JAMA:体检的价值有多大?恐怕远超你的想象!

2021-06-14 MedSci原创 MedSci原创

常规体检与死亡率或心血管事件的减少无关,但与慢性病识别和治疗、风险因素控制、预防性服务获取和患者预后更加有关。

健康检查——也称为体检——是门诊护理访视的第二大常见原因,美国每年9亿次门诊中约占8%。几乎所有保险公司都通过商业保险以覆盖各类体检套餐,同时医疗保险受益人年度健康访视等机制为这些访视提供部分或全部财务覆盖。

尽管普通健康检查在日常临床护理中很流行,但关于这些访问的价值、目标和组成部分的问题仍然存在。例如,内科学会明确建议不要对无症状的成年人进行年度普通健康检查。其他学科专家则呼吁应优化这些检查,以便医生领导的团队进行“年度健康审查”,促进信任的治疗关系。

另一个混淆的来源是术语“年度体检”,这是一个用词不当的说法,因为一般健康检查不一定需要每年进行,也不包括血压和体重指数以外的体检。

先前的研究对一般体检的价值得出了不同的结论。2007年,一份医疗保健研究和质量机构(AHRQ)证据报告/技术评估和伴随的审查手册发现,定期健康评估与接受某些癌症筛查胆固醇筛查一致,可以减少患者的担忧。然而,定期健康评估对死亡率、其他临床结果和成本的影响是复杂的。

2016年,Cochrane对血管疾病一级预防的系统风险评估的审查发现,对死亡率或心血管终点没有影响,但有一些证据表明总胆固醇和血压降低。为了更好地对该问题进行阐述,来自费恩伯格医学院西北大学的专家开展了一项系统回顾,结果发表在JAMA杂志。

研究人员纳入了之前系统综述和截至2020年12月的最新文献综述中的随机试验和对照组观察研究。其中有19项随机试验(906-59616名参与者;随访1-30年),5项评估了单次体检项目,7名评估了年度体检项目。所有12项研究都是观察性研究(240-471415名参与者;横断面至随访5年),评估单次体检项目。

常规体检对对心血管死亡率的影响

总的来说,常规体检与死亡率、心血管事件或心血管疾病发病率的降低无关。然而,常规体检却与慢性病的检出率增加有关,如抑郁症和高血压。在丹麦45岁-64岁低教育程度人群中,接受一次体检的人更多获得了新的抗抑郁药处方(为对照组2.9倍)。

同时,常规体检可使参与者在控制血压和胆固醇等风险因素方面的适度改善:25-74岁农村成人接受常规体检1年后,比未体检人群的收缩压(低1.3 mm Hg)和总胆固醇(低4.6 mg/dl)都控制得更好。

常规体检对总体死亡率的影响。

同样,常规体检还能更多接受临床预防性服务,如结直肠癌(69% vs 60%)和宫颈癌(81% vs 66%)筛查;以及患者预后结果得到更加明显的改善,如生活质量和自我评价的健康。

此外,常规体检还与身体活动和饮食等健康行为的改善有关。例如,在OXCHECK试验中(n=4121),年度体检参与者每月锻炼少于一次的干预参与者较少(68% vs 71%),食用黄油的人也更少(22% vs 31%)。

由此可见,常规体检与死亡率或心血管事件的减少无关,但与慢性病识别和治疗、风险因素控制、预防性服务获取和患者预后更加有关。

 

参考文献:

Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General Health Checks in Adult Primary Care: A Review. JAMA. 2021;325(22):2294–2306. doi:10.1001/jama.2021.6524

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    2021-06-16 marongnuan
  2. [GetPortalCommentsPageByObjectIdResponse(id=1305246, encodeId=dc4c130524686, content=<a href='/topic/show?id=ba392659e58' target=_blank style='color:#2F92EE;'>#体检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26597, encryptionId=ba392659e58, topicName=体检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b191324, createdName=marongnuan, createdTime=Wed Jun 16 13:57:00 CST 2021, time=2021-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=973632, encodeId=4a599e36322c, content=体检预防很重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Tue Jun 15 07:07:33 CST 2021, time=2021-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036679, encodeId=fe5510366e9df, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Jun 15 01:57:00 CST 2021, time=2021-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=973617, encodeId=5be59e36179e, content=积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b255520900, createdName=ms7000001644417250, createdTime=Tue Jun 15 00:43:59 CST 2021, time=2021-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=973616, encodeId=27609e3616a4, content=积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b255520900, createdName=ms7000001644417250, createdTime=Tue Jun 15 00:41:53 CST 2021, time=2021-06-15, status=1, ipAttribution=)]
    2021-06-15 学医无涯

    体检预防很重要

    0

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    2021-06-15 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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    2021-06-15 ms7000001644417250

    积分

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    2021-06-15 ms7000001644417250

    积分

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