论实验室检查临床解读的五重境界

Discussion about the five states of clinical interpretation of laboratory examination

为深入解读实验室检查的临床意义,本文诠释了实验室检查结果临床分析的五重境界:通常情况下判断正常与异常是最基本的层面,临床怀疑检验误差时应进行复检,所遵循的数学原理是“均数回归现象”;敏感性与特异性的理解为第二重;熟练运用阳性预测值和阴性预测值指导临床为第三重,血常规、尿常规、肌钙蛋白、降钙素原、C反应蛋白、脑钠肽及D二聚体均为阴性预测值很高的指标,是临床诊断的方向性指标——“北斗七星”;用Bayes定理解释实验室检查结果为第四重境界;第五重境界则是用药代动力学等类似原理解读实验室指标的动态变化曲线,并结合患者基本病情、重要器官功能及局部组织循环情况等因素进行综合的立体分析.这提示临床医师应立体、多维地解读每份实验室检查.

In order to further understand the clinical significance of laboratory examination,this paper interprets the five states of clinical analysis of laboratory examination results.Generally,it is the most basic level to judge normal and abnormal results.When the clinical test error is suspected,the retest follows the mathematical principle of "mean reversion phenomenon".The understanding of sensitivity and specificity is the second level.The skilled use of positive and negative predictive value guides clinical practice as the third level.The blood routine test,urine routine test,troponin,procalcitonin,C-reactive protein,brain natriuretic peptide and D-dimer are all indicators with high negative prediction value,which are directional indicators for clinical diagnosis-"Big Dipper in the sky";Bayes theorem is used to explain laboratory examination results as the fourth level.The fifth level is to interpret the dynamic change curve of laboratory indicators based on similar principles such as pharmacokinetics,and to conduct a comprehensive three-dimensional analysis combined with the basic conditions of patients,important organ functions,and local tissue circulation.This suggests that clinicians should interpret every laboratory examination in a three-dimensional and multi-dimensional way.