Takemura Y, Hayashi K, Miyoshi K, Mori S, Kugai N, Sekiguchi S
Department of Laboratory Medicine, National Defense Medical College, Tokorozawa.
Rinsho Byori. 1992 Apr;40(4):403-9.
We evaluated diagnostic utility of the hematological, biochemical and serological tests comprised in the "essential laboratory tests" advocated by the Japan Society of Clinical Pathology in 1,026 new patients visiting the outpatient unit of Comprehensive Medicine, National Defense Medical College. Of 750 evaluable patients, 52 showed anemia associated with such conditions as ulcer or cancer of digestive tract, inflammatory disease, or renal failure. Leukocytosis (greater than 9,000/microliters) was found only in 25 of 112 CRP-positive (greater than 0.3 mg/dl) patients, suggesting bacterial infection. Forty-four patients showed hypoproteinemia and/or hypoalbuminemia indicating chronic conditions including liver and inflammatory disease. Elevation of serum creatinine level was found in 4 patients subsequently diagnosed with renal failure, whereas 32 patients demonstrated elevated BUN. After application of the "essential laboratory tests", 97 patients were diagnosed with hyperlipidemia (total cholesterol greater than 230 mg/dl and/or triglyceride greater than 250 mg/dl). Determination of serum enzyme activity was useful not only for the diagnosis of liver dysfunction or biliary tract disease but also for those of hematological malignancies or myogenic disorders; however, in patients with abnormal values of LDH, gamma-GT and ALP, clinical significance was not clarified in 53%, 38% and 59%, respectively. These results indicate that the "essential laboratory tests" are useful in the following aspects of primary care medicine: for (1) estimation of the degree or nature of infection or inflammatory status; (2) classification of anemia and its relation to underlying diseases; (3) evaluation of patient general condition and protein-producible function of liver; (4) evaluation of renal function; (5) ambulatory screening for metabolic diseases such as hyperlipidemia; and (6) diagnosis of liver and biliary tract diseases.
我们对日本临床病理学会提倡的“基本实验室检查”中包含的血液学、生化和血清学检查在1026名前往国防医科大学综合医学门诊的新患者中的诊断效用进行了评估。在750名可评估患者中，52名出现贫血，与消化道溃疡或癌症、炎症性疾病或肾衰竭等情况相关。仅在112名C反应蛋白阳性（大于0.3mg/dl）患者中的25名发现白细胞增多（大于9000/微升），提示细菌感染。44名患者出现低蛋白血症和/或低白蛋白血症，表明存在包括肝脏和炎症性疾病在内的慢性疾病。4名随后被诊断为肾衰竭的患者血清肌酐水平升高，而32名患者血尿素氮升高。应用“基本实验室检查”后，97名患者被诊断为高脂血症（总胆固醇大于230mg/dl和/或甘油三酯大于250mg/dl）。血清酶活性的测定不仅对肝功能障碍或胆道疾病的诊断有用，而且对血液系统恶性肿瘤或肌源性疾病的诊断也有用；然而，在乳酸脱氢酶、γ-谷氨酰转移酶和碱性磷酸酶值异常的患者中，分别有53%、38%和59%的患者临床意义不明确。这些结果表明，“基本实验室检查”在初级保健医学的以下方面有用：用于（1）估计感染或炎症状态的程度或性质；（2）贫血的分类及其与基础疾病的关系；（3）评估患者的一般状况和肝脏的蛋白质生成功能；（4）评估肾功能；（5）对高脂血症等代谢疾病进行门诊筛查；以及（6）诊断肝脏和胆道疾病。
