從實證醫學角度看自費健康檢查

Self-paid Health Examination: An Evidence-based Perspective

曾屏輝(Ping-Huei Tseng) ； 林鴻儒(Hung-Ju Lin) ； 邱瀚模(Han-Mo Chiu) ； 李百卿(Bai-Chin Lee) ； 吳明賢(Ming-Shiang Wu) ； 陳明豐(Ming-Fong Chen)

《內科學誌》 20卷6期 (2009/12) Pp. 532-543

https://doi.org/10.6314/JIMT.2009.20(6).08

摘要

健康檢查目的係在篩檢疾病，針對外表健康、無明顯症狀的人群施予檢查，俾便早期發現可能發生某種疾病之高危險群個案，再做進一步檢查，以求得正確診斷與必要之後續追蹤與治療。目前常見之自費健康檢查項目，主要包括多種癌症篩檢及心血管的高階檢查。有效的健康檢查及疾病篩檢可限制疾病發展，促進大眾健康；然而，若是篩檢的真義被誤解或濫用，則可能衍生許多醫療、經濟及社會問題。篩檢的工具選擇及策略擬定時，不宜只考量篩檢工具的敏感度與特異度高低，尚須思考疾病本身的特性、疾病於該族群之盛行率、篩檢工具本身的極限及其可能伴隨之風險。唯有設計精良的大規模隨機對照試驗，才能無偏差地評估篩檢計畫的臨床效益。因此，本文將以常見的自費健康檢查項目爲例，針對疾病篩檢之優缺點、條件，及可能產生的偏差與解決之道，以實證醫學的角度做進一步分析與探討。

關鍵字

自費健康檢查 ； 疾病篩檢 ； 癌症篩檢 ； 心血管疾病 ； 實證醫學

並列摘要

In recent days, self-paid health check-ups are getting popular and mainly focus on screening of common cancers and cardiovascular diseases. Screening is defined as finding out those at increased risks of having a disease in apparently healthy subjects and may have its own advantages and disadvantages. In addition to the validity of screening tools, several aspects also need to be considered thoroughly before choosing a screening test or making a screening program, including the disease character, the approximate prevalence of the disease, cost-effectiveness and possible biases that may alter the interpretation of screening program. Randomized controlled trials are the only way to study the true efficacy of a screening program. From an evidence-based perspective, we evaluate several screening tools frequently adopted in self-paid health examination.

並列關鍵字

Self-paid Health Examination ； Screening ； Cancer Screening ； Cardiovascular Disease ； Evidence-based Medicine