Doctors from Peking Union Medical College say | Do you really understand the physical examination report?

"Doctor, what do these indicators and symbols on the physical examination report mean? Is there something wrong with my health?" After opening the physical examination report, Xiao Li was dumbfounded. Faced with the dense numbers and arrows, Xiao Li was afraid that he had misunderstood and would affect the subsequent treatment. So, how should the physical examination report be read? What should I do if the indicators are abnormal? Don't worry, today, doctors from the Department of Health Medicine of Peking Union Medical College Hospital will explain to you in detail how to understand the physical examination report. Full of useful information, quickly forward and collect it——

Author: Li Jing

Li Jing, attending physician, Department of Health Medicine, Peking Union Medical College Hospital

Audit expert: Lin Songbai

Lin Songbai, Director of the Department of Health Medicine, Peking Union Medical College Hospital

Meaning of symbols

(1) Upward and downward arrows (↑, ↓) : In the physical examination report, the numerical indicators have a reference range (medically, the range of a certain indicator of 95% of normal people is usually used as the reference value range). If the indicator value is not within the range, it will be marked as rising (↑) or falling (↓).

(2) Plus sign and minus sign (+, -) : represent "yes" and "no", respectively, that is, the test results are positive and negative, respectively.

(3) Plus or minus sign (±) : represents an uncertain positive result.

In fact, there is almost no "standard person" without any symbol in the physical examination report. The presence of an arrow in the report does not mean that the indicator must be abnormal or that you have a certain disease, and a positive result does not necessarily mean that there is a problem. For example, when the hepatitis B surface antibody is positive, it means that you have resistance, which is a good thing. Therefore, when you see the symbol, you don't have to worry too much.

Friendly reminder from Peking Union Medical College doctors : In formal physical examination reports, we recommend that you focus on the summary of abnormal results and clear suggestions on the next steps.

Complete blood test

(1) Which indicators should be focused on? What do they represent?

Routine blood test is the most basic and widely used examination item, which reflects the distribution of cells in the blood.

The focus should be on the "three systems" , namely red blood cells (responsible for oxygen transport), white blood cells (responsible for immune response), and platelets (responsible for blood clotting), just like chefs, security guards, and doctors. A significant increase or decrease in the "three systems" indicates that there are certain problems. For example, a low level of white blood cells may lead to a decrease in human resistance, while a high level may indicate an inflammatory response in the body and an infection.

(2) Does an increase in white blood cell count mean that the patient has leukemia?

Leukemia is a malignant tumor of the hematopoietic system, which is divided into multiple types. The blood routine indicators of patients with different types of leukemia vary . Although some will show a significant increase in white blood cells, there are also cases where the white blood cell count does not increase or decreases, which is often accompanied by abnormal indications of other blood routine indicators. Usually, the most common cause of increased white blood cells is the body's inflammatory response.

cholesterol

Is high cholesterol a good thing or a bad thing? Can you still eat meat, eggs and milk? In fact, cholesterol is not entirely a "bad thing".

High-density lipoprotein cholesterol can protect blood vessels, so the higher the better; but if low-density or non-high-density lipoprotein cholesterol is high, you should be careful, because this indicates that your lifestyle needs to be improved - it is recommended to reduce the intake of greasy food and drink low-fat milk. However, if there is no intake of animal nutrients, the human body will lack some necessary nutrients such as vitamin B12, so this type of food cannot be completely avoided. Emphasize controlling the intake of animal offal, fried food, desserts, snacks, etc., and reduce social activities. It is also necessary to increase the amount of exercise, and it is recommended to exercise at least 5 times a week. In addition, dyslipidemia may also be related to genetic factors, and you can actively carry out drug treatment under the advice of a professional doctor.

Tumor markers

(1) What are tumor markers? What are the common tumor markers in physical examinations?

Tumor markers are substances detected in the blood that are related to the occurrence and development of tumors. There are a wide range of types, and the more commonly used ones are PSA (prostate-specific antigen), AFP (alpha-fetoprotein), CEA (carcinoembryonic antigen), and CA199 and CA125 of the carbohydrate antigen CA series. Some indicators whose names have nothing to do with tumors, such as ferritin, M protein, HCG, etc., may also be related to tumors.

(2) Which groups of people need to focus on testing tumor markers?

Men over 40 can screen for prostate cancer by regularly testing PSA. Those with a history of chronic hepatitis or an increased risk of liver cancer should regularly test AFP. People with a family history of hereditary tumors or an increased risk of ovarian or pancreatic cancer can regularly test CA125 and CA199.

But be aware: tumor markers cannot replace imaging or endoscopic examinations.

(3) If a physical examination reveals elevated tumor markers, does this mean that I have cancer?

Tumor markers and tumors do have a correlation, but in most cases they do not correspond one to one. This means: if you have a tumor, the tumor markers may not be elevated, and an elevated marker does not necessarily mean you have a tumor. However, when tumor markers increase significantly and get higher and higher, we need to pay attention. At this time, we often need to combine imaging examinations to find possible tumors. Therefore, once you find that the tumor markers are elevated, don't be too nervous. Be sure to listen to the advice of professional doctors, complete necessary examinations, and observe the dynamic changes of indicators.

