粪便隐血试验在慢性肾脏病患者发生结直肠病变的预测意义

摘要

目的:通过研究慢性肾脏病(CKD)患者粪便隐血阳性的发生率,探讨粪便隐血试验在慢性肾脏病患者发生结直肠病变的预测意义.方法:使用免疫法粪便隐血试验(IFOBT)检测2007年03月~2007年06月于我院肾脏科就诊的176例CKD患者和同期我院体检中心180例健康体检者,比较粪便隐血阳性发生率,同时对CKD患者的临床、生化等指标进行统计分析.结果:176例CKD患者IFOBT阳性率17%,180例正常对照组IFOBT阳性率5%,CKD组高于正常对照组(χ2=13.236,P＜0.01).CKD组血红蛋白低于正常对照组[(105.59±27.03)g/dl vs (121.00±25.62)g/dl,P<0.05],血沉[(59.77±32.91)mm/h vs (9.54±3.21)mm/h,P<0.05]、血肌酐[203.75(74.50~567.25)μmol/L vs 68.00 (45.00~95.00)μmol/L,P<0.05]高于正常对照组.CKD组中,IFOBT阳性的患者与IFOBT阴性的患者相比,年龄大(P<0.01)、血沉升高(P<0.05)、C反应蛋白升高(P<0.05),而血红蛋白(P<0.05)及肾小球滤过率(P<0.01)降低.IFOBT阳性患者血红蛋白随肾小球滤过率下降而降低,血沉、血磷、iPTH随GFR下降而升高.相关法分析显示CKD患者IFOBT检测值与GFR(r=-0.191,P<0.05)呈负相关;与年龄呈正相关(r=0.175,P<0.05).对CKD患者IFOBT阳性的30例患者行肠镜检查,结果发现结肠癌2例(6.7%),结直肠腺瘤性息肉11例(36.7%),活动期溃疡性结肠炎4例(13.3%),出血性肠炎9例(30%),4例患者未见明显异常(13.3%).结论:CKD患者易发生结直肠出血性疾病,随着患者GFR的下降,发生病变的几率升高.而IFOBT是可行有效地检测方法,对于CKD患者结直肠病变的预测具有重要的临床意义.%Objective: To study the incidence of fecal occult blood in chronic kidney diseased CKD ) patients, and to discuss the predictive significance of immunofecal occult blood test( IFOBT ) in patients with chronic kidney disease occurs colorectal lesions. Methods: We prospectively enrolled 176 patientsnts with CKD and 180 persons as a normal control group. Immunofecal occult blood test, fasting blood triglyceride, cholesterol, glucose, creatinine, albumin, calcium, phosphorus, iPTH and serum Fe were examined. Estimated glomerular filtration rate ( eGFR ) was calculated. Results:The positive rate of IFOBT in 176 cases of patients with CKD is 17% , higher than the control group( x2 = 13. 236,P ＜ 0. 01 ). The hemoglobin of CKD is lower than that of the control group( P ＜ 0.05 ),while the ESR(P＜0.05) and creatinine( P ＜0. 05 )are higher. Compared with IFOBT - negative patients with CKD ,IFOBT - positive patients with CKD were older ( P ＜ 0. 01 ), ESR (P＜0.05), C- reactive protein were significantly higher ( P ＜ 0. 05 ), and hemoglobin ( P ＜0.05 ) and glomerular filtration rate ( P ＜ 0. 01 ) decreased significantly. Univariate analysis found that IFOBT detected values of patients with CKD was negatively correlated with GFR ( r = - 0. 191,P＜0.05) and was positively correlated with age ( r =0. 175 ,P ＜0. 05 ). Thirty IFOBT - positive patients with CKD underwent colonoscopy, and found that colon cancer in 2 cases (6.7% ), colorectal adenomatous polyps in 11 cases(36.7% ), active ulcerative colitis in 4 cases ( 13. 3% ), hemorrhagic colitis in 9 cases ( 30% ), 4 patients had no obvious abnormalities ( 13. 3% ). Conclusion:CKD patients prone to colorectal bleeding disorders, and the incidence would increase while the GFR of patients were declined. The Immunofecal occult blood test is feasible and effective detection methods, which has an important clinical predictive significance for colorectal lesions in patients with CKD.