在初级保健中高血压患者的肝功能测试:前性队列研究
Thuraiya Al Harthi1, Penny Whiting2, Jessica Watson3
1Research Department, The Royal Hospital, Ministry of Health, Muscat, Oman.
BJGP open
|September 19, 2023
概括
对高血压的常规肝功能测试 (LFT) 缺乏诊断准确性,并导致不必要的后续护理. 避免LFT可以减少患者的焦虑,GP的工作量和医疗保健费用.
科学领域:
- 临床医学 临床医学
- 诊断的准确性 诊断的准确性
- 初级保健研究研究初级保健研究
背景情况:
- 肝功能测试 (LFT) 在英国的初级保健中常用于监测高血压患者.
- 关于LFTs在这个人群中的结果益处的证据有限.
研究的目的:
- 评估高血压患者肝脏疾病的LFT诊断准确性.
- 为了评估下游医疗保健利用,在这个队列中遵循LFT.
主要方法:
- 一项前性研究利用了临床实践研究数据链 (CPRD) 的数据.
- 在2015年随机选择了30,000名患有LFT的高血压患者.
- 诊断准确度指标是根据肝病参考标准计算的;下游咨询,转诊和六个月内血液测试被记录下来.
主要成果:
- 肝病的一年发病率为0.5%.
- LFT面板显示了适度的敏感性 (61.3%) 和特异性 (73.8%).
- 个别的LFT分析结果具有较低的正预测值 (PPVs),从0.2%到8.9%. 假阳性LFT导致与真阴性相比,咨询,转诊和血液检测的比率更高.
结论:
- 在初级保健中用于高血压监测的LFTs表现出低的PPV和高的错误阳性率.
- 这导致下游医疗保健利用率增加,包括咨询和进一步测试.
- 停止常规LFT可能会减轻患者的焦虑,减少GP的工作量,降低医疗保健支出.
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