ABSTRACT
Objective To evaluate the value of immunofecal occult blood test (IFOBT) as a prognostic indicator in CKD patients with colorectal impairment.Methods A total of 176CKD patients and 180 healthy adults as control were enrolled.Serum biochemistry was measured at baseline and gastrointestinal bleeding was determined by IFOBT.All the CKD patients were followed up for 4.5 years.Renal replacement therapy or death was defined as end-point event.The Logistic regression analysis was used for risk factors.Kaplan-Meier analysis and COX regression model were used for survival analysis.Results The positive rate of IFOBT in CKD patients was significantly higher than healthy control (17％ vs 5.3％,χ2=13.236,P＜0.01).When comparing with IFOBT negitive patients,IFOBT positive patients were older [(62.030±15.544) years old vs (48.660±19.018)years old,P＜0.01],had higher ESR [(71.800±31.657) mu/h vs (57.210±32.712) mm/h,P＜0.05],C-reactive protein [6.230 (3.000～14.148) mg/L vs 3.000 (3.000～6.833)mg/L,P＜0.05],serum creatinine [419.100 (103.200～546.625) μmol/L vs 175.100 (68.150～462.950) μmol/L,P＜0.05],and had lower hemoglobin level [(97.970±20.590) g/L vs (107.170±27.988) g/L,P＜0.05] and eGFR [11.400 (8.671～53.544) ml·min1·(1.73 m2)1 vs 35.274(10.961～82.145) ml·min-1·(1.73 m2)-1,P＜0.01].There was a negative correlation between IFOBT value and eGFR in CKD patients (r=-0.20,P＜0.01).Positive correlations of IFOBT value with age (r=0.175,P＜0.05) and serum creatinine (r=0.171,P＜0.05) were found.Logistic regression and COX regression analysis showed that IFOBT value,eGFR and ESR were important factors that influenced the prognosis of CKD patients.Kaplan-Meier analysis revealed that IFOBT value ＞100μg/L predicted progression of renal function.Conclusions The prevalence of gastrointestinal bleeding disorder is high in patients with CKD.Value of IFOBT independently predicts decline in renal function of CKD patients.
ABSTRACT
Objective To discuss the clinical value of immunofecal occult blood test in screening of colorectal cancer and its precancerous lesions in a large series of health checkup population. Methods Colorectal cancer and its precancerous lesions in 5919 subjects undergoing health checkup in our hospital were screened out by using immunofecal occult blood test from July 2006 to June 2007; positive cases with the test were subjected to colorectal endoscopy or X-ray barium enema examination. Relevant results were analyzed in combination with clinical and pathological data. Results Positive result was obtained in 314 out of the 5919 subjects undergoing health checkup with immunofecal occult blood test; the positive rate was 5.30%. 241 cases(76.75% )of them accepted colorectal endoscopic examination and 23 cases(7.32%) accepted X-ray barium enema examination. The total follow up rate was 84.08% with 50 cases out of contact. After excluding the cases out of cantact, 16 cases of colorectal cancer were found morbidity 2.37‰ including 8(50.00% )cases of Dukes A,7 cases (43.75%)of Dukes B and 1 case of Dukes C (6 .25%).The detection rate of colorectal cancer with postive imunofecal occult blood test was 6.06% (16/264). 94 cases (16.01‰) of adenomatous polyps were found including 55 cases (58.51%) of tubular adenoma, 23 cases (24.47% )of villiform- tubular adenoma and 16 cases(17.02%) of villfform adenoma. Among these cases 55 (58.51%)were solitary and 39(41.49%) multiple. In addition, 6 cases of ulcerative colitis in active phase were found. Altogether 116 (43.94%)of the 264 cases with positive immunofecal blood test and not out of contact were found to have colorectal cancer or its precancerous lesions. Conclusion Immunofecal occult blood test is suitable for screening of colorectal cancer and its precancerous lesions in large series of population. Colorectal cancer and its precancerous lesions may be found in relatively early phase and be eradicated in curable stage, thus to reduce the morbidity and mortality.