消化
词汇介绍
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解析
fical 英 [ˈfiːkl] 美 [ˈfiːkl]
释义 adj. 排泄物的;残渣的;糟粕的
例句 Fecal matter should move through your colon easily and in a short time. 粪便的问题应该通过您的结肠容易在很短的时间。
immunochemical 英 [,ɪmjʊnəʊ'kemɪkəl]
释义 adj. 免疫化学的
例句 Within the last year, have you had a fecal occult blood test (FOBT) or a fecal immunochemical test (FIT)? 过去一年内,是否曾接受过大便隐血测试或大便免疫化学测试?
test 英 [test]
释义 n. 测验,考查;测试;检验;化验
v. 测验;化验,检查;试验,测试;考验
例句 You should test for the overload at each point of the cycle. 您应当在周期的每个时刻都测试超负荷。
概述
概述
粪便免疫化学检测法FIT(fical immunochemical test,FIT) 是利用单克隆或多克隆抗体直接检测人粪便中的血红蛋白,不受进食食物的影响。定性 FIT 是在粪便中血红蛋白含量超过一定阈值后会产生可视性的颜色变化,定量 FIT 则可测量数值,当超过一定的正常值范围后被定义为阳性。
适应症
可用于大肠癌程序性筛查。
临床应用
(1)推荐每年1次采样进行FIT检查;
(2)推荐选择定量检测方法而非定性检测方法;
(3)建议选择较低的阈值(如20μg/g或更低)作为判断为阳性的阈值;
(4)当FIT检测为阳性时,推荐进一步进行结肠镜检查;
(5)若FIT检测为阳性,但结肠镜检查为阴性时,若无上消化道病变的症状或体征,不建议进行上消化道病变筛查;
(6)近期进行过结肠镜检查而之后出现FIT阳性的人群,需要重复进行结肠镜检查;
(7)在个体进行FIT检查时没有必要对饮食或药物使用进行控制;
(8)进行FIT的样本应为自然排除的粪便而非直肠指检获得的样品;
(9)在不同地区进行筛查无需对环境温度进行校正;
(10)筛查策略制定时需制定质控标准来控制关键质量指标:在所有所提供的测试中,FIT的完成率需≥60%;实验室无法进行 FIT检测的样本返还率需<5%;FIT阳性的人群中完善结肠镜检查的比例需≥ 80%;评估FIT阳性而进行的结肠镜检查中,男性ADR建议大于45%,女性建议大于35%。
肿瘤筛查中FIT实施特点
1)FIT 1 次检测检出癌症的敏感性为 80%,检出高度不典型增生的敏感性为 20%~30%。为增强高级别腺瘤的检出率,需要重复进行 FIT。在本共识意见中推荐重复进行 FIT 以使得癌症检出率获得最大化。
2)作为个体在接受 FIT 时需清楚当首次 FIT 结果为阳性时,有进行重复检测或者进行结肠镜检查的必要。鼓励将检测周期在筛查策略中程序化,以提高筛查完成依从性(强推荐,中等质量证据)。
3)考虑到 FIT 阳性对癌症检测具有很高的敏感性,推荐当 FIT 为阳性时进行结肠镜检查,而不是重复进行 FIT(强推荐,中等质量证据)
较低的异常粪便免疫化学检测临界值可提高系统水平筛查中的结直肠癌检测
发表时间:2019-05-11
影响指数:8.0
作者: Emily Berry
期刊:Clinical Gastroenterology and Hepatology
Colorectal cancer (CRC) is the second leading cause Q16 of cancer death in the United States (ACS-CFF). Q15 Screening can reduce CRC incidence and mortality,1–6 but participation is suboptimal among underserved populations, particularly minorities and the uninsured.2,7–10 Noninvasive tests for CRC screening such as the fecal immunochemical test (FIT) have been linked to higher participation rates,6,11–13 but have lower sensitivity for CRC and advanced adenoma than colonoscopy. Some FITs are quantitative and measure the absolute hemoglobin (Hgb) concentration within a stool sample. One strategy to improve neoplasia detection among individuals preferring FIT would be to decrease the Hgb concentration that would indicate an abnormal test result requiring diagnostic colonoscopy. Prior work has suggested that a lower threshold can improve neoplasia detection; a meta-analysis of FIT performance found that using a lower hemoglobin concentration cut-off value to designate an abnormal FIT optimized sensitivity for CRC: 89% for a cut-off value of less than 20 mg hemoglobin/g feces vs 70% for cut-off values of 20 to 50 mg hemoglobin/g feces.14 A challenge of this approach, however, particularly in settings with constrained colonoscopy capacity, is that decreasing the threshold also may increase colonoscopy demand. In the United States in particular, real-world data specific to the impact of using a lower Hgb concentration threshold for diagnostic colonoscopy demand and neoplasia detection when implemented within screening programs are sparse.
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