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案例 33：体检指标异常筛查与风险标注

本案例对应 JQuick-Java USE-CASES 场景 33（诉求 40：体检指标异常筛查与风险标注），属于医疗公卫/健康管理领域，决策内容是对体检报告中的八项生理指标逐项做医学分级，聚合输出整体风险层级、异常计数、组合风险标签、复查建议与首诊科室。

行业场景

Section titled “行业场景”

体检中心与公共卫生机构在批量出具体检报告时，需要把检验数值自动翻译成统一的医学风险语言。入参模型 HealthScreeningReport 承载报告号、受检人、性别（M/F）、年龄，以及八项指标：收缩压/舒张压、空腹血糖、总胆固醇、体质指数 BMI、静息心率、谷丙转氨酶 ALT、血肌酐，并附带吸烟史与糖尿病/高血压家族史两个流行病学因子。

规则层为每个指标提供独立分级方法，统一输出 NORMAL/ATTENTION/HIGH/CRITICAL 四档（ALT 用 0/1/2 秩返回，由 Service 映射）。血压双值在编排侧取较高档作为“血压”一项；血肌酐执行男女差异化阈值（男性 97/115、女性 70/80 两道关注线）；BMI 同时覆盖肥胖与低于 18.5 的消瘦提示；心率同时覆盖心动过速与低于 50 次/分的心动过缓。编排层遍历七项（血压合并后）统计异常数、HIGH 数、CRITICAL 数并取最高级，再按组合因子贴风险标签：血压 HIGH 及以上合并吸烟史标注“心血管高风险”，血糖 HIGH 及以上合并家族史标注“糖尿病高危人群”。

决策结果由 HealthScreeningDecision 承载：整体最高级别、三类计数、风险标签 riskTags、逐项带【危急】/【异常】/【关注】前缀的建议清单 advice，以及建议首诊科室与复查时限——危急值 3 日内就诊、两项 HIGH 两周内、单项 HIGH 一个月内、临界项 6 个月生活方式干预复评、全正常按年度体检。科室按优先级路由心血管内科、内分泌科、肾内科、消化内科或全科/健康管理科。

业务痛点

Section titled “业务痛点”
  • 医学阈值随指南与人群更新：血压、血糖、血脂的临界值在不同指南版本和体检套餐中存在差异，写死在 HIS/体检系统代码里，每次调整都要厂商配合发版。
  • 八项指标口径必须独立可调：不同指标的分档线、性别差异（血肌酐）、双向异常（BMI 消瘦/肥胖、心率过缓/过速）混在一个大方法里，维护时极易改错档位。
  • 组合风险因子难以表达：单看血压或血糖值并不触发高危结论，必须叠加吸烟史、家族史等因子形成标签，传统硬编码分支又多又散。
  • 异常结果缺少可执行的就诊指引：只标红数值没有科室与时限，受检人仍需人工解读，体检机构电话回访与健康干预工作量大。
  • 医疗遗留系统与信创环境约束：区域公卫平台、医院体检系统大量运行在 JDK 8 与国产 JDK 上，不适合引入需要独立部署的重型临床规则平台。

方案架构

Section titled “方案架构”

本案例采用 JQuick-Java 标准六件套：入参模型、决策结果模型、Rules 规则接口、XML 规则脚本、Service 编排服务、JUnit 测试，全部代码在 Oracle JDK 1.8 下实测通过。

层次 职责 对应文件
领域模型 承载体检八项指标要素与异常筛查、风险分层决策 HealthScreeningReport.java、HealthScreeningDecision.java
规则层 八项指标各自医学分级，阈值与性别差异全部外置 HealthScreeningRules.java、health-screening.xml
编排层 血压合并取高、异常计数、组合风险标签、科室与复查时限路由 HealthScreeningService.java
测试 6 组体检真实形态 HealthScreeningServiceTest.java

