUSION: The effluent MMP-2 level most closely reflected peritoneal solute transport rate. MMP-2 can be a reliable indicator of peritoneal deterioration with functional decline.