Urinalysis

(1) What kind of urine is normal?

Normal urine is light yellow and clear. If it is dark tea color or soy sauce color, it indicates that the urine may be abnormal. The normal range of urine pH is 4.5-8, but pathological changes in pH are often caused by acidosis, so people with normal physical examinations do not need to pay too much attention to it.

(2) Are positive urine ketones and urine glucose related to diabetes?

Diabetic patients whose condition is not well controlled often have positive urine ketones and glucose, but the positive urine ketones seen in the physical examination report are mostly caused by fat metabolites produced in fasting and hungry states. When people with no blood sugar problems have positive urine glucose, it is important to check whether there is a problem with the renal tubular reabsorption capacity.

(3) Do positive urobilinogen and bilirubin levels indicate liver disease?

Positive urobilinogen and bilirubin are related to bilirubin metabolism, but may also be related to some blood system diseases, and do not necessarily represent liver diseases. Therefore, it should be combined with blood indicators and abdominal ultrasound.

(4) What cells should not be found in urine? What should I do if they are found?

Normal urine can contain a small amount of red and white blood cells. However, after excluding contamination factors, if the number of red and white blood cells increases, further examination is required. Patients at high risk or with a history of urinary tract tumors can detect tumor cells through urine pathology examination. Patients with hypertension and diabetes are advised to regularly perform urine ACR examinations to detect urine microalbumin in order to detect early kidney damage and adjust medication in a timely manner.

Stool examination

Fecal examination is the item with the highest abandonment rate in physical examinations, and positive fecal occult blood is also the most easily overlooked abnormal result. Routine physical examination packages generally do not include colonoscopy. At this time, the most effective method for colorectal cancer screening is fecal occult blood, so do not give up easily. If there is no fecal matter on the day of the physical examination, you can collect and send it for examination on another day according to relevant requirements.

When fecal occult blood is positive, do not assume that it is "hemorrhoids". It is recommended that people over 50 years old or those with a family history of digestive system tumors should complete gastrointestinal endoscopy. Young people should not take fecal occult blood positive lightly and should undergo at least three consecutive reexaminations.

Helicobacter pylori

(1) What is Helicobacter pylori and how to detect it?

Helicobacter pylori is a bacteria in the stomach that has coexisted with humans for more than 50,000 years, with an infection rate of over 50% of the world's population. Due to the eating habits of communal dining, the infection rate among Chinese people is relatively high.

The detection methods of Helicobacter pylori are divided into current infection detection and infection trace detection. Current infection detection includes urea breath test, stool antigen and gastroscopy urease test; infection trace detection requires blood test for antibodies. When the blood antibody is positive, it means that the person has been infected with Helicobacter pylori.

(2) What are the dangers of Helicobacter pylori infection? How to treat it?

Helicobacter pylori is associated with the incidence of gastritis, gastric ulcers, gastric cancer and gastric lymphoma, but there is still controversy as to whether it should be eradicated.

In general, it is recommended that people with gastric diseases must undergo bactericidal treatment. The most commonly used method is quadruple therapy, which is a combination of two antibiotics, bismuth and acid suppressants for about 2 weeks. It should be noted that there must be evidence of current infection before deciding on treatment.

Other abnormal situations

(1) What is the difference between hyperplasia, abnormal masses, and cysts? Will they turn into cancer?

In physical examination reports, we often see descriptions such as "hyperplasia", "cysts", "nodules" and "space-occupying". What risks do these indicate? The potential risks of lesions in different parts of the body are different and cannot be generalized. For example, for the breast, hyperplasia is a normal manifestation of the breast of women of childbearing age, and cysts are generally benign. However, the same cyst has the potential risk of malignancy when it appears in the pancreas, kidneys, and ovaries.

(2) Which parts of the body should we be wary of nodules?

Physical examination reports often give grading indexes for breast, thyroid, and lung nodules. Once the index is above grade 4, you need to be alert. It is recommended to pay attention to and compare physical examination reports from previous years, increase the frequency of observation for newly discovered cysts and nodules, and observe the size changes every 3 months.

(3) Where are polyps more dangerous?

Polyps are lesions that grow on the mucosa, so they can appear in the gastrointestinal tract, gallbladder, uterus, etc. Gastrointestinal polyps have the potential to become malignant and should be removed promptly. Polyps in the gallbladder are generally measured at 1 cm in size, and those larger than 1 cm should be removed. In addition, gallbladder polyps that grow too fast also require timely intervention. Cervical polyps or endometrial polyps are often found during female physical examinations. Most of them are benign, so there is no need to worry too much. However, when polyps are larger or clinical symptoms such as bleeding occur, removal can be considered.

Friendly reminder from Peking Union Medical College doctors: Professional and formal medical examination institutions will proactively remind you when they find high-risk abnormal values, and clearly inform you in the medical examination report whether you need to see a doctor or have a follow-up examination a few months later. Therefore, it is not recommended that you search and diagnose on the Internet after finding abnormal indicators. After getting the medical examination report, you are encouraged to consult a professional doctor face to face. The doctor can give more accurate advice based on your specific situation~

Content from: Li Jing, a doctor at Union Medical College Hospital