Vleugels Jasper L A, Vlijm-Kiewiet Anniek, Kallenberg Frank G J, Linthorst Gabor E
Amsterdam UMC, afd. Inwendige Geneeskunde, Amsterdam.
Contact: Jasper L.A. Vleugels (
Ned Tijdschr Geneeskd. 2022 Nov 30;166:D6230.
Unexpected weight loss presents a diagnostic challenge as it is associated with a wide range of benign and serious conditions. Although it is readily associated with malignancy, the risk of cancer in adults with unexpected weight loss presenting to primary care is 2% or less. In male patients aged 60 years or older and in patients with concurrent clinical symptoms, signs and abnormal blood test, the risk of cancer increases. Initial testing should include a history including medication review, physical examination and blood tests. Recommended blood tests include a complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein level, erythrocyte sedimentation rate and lactate dehydrogenase measurement. Imaging and invasive testing may be considered based on initial evaluation. When the initial evaluation is unremarkable, an observation period is recommended for young patients in particular.
意外体重减轻带来了诊断挑战,因为它与多种良性和严重疾病相关。尽管它很容易与恶性肿瘤相关联,但在基层医疗中出现意外体重减轻的成年患者患癌症的风险为2%或更低。在60岁及以上的男性患者以及伴有临床症状、体征和血液检查异常的患者中,患癌风险会增加。初始检查应包括病史(包括药物审查)、体格检查和血液检查。推荐的血液检查包括全血细胞计数、基本代谢指标、肝功能检查、甲状腺功能检查、C反应蛋白水平、红细胞沉降率和乳酸脱氢酶测量。根据初始评估结果可考虑进行影像学检查和侵入性检查。当初始评估无异常时,尤其建议对年轻患者进行观察期。