血吸虫病和激动的肠炎的诊断和流行病学的tools课件.ppt

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1、The Association of Schistosomiasis and Inflammatory Bowel Disease with Colorectal Cancer:Tools for Diagnosis and EpidemiologyPeter Chun,Ph.D 天马行空官方博客：；QQ:1318241189；QQ群：175569632In Egypt,schistosomiasis(from S.haematobium and mansoni)has been strongly linked to bladder cancer.The evidence includes:n

2、 nEpidemiological evidencen nExperimentally induced schistosomiasisn nHistopathology n nAge and gender ratios M.H.Mostafa et al.Relationship between Schistosomiasis and Bladder Cancer.Clin Microbiol Rev 1999.12(1)97-111The evidence linking S.manosini&haematobium infection to cancer of the large inte

3、stine is scant,but intestinal infestation with S.japonicum is considered a significant contributory factor to the development of cancer of the colon and rectum.A.Ishii et al.Parasitic infection and cancer:with special emphasis on Schistosoma japonicum infections(Trematoda).A review.Mutat Res.1994 30

4、5(2)273-81n nColorectal cancer correlates with prevalence and intensity Colorectal cancer correlates with prevalence and intensity of shistosome infection.of shistosome infection.n nThe age of onset of cancer is lower in areas of shcistosome The age of onset of cancer is lower in areas of shcistosom

5、e endemicity and length of survival is shorter.endemicity and length of survival is shorter.n nAffected individuals usually have a long history of Affected individuals usually have a long history of inflammatory large bowel symptoms.inflammatory large bowel symptoms.n nThe cancers correspond in anat

6、omic location to the area The cancers correspond in anatomic location to the area most affected by the parasite.most affected by the parasite.Z.Xu et at.Schsitosoma japonicum and colorectal cancer:an epidemiological study in the Peoples Republic of China.Int J Cancer.1984.34(3):315-8C.Ming-Chai et a

7、l.Evolution of colorectal cancer in schistosomiasis:transitional mucosal changes adjacent to large intestinal carconoma in colectomy specimens Cancer 1980.46(7):1661-75Chen et al.Colorectal cancer and schistosomiasis.Lancet 1981 971-3ES.Zhao et al.Carconoma of the large instestine with schistosomias

8、isanalysis of 279 cases.Zhonghua Zhong Liu Za Zhi.1981 3(1):67-9ES Zhao.Cancer of the colon and schistosomiasis.J R Soc Med.1981 74(9):645K.Shindo.Significance of schistosomiasis japonica in the development of cancer of the large intestine.Dis Colon Rectum 1976;(19)460-9K.Inoguchi et al.The correlat

9、ion between primary colorectal carcinoma and schistosomiasis japonica.Igakku Kenkyu 1978;(48)93-9K.Matsuda et al.Possible Associations of Rectal Carcinoma with Schistosoma japonicum Infection and Membranous Nephropathy:a Case Report with a Review.Japanese J Clin Oncol(29)576-581 天马行空官方博客：；QQ:1318241

10、189；QQ群：175569632Pathologically,patients with colonic schistosomiasis manifest epithelial dysplasia,and resemble the changes found in long-standing chronic ulcerative colitis.Chen et al.considered these dysplastic changes as premalignant lesions.Chen et al.Colorectal cancer and schistosomiasis.Lance

11、t 1981 971-3The evidence associating colorectal cancer and ulcerative colitis and Crohns disease is strong.Tumors often occur at the site of chronic inflammation.The absolute risk of developing colorectal hanker is high when extensive disease begins at a young age.40%of patients diagnosed with panco

12、litis from ulcerative colitis before age 15 years developed colon cancer during 20 years of follow up in a population-based linkage study in Sweden.DK Podolsky.Inflammatory bowel disease.N Engl J Med.2002.347:417-429We describe here two membrane based colloidal gold tests which can aid in the detect

13、ion of inflammatory bowel disease and schistosomiasis.Both are easy to perform and can be done at the clinic level at the same time that other screening tests for colorectal cancer are done.We propose the use of these new tests to secure large scale epidemiological evidence linking these two disease

14、s to colorectal cancer in ChinaTests for Fecal Occult BloodChemical TestsChemical Testsn nPrinciple:Based on Principle:Based on peroxidase activity of peroxidase activity of heme.heme.n nAdvantages:Sensitive,Advantages:Sensitive,Inexpensive.Will detect Inexpensive.Will detect digested blood.digested

15、 blood.Quantitation possible.Quantitation possible.n nDisadvantages:Not Disadvantages:Not specific.Dietary specific.Dietary restriction required.restriction required.Immunological TestsImmunological Testsn nPrinciple:Based on Principle:Based on detection of human detection of human hemoglobin.hemogl

16、obin.n nAdvantages:Very specific.Advantages:Very specific.No dietary restrictions.No dietary restrictions.n nDisadvantages:Disadvantages:Expensive.More complex Expensive.More complex to perfom.to perfom.Examples of Chemical Testsn nChromogens:O-tolidine/Benzidine,Guaic,Chromogens:O-tolidine/Benzidin

17、e,Guaic,Pyramidon.Pyramidon.An algorithm which uses a two stage testing protocol is much more cost effective given the price difference between the chemical and immunological tests for fecal occult blood.Immunochemical vs.Guaiac Fecal Occult Blood Tests.2004.Technology Evaluation Center.Assessment P

18、rogram vol 19,No.5.Blue Cross&Blue Shield Association.(A 27 page review.)Other non-invasive commercial tests available today:PreGen-Plus from Exact Sciences Corp.()Detection of altered DNA from exfoliated cells in stool specimen.A comparison was made among four neutrophil-derived proteins in A compa

19、rison was made among four neutrophil-derived proteins in stool as an indicator of disease activity in ulcerative colitis.stool as an indicator of disease activity in ulcerative colitis.J.Langhorst et al.Digestive Disease Week.May 2004.New Orleans,LA.SensitivitySpecificityCorrelation Lactoferrin 86.4

20、%69.8%0.75(above 7.25 ug/g)PNM-Elastase 81.8%48.8%0.60(above 0.062ug/g)Calprotectin 72.7%60.5%0.65(above 6 ug/g)Lysozyme 54.5%48.8%0.55(above 0.6 ug/g)IBD-Scan:A commercial quantitative ELISA for measuring fecal lactoferrin.Instruments which allow for quantitationFlow through membrane test for detec

21、ting S.japonicum antibodiesTTest spotAntigenControl spotProtein ACTest Procedure1.Wet membrane2.Add serumFlow through membrane test for detecting S.japonicum antibodiesTC*Specific anti-S.japonicum antibodies are captured on the antigen test spot.*Serum antibodies are nonspecifically captured on Protein A control spot via its Fc region.0YYFcThank you The staff of MedTrend Diagnostic Forumfrom