Mold J W, Aspy C B, Lawler F H
Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA.
J Fam Pract. 1998 Aug;47(2):110-7.
The use of serum chemistry panels as screening tests has been studied in a variety of clinical and nonclinical settings. None of the studies, however, has attempted to carefully examine any potential harm done to participants, and none has measured the impact on health-related quality of life.
Consenting participants in an insurance company-sponsored screening initiative completed a questionnaire before and 6 months after having blood drawn for a 25-item chemistry panel and a lipid profile; for men older than 50, a prostate-specific antigen (PSA) test was also done. The prescreening questionnaire included demographic and health information. The postscreening questionnaire included questions about specific outcomes. Included in both questionnaires were single-item measures of self-rated health and self-rated worry about health, and the 17-item Duke Health Profile (DUKE), a measure of health-related quality of life. Various outcomes were examined, including the numbers of new diagnoses, numbers and types of new treatment recommendations, change in self-reported health and worry, and change in DUKE subscale scores. Participants who were potentially helped and those who were potentially harmed by the serum chemistry panels screening program were identified and further characterized.
Of the 2249 subjects who satisfactorily completed both questionnaires, 2012 (89%) had at least one abnormal test result, but only 985 of these (49%) remembered having discussed their test results with a physician. A total of 342 individuals received new treatment advice. However, 29 (10%) of them indicated that they would be "somewhat unlikely" to "very unlikely" to follow it. Following the intervention questionnaire, there were statistically significant average decrements in the General Health, Physical Health, and Pain subscales of the DUKE for participants with abnormal results. Self-rated health status did not change but level of worry about health increased significantly. At least 250 (11%) subjects were potentially helped by the screening initiative, but at least 574 (26%) were potentially harmed by it.
The use of serum chemistry panels as screening tests in nonclinical settings should probably be discouraged, since health-related quality of life is not improved and the intervention may harm more individuals than it benefits.
血清化学指标作为筛查检测手段已在多种临床和非临床环境中得到研究。然而，尚无研究试图仔细审视对参与者造成的任何潜在危害，也没有衡量其对健康相关生活质量的影响。
参与保险公司发起的筛查项目的受试者在抽取血样进行25项化学指标检测和血脂检测前及6个月后完成一份问卷；50岁以上男性还进行了前列腺特异性抗原（PSA）检测。筛查前问卷包括人口统计学和健康信息。筛查后问卷包括关于特定结果的问题。两份问卷均包含自我健康评分和对健康担忧程度的单项测量，以及17项杜克健康量表（DUKE），用于衡量健康相关生活质量。研究了各种结果，包括新诊断病例数、新治疗建议的数量和类型、自我报告的健康和担忧程度的变化，以及杜克分量表得分的变化。确定并进一步描述了血清化学指标筛查项目可能受益和可能受伤害的参与者。
在2249名满意完成两份问卷的受试者中，2012人（89%）至少有一项检测结果异常，但其中只有985人（49%）记得与医生讨论过检测结果。共有342人收到了新的治疗建议。然而，其中29人（10%）表示他们“有些不太可能”到“非常不可能”遵循该建议。干预后问卷显示，检测结果异常的参与者在杜克健康量表的总体健康、身体健康和疼痛分量表上的平均得分有统计学意义的下降。自我健康评分没有变化，但对健康的担忧程度显著增加。至少250名（11%）受试者可能从筛查项目中受益，但至少574名（26%）受试者可能受到伤害。
在非临床环境中使用血清化学指标作为筛查检测手段可能应受到劝阻，因为这并未改善健康相关生活质量，而且该干预措施可能对更多人造成伤害而非带来益处。
