免疫法与化学法便潜血试验对消化道出血性疾病误诊原因分析及对策  

Analysis and Countermeasures of the Reason of Mistake in Diagnosis on Occult Bleeding from Gastrointestinal Tract Diseases by Immunologic and Chemical Fecal Occult Blood Tests

作　　者：江晓肖[1] 成军[2] 陈达伟[1] 孙长贵[2] 李早荣[2] 孙关忠[2] 

机构地区：[1]解放军第117医院消化内科,杭州310013 [2]解放军第117医院临床实验中心,杭州310013

出　　处：《现代检验医学杂志》2011年第3期56-58,61,共4页Journal of Modern Laboratory Medicine

摘　　要：目的分析免疫法、化学法便潜血试验对消化道出血性疾病误诊的原因，探讨免疫法、化学法便潜血试验联合应用的价值。方法采用体外试验分别对上、下消化道出血患者粪便的吸收光谱进行扫描，并将血红蛋白液分别加入胃液、十二指肠波和多酶液孵育1～4h后观察吸收曲线和潜血结果，同时采用两种方法对149例经临床确诊的不同类型受检者（56例上消化道出血病人、48例下消化道出血病人、38例健康对照组、7例上下消化道均出血的病人）和340例体检人群粪便进行便潜血试验，以评价两种便潜血试验结果差异。结果在体外经胃液、十二指肠液和多酶液消化处理后的血红蛋白与上消化道出血病人粪便均有一不规则梯形特征性吸收峰，且免疫法便潜血试验呈阴性结果而化学法则为阳性结果；56例上消化道出血病人免疫法便潜血阳性率为5．4％，明显低于化学法的73．2％（x2=36．02，P〈0．01），48例下消化道出血病人免疫法便潜血阳性率为75．0％，高于化学法的58．3％（x2=4．90，P〈0．05），而健康对照组和上／下消化道同时出血的病人两种方法无显著性差异（x2=0～0．03，P〉0．05）；340例体检人群便潜血进行筛选结果表明两种方法在28例不同原因引起便潜血受检者中存在显著差异（x2=12．04，P〈0．05）。结论免疫法应用于上消化道出血性疾病的诊断应慎重，而对于下消化道出血性疾病则是首选，应将两种方法联合应用于粪便常规检查和体检普查项目，并结合受检者自身情况进行综合判断，以免造成漏诊或误诊。Objective To analyse the reason of mistake in diagnosis on occult bleeding from gastrointestinal tract diseases which are detected by immunologic（I-FOB） and chemical （C-FOB） fecal occult blood tests ,discuss the value of combining immunologic and chemical fecal occult blood tests. Methods The absorbent spectrum of feces from patients with upper and lower gastrointestinal tract bleeding and that of hemoglobin（Hb） which was incubated for 1 hour,2 hours and 4 hours with gastric juice,duodenal juice and multienzyme juice were investigated in vitro,and the occult blood tests were detected by I-FOB and C-FOB,respectively. Then the fecal occult blood results of 149 cases by clinical diagnosis included 56 upper and 48 lower gastrointestinal tract bleeding patients, 38 healthy control group, 7 upper and lower gastrointestinal tract bleeding patients,340 health examination people were analyzed by the two methods. Results Both the Hb digested by gastric juice,duodenal juice and multienzyme juice in vitro and the feces of, the upper gastrointestinal tract bleeding patients had a characteristic absorption peak which is irregular trapezoid,and fecal occult blood tests were negative with I-FOB but positive with C-FOB. The postive rates with I-FOB and C-FOB in 56 upper gastrointestinal tract bleeding patients were 5.4% and 73.2% ,and that in 48 lower gastrointestinal tract bleeding patients were 75.0% and 58. 3% ,respectively. Furthermore,the postive rate of I-FOB was significantly lower than that of C-FOB in 56 upper gastrointestinal tract bleeding patients （x2 = 36. 02,P〈0.01 ） ,but opposition in 48 lower gastrointestinal tract bleeding patients （x2 =4.90,P〈0. 05）. While the results had no significant differences between 38 healthy control group and 7 upper and lower gastrointestinal tract bleeding patients （x2=-0.03 ,P〉0. 05）. The scanning results of fecal occult blood of 340 health examination people showed that 28 positive subjects of different reasons were significantly different in two method

关 键 词：粪便潜血试验 潜血 消化道出血 

分 类 号：R573.1[医药卫生—消化系统] R446.133[医药卫生—内科学]