摘要目的通过比较不同筛查级别的准确性，探讨应用“健康体检自测问卷”开展高血压阶梯式筛查的价值。方法对在中南大学湘雅三医院健康管理科完成体检且诊断高血压的6715例患者[平均年龄（53.47±11.07）岁]进行问卷、常规检查、高血压专项检查，根据结果进行高血压危险分层，并将问卷、常规检查、问卷+常规检查与问卷+常规检查+专项检查对照，分别计算出单项检查和联合检查的灵敏度、特异度、阳性预测值、符合率。结果研究对象中高血压合并危险因素者占90.00%，合并有临床疾病占20.83%（其中糖尿病占14.88%）。根据指南分层，低危3.41%、中危23.78%、高危47.85%、很高危24.96%。常规检查判断中危的灵敏度为95.56%，特异度为45.51%，增加问卷后，灵敏度为100.00%，特异度为45.51%，灵敏度提高；常规检查判断高危的灵敏度为15.03%，特异度为96.28%，增加问卷后，灵敏度为30.03%，特异度为99.14%，灵敏度提高1倍；常规检查判断很高危的灵敏度为15.03%，特异度为100.00%，增加问卷后，灵敏度升至94.45%，特异度未变。结论在常规体检的基础上增加问卷项目，能大幅增加高血压患者危险分层的检出率，并提高中危、高危、很高危患者检出的灵敏度、特异度。问卷获取的健康信息及数据与医学检查设备获取的健康信息同等重要，建议各健康管理（体检）机构将问卷作为体检及慢病筛查的必备项目和初级筛查手段。

abstractsObjective To explore the application value of stepped screening on hypertension with self-report health measurement questionnaire by comparing the accuracy of the different levels of screening. Methods A total of 6 715 subjects with hypertension (average age of 53.47 ± 11.07 years) were selected from those who completed the physical examination in the department of health management in the Third Xiangya Hospital of Central South University for questionnaire survey, routine inspection and special inspection for hypertension. And the patients were divided into four groups based on their hypertension risk levels: the questionnaire survey group, routine inspection group, questionnaire + routine inspection group and questionnaire+routine inspection+special inspection group. The results were compared respectively to calculate the sensitivity, specificity, positive predictive value and coincidence rate of single inspection and joint inspection. Results Nearly 90.00%of the subjects had hypertension associated with the risk factors, while 20.83% of the subjects had hypertension associated with other clinical diseases (the highest percentage was seen in hypertension with diabetes as 14.88%). According to the guidelines of stratification, 3.41% of the patients were at low risk, 23.78% at moderate risk, 47.85% at high risk, and 24.96% at extremely high risk. Sensitivity and specificity of routine inspection were 95.56%and 45.51%in judgment of moderate risk, which became 100.00%and 45.51%after addition of questionnaire survey;as a result, thesensitivity increased. Sensitivity and specificity of routine inspection were 15.03%and 96.28%in judgment of high risk, which became 30.03% and 99.14% after addition of questionnaire survey; as a result, the sensitivity doubled. Sensitivity and specificity of routine inspection were 15.03%and 100.00%in judgment of extremely high risk, and the sensitivity increased to 94.45%after addition of questionnaire survey, while the specificity remained unchanged. Conclusion Addition of questionnaire on the basis of routine physical examination could greatly increase the detection rate of hypertension patients at different risk levels, and increase the sensitivity as well as specificity for detection of moderate risk, high risk and extremely high risk. Therefore, health information and data acquired from the questionnaire and data obtained from the medical inspection equipment are equally important and suggest health management (physical examination) institutions to take questionnaire as a necessary and primary screening in physical examination and chronic disease screening.