Wu Jingxin Fan Jingyan

  During the peak season of medical examinations, everyone must know the importance of regular medical examinations, but many people have received medical examination reports, and they are still confused when faced with obscure medical terms and dense numbers. Arrows with floating up and down are more nervous, and the stimulation is comparable to "opening a blind box".

How to interpret the medical report correctly?

Next, step by step teach you the meaning of common indicators.

Indicator one: blood pressure

  The upper limit of normal for systolic blood pressure is 140 mm Hg, and the upper limit for diastolic blood pressure is 90 mm Hg, above which blood pressure is considered above normal.

  During the physical examination, it is necessary to sit still for 10 minutes in advance to maintain emotional stability. In addition, once the blood pressure is increased, it is not possible to diagnose high blood pressure. The diagnosis requires at least three blood pressure measurements on different days.

  Health prescription: low-salt diet, proper exercise, quit smoking and limit alcohol; blood pressure should be monitored regularly, antihypertensive drugs should be taken as prescribed by a doctor, and sudden drug withdrawal or reduction should be avoided.

Indicator two: blood sugar

  Blood glucose testing mainly includes fasting blood glucose and glycated hemoglobin (glycated HGB).

The normal value of fasting blood glucose (no sugar and any sugary food intake within 8 hours) is 3.9-6.1 mmol/L.

When fasting blood sugar is above the normal range of 6.1 mmol/L, it is called hyperglycemia.

  Glycated HGB reflects the average level of glycemic control over the past 90 days and is used to evaluate long-term glycemic control.

  The blood sugar is not fixed, and is affected by many factors. An indulgent meal, high-intensity exercise or emotional agitation will cause the blood sugar to increase. These conditions are transient hyperglycemia, but if the hyperglycemia is not controlled for a long time, it may eventually Wear a "diabetic" hat.

  Health prescription: control total calories, eat small meals frequently, quit smoking and limit alcohol, avoid overwork; monitor blood sugar, follow doctor’s orders for long-term drug treatment, and follow up regularly in outpatient clinics.

Indicator three: transaminase

  Transaminases are the most direct indicators of damage to liver cells, mainly focusing on alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

  The normal range of ALT is 0U/L-40U/L.

However, ALT lacks specificity. Fatigue, drinking, colds, emotional factors and other factors can cause changes in the permeability of liver cell membranes, but the resulting increase in transaminase is generally not higher than 60U/L.

Once the ALT value is higher than 80U/L, it has diagnostic value and needs to go to the hospital for treatment.

  The normal range of AST is 0U/L-40U/L.

The significance of elevated AST is similar to ALT in the diagnosis of hepatitis.

In general, AST does not increase as much as ALT.

Once the AST value is higher than the ALT value, it indicates that the degree of liver cell damage and necrosis is more serious. At this time, the determination of isoenzymes (ASTs and ASTm) is of greater significance. Only AST increases in mild liver damage, and ASTm in severe liver damage significantly increased.

  The increase of these two indicators was more common in hepatitis, liver tumors, and the use of liver-damaging drugs.

However, "false positives" may also occur in some physiological conditions, and it is necessary to exclude heavy drinking, strenuous exercise, overwork, fever, pregnancy, etc.

  The liver function test is to draw blood on an empty stomach, and the fasting time is generally 8-12 hours.

It is recommended not to eat after 21:00 the night before the examination, to avoid eating high-fat, high-protein, and carotene- and lutein-rich foods for dinner, and to ensure adequate sleep.

On the day of the test, do not eat breakfast, drink water, or do physical exercise or strenuous exercise before the test.

After arriving at the hospital, you should rest quietly for 20 minutes before taking a blood test.

  Drinking alcohol will affect the indicators of transaminase in liver function, so don't drink alcohol the night before the test.

At the same time, try to avoid liver function tests during intravenous infusion or within 4 hours of medication.

If physical conditions permit, it is best to stop the drug 3-5 days before the liver function test.

  Health prescription: avoid the use of hepatotoxic drugs, quit smoking and limit alcohol, and moderate work and rest; outpatient review after two weeks.

