血吸虫病和激动的肠炎的诊断和流行病学的Tools

TheAssociationofSchistosomiasisandInflammatoryBowelDiseasewithColorectalCancer:ToolsforDiagnosisandEpidemiologyPeterChun,Ph.DInEgypt,schistosomiasis(fromS.haematobiumandmansoni)hasbeenstronglylinkedtobladdercancer.Theevidenceincludes:EpidemiologicalevidenceExperimentallyinducedschistosomiasisHistopathologyAgeandgenderratiosM.H.Mostafaetal.RelationshipbetweenSchistosomiasisandBladderCancer.ClinMicrobiolRev1999.12(1)97-111TheevidencelinkingS.manosini&haematobiuminfectiontocancerofthelargeintestineisscant,butintestinalinfestationwithS.japonicumisconsideredasignificantcontributoryfactortothedevelopmentofcancerofthecolonandrectum.A.Ishiietal.Parasiticinfectionandcancer:withspecialemphasisonSchistosomajaponicuminfections(Trematoda).Areview.MutatRes.1994305(2)273-81Colorectalcancercorrelateswithprevalenceandintensityofshistosomeinfection.Theageofonsetofcancerislowerinareasofshcistosomeendemicityandlengthofsurvivalisshorter.Affectedindividualsusuallyhavealonghistoryofinflammatorylargebowelsymptoms.Thecancerscorrespondinanatomiclocationtotheareamostaffectedbytheparasite.Z.Xuetat.Schsitosomajaponicumandcolorectalcancer:anepidemiologicalstudyinthePeople’sRepublicofChina.IntJCancer.1984.34(3):315-8C.Ming-Chaietal.Evolutionofcolorectalcancerinschistosomiasis:transitionalmucosalchangesadjacenttolargeintestinalcarconomaincolectomyspecimensCancer1980.46(7):1661-75Chenetal.Colorectalcancerandschistosomiasis.Lancet1981971-3ES.Zhaoetal.Carconomaofthelargeinstestinewithschistosomiasis—analysisof279cases.ZhonghuaZhongLiuZaZhi.19813(1):67-9ESZhao.Cancerofthecolonandschistosomiasis.JRSocMed.198174(9):645K.Shindo.Significanceofschistosomiasisjaponicainthedevelopmentofcancerofthelargeintestine.DisColonRectum1976;(19)460-9K.Inoguchietal.Thecorrelationbetweenprimarycolorectalcarcinomaandschistosomiasisjaponica.IgakkuKenkyu1978;(48)93-9K.Matsudaetal.PossibleAssociationsofRectalCarcinomawithSchistosomajaponicumInfectionandMembranousNephropathy:aCaseReportwithaReview.JapaneseJClinOncol(29)576-581Pathologically,patientswithcolonicschistosomiasismanifestepithelialdysplasia,andresemblethechangesfoundinlong-standingchroniculcerativecolitis.Chenetal.consideredthesedysplasticchangesaspremalignantlesions.Chenetal.Colorectalcancerandschistosomiasis.Lancet1981971-3TheevidenceassociatingcolorectalcancerandulcerativecolitisandCrohn’sdiseaseisstrong.Tumorsoftenoccuratthesiteofchronicinflammation.Theabsoluteriskofdevelopingcolorectalhankerishighwhenextensivediseasebeginsatayoungage.40%ofpatientsdiagnosedwithpancolitisfromulcerativecolitisbeforeage15yearsdevelopedcoloncancerduring20yearsoffollowupinapopulation-basedlinkagestudyinSweden.DKPodolsky.Inflammatoryboweldisease.NEnglJMed.2002.347:417-429S.japonicumlaysaverylargenumberofegg,andrepresentsaconstantsourceofirritation.Inflammationinvolvesaseriesofhostreponsesthatisdesignedtopromotehealingandtissueregeneration.Theseincluderecruitingspecifictypesofcells,releaseofmediatorsandinteractionsofchemokineswithvarioustargetsthataffectcytologicalchanges.Leukocytesgeneratereactiveoxygenandnitrogenradicalswhichcandamageproteins,membranesandDNA(includingthegenescontrollingcellgrowth&proliferation).Inflammatorycellsalsoreleasefactorsthatinhibitapoptosis,induceangiogenesis,andimpaircertainimmuneresponses.Collectively,thesefactorscanacceleratemutagenesis,promotethesurvivalandclonalproliferationofmutatedcells,someofwhichmaybecomeinvasiveandmetastatic.M.Thunetal.Inflammationandcancer:anepidemiologicalperspecitive.In2004CancerandInflammation.Wiley,Chichester(NovartisFoundationSymposium256).P6-28.Wedescribeheretwomembranebasedcolloidalgoldtestswhichcanaidinthedetectionofinflammatoryboweldiseaseandschistosomiasis.Bothareeasytoperformandcanbedoneatthecliniclevelatthesametimethatotherscreeningtestsforcolorectalcanceraredone.WeproposetheuseofthesenewteststosecurelargescaleepidemiologicalevidencelinkingthesetwodiseasestocolorectalcancerinChinaTestsforFecalOccultBloodChemicalTestsPrinciple:Basedonperoxidaseactivityofheme.Advantages:Sensitive,Inexpensive.Willdetectdigestedblood.Quantitationpossible.Disadvantages:Notspecific.Dietaryrestrictionrequired.ImmunologicalTestsPrinciple:Basedondetectionofhumanhemoglobin.Advantages:Veryspecific.Nodietaryrestrictions.Disadvantages:Expensive.Morecomplextoperfom.ExamplesofChemicalTestsChromogens:O-tolidine/Benzidine,Guaic,Pyramidon.ExampleofImmunologicalTestAnalgorithmwhichusesatwostagetestingprotocolismuchmorecosteffectivegiventhepricedifferencebetweenthechemicalandimmunologicaltestsforfecaloccultblood.Immunochemicalvs.GuaiacFecalOccultBloodTests.2004.TechnologyEvaluationCenter.AssessmentProgramvol19,No.5.BlueCross&BlueShieldAssociation.(A27pagereview.)Othernon-invasivecommercialtestsavailabletoday:PreGen-PlusfromExactSciencesCorp.()DetectionofalteredDNAfromexfoliatedcellsinstoolspecimen.Acomparisonwasmadeamongfourneutrophil-derivedproteinsinstoolasanindicatorofdiseaseactivityinulcerativecolitis.J.Langhorstetal.DigestiveDiseaseWeek.May2004.NewOrlean