免疫化学的糞便潜血反応法の臨床的意義, とくに出血部位の診断について

概要

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Immunochemical method employing anti-human hemoglobin (rabbit r-globulin) is considered to be very specific in detecting fecal occult blood due to gastrointestinal bleeding. The clinical evaluation, however, has not been established. Our method is single radial immunodiffusion (SRID). Its sensitivity to human hemoglobin is 1-2mg/dl hemoglobin concentration, which is almost same as guaiac method. Feces in 20 cases with upper gastrointestinal bleeding, which showed strongly positive reaction in guaiac method, revealed negative in all except one in SRID. On the otherhand 15 cases with bleeding due to colonic diseases are all positive in both method, but 5 in 11 cases with ulcerative colitis in remission, feces of which are negative in guaiac method, showed positive reaction in SRID. To confirm the different reaction in different sites of gastrointestinal tract, we instilled 10ml whole blood to the stomach, upper jejunum and lower jejunum in three healthy volunteers. The results also showed strong positive reaction in guaiac method and negative in SRID in any cases. These results suggest that SRID has specific reaction in the bleeding of lower digestive tract and this method, when combined with guaiac method, may differentiate the bleeding site of the digestive tract.