Indicator 4: Tumor Markers

  Alpha-fetoprotein (AFP): commonly used in the monitoring of primary liver cancer and liver metastases of digestive tract tumors.

One of the diagnostic criteria for liver cancer is AFP ≥ 400 μg/L, and AFP may also increase to varying degrees in hepatitis B, liver cirrhosis, pregnancy or reproductive tumors.

For patients with low alpha-fetoprotein elevation, dynamic observation should be done in combination with imaging.

  Carcinoembryonic antigen (CEA): a broad-spectrum tumor marker, which can be elevated in colorectal cancer, gastric cancer, lung cancer, and breast cancer.

Clinically, it is mainly used to monitor the recurrence and metastasis of gastrointestinal tumors.

  Carbohydrate antigen CA153: a specific marker of breast cancer, CA153 can be increased in 30%-50% of breast cancer patients, but the positive rate of CA153 is low in the early stage of breast cancer.

  Health prescription: Most tumor markers have limited specificity and sensitivity. If there is only one increase, there is no need to panic. It is recommended to visit a tumor specialist after 1 month to dynamically monitor the indicators.

What are nodules, polyps, and space-occupying lesions?

  - Nodules/mass

  A nodule is a relatively small mass, or a slightly larger mass called a mass, that can occur anywhere on the body.

Most nodules are benign and regular follow-up is sufficient.

  Thyroid nodules are very common in physical examinations, with an average of one in every five Chinese suffering from thyroid nodules.

Whether a thyroid nodule needs treatment is mainly determined by the nature of the nodule.

The vast majority of thyroid nodules found in physical examination are benign. However, in recent years, the incidence of thyroid cancer has increased year by year (related to radiation exposure, autoimmunity, genetics and other factors), so it is very important to distinguish benign from malignant nodules. The main method is to judge by ultrasonography.

  If a nodule/mass is found on physical examination, attention should be paid to its stiffness, mobility, borders, and growth rate.

If a nodule/mass is found in the group examination of middle-aged and elderly people, even if it is not painful or itchy and has no symptoms, attention should be paid to it and seek medical treatment in time.

  -polyp

  Polyps refer to the growths on the surface of human mucous membranes, most of them are benign, and a few have malignant tendency.

Taking gallbladder polyps as an example, non-neoplastic polyps account for 90% and are basically not cancerous.

65% of non-neoplastic polyps are cholesterol polyps, which are highly related to diet, and patients with high cholesterol diet or fatty liver are particularly prone to develop cholesterol polyps.

  Cholesterol polyps are mostly within 1 cm and are common in multiple forms.

For cholesterol polyps less than 1 cm, B-ultrasound can be reviewed every six months to one year to observe changes in size, shape, and number without surgery.

If cholesterol polyps are associated with gallstones and gallbladder inflammation, surgical removal is recommended.

If the polyp diameter is greater than 1 cm, and the age is older than 50 years, it is recommended to seek medical treatment as soon as possible, and surgical treatment may be considered.

  - Space-occupying lesions

  It usually appears in imaging results such as B-ultrasound, CT, MRI, etc. Space-occupying lesions generally refer to tumors (benign/malignant), parasites, stones, etc. According to the space-occupying parts of different parts, the situation is different, and it is recommended that specialists conduct further examination .

  It should be noted that the abnormality of some indicators on the medical report does not mean that it is equal to "sick". There is absolutely no need to be frightened by the medical report.

For all kinds of nodules, polyps, space-occupying lesions, etc. found in the physical examination, follow-up is still required.

Especially those suffering from irregular thyroid nodules with fine calcification and gradually enlarged gallbladder polyps, etc., are often evidence of malignant transformation.

  In addition, the physical examination reports of the past years can be collected, and the “Lianliankan” can be carried out every year to observe the changes of the indicators, review the examinations on a regular basis, and go to the doctor for further examinations, so that the physical examination can truly check the health.

  (The author Wu Jingxin is the deputy chief physician of the Health Checkup Department of Shanghai Tenth People's Hospital, and Fan Jingyan is the attending doctor of the Health Checkup Department)