规则方法拆分

Section titled “规则方法拆分”
规则方法 口径 分值/输出
systolicLevel 收缩压 ≥180 CRITICAL；≥140 HIGH；≥130 ATTENTION；否则 NORMAL NORMAL/ATTENTION/HIGH/CRITICAL
diastolicLevel 舒张压 ≥110 CRITICAL；≥90 HIGH；≥85 ATTENTION；否则 NORMAL NORMAL/ATTENTION/HIGH/CRITICAL
glucoseLevel 空腹血糖 ≥7.0 CRITICAL；≥6.1 HIGH；≥5.6 ATTENTION；否则 NORMAL NORMAL/ATTENTION/HIGH/CRITICAL
cholesterolLevel 总胆固醇 ≥6.2 HIGH；≥5.2 ATTENTION；否则 NORMAL（无 CRITICAL 档） NORMAL/ATTENTION/HIGH
bmiLevel BMI ≥32 CRITICAL；≥28 HIGH；≥24 ATTENTION；低于 18.5 亦为 ATTENTION（消瘦）；否则 NORMAL NORMAL/ATTENTION/HIGH/CRITICAL
heartRateLevel 静息心率 ≥120 CRITICAL；≥100 HIGH；低于 50 HIGH；≤55 ATTENTION；否则 NORMAL NORMAL/ATTENTION/HIGH/CRITICAL
altLevelRank 谷丙转氨酶大于 120 返回 2；大于 40 返回 1；否则 0（Service 再映射 HIGH/ATTENTION/NORMAL） 0/1/2
creatinineLevel 血肌酐男性大于 115 HIGH、大于 97 ATTENTION；女性大于 80 HIGH、大于 70 ATTENTION；否则 NORMAL NORMAL/ATTENTION/HIGH

代码实现（完整可运行）

Section titled “代码实现（完整可运行）”

将两个模型类放入 src/test/java/com/github/paohaijiao/demo/model/，规则接口放入 demo/，Service 放入 demo/service/，XML 脚本放入 src/test/resources/demo/，测试类放入 demo/，包名保持源码原样。工程根目录执行 mvn test -Dtest=HealthScreeningServiceTest 即可复现全部 6 个用例。

HealthScreeningReport.java

Section titled “HealthScreeningReport.java”
package com.github.paohaijiao.demo.model;


import lombok.AllArgsConstructor;
import lombok.Data;
import lombok.NoArgsConstructor;


/**
 * 体检指标要素
 */
@Data
@NoArgsConstructor
@AllArgsConstructor
public class HealthScreeningReport {


    /**
     * 体检报告号
     */
    private String reportId;


    /**
     * 受检人
     */
    private String personName;


    /**
     * 性别：M 男 / F 女
     */
    private String gender;


    /**
     * 年龄
     */
    private int age;


    /**
     * 收缩压（mmHg）
     */
    private int systolicBp;


    /**
     * 舒张压（mmHg）
     */
    private int diastolicBp;


    /**
     * 空腹血糖（mmol/L）
     */
    private double fastingGlucose;


    /**
     * 总胆固醇（mmol/L）
     */
    private double totalCholesterol;


    /**
     * 体质指数
     */
    private double bmi;


    /**
     * 静息心率（次/分）
     */
    private int heartRate;


    /**
     * 谷丙转氨酶（U/L）
     */
    private int alt;


    /**
     * 血肌酐（μmol/L）
     */
    private int creatinine;


    /**
     * 是否有吸烟史
     */
    private boolean smokingHistory;


    /**
     * 是否有糖尿病/高血压家族史
     */
    private boolean familyHistory;
}

HealthScreeningDecision.java

Section titled “HealthScreeningDecision.java”
package com.github.paohaijiao.demo.model;


import lombok.Data;


import java.util.ArrayList;
import java.util.List;


/**
 * 体检异常筛查与风险分层决策
 */
@Data
public class HealthScreeningDecision {


    /**
     * 报告号
     */
    private String reportId;


    /**
     * 整体风险级别：NORMAL / ATTENTION / HIGH / CRITICAL
     */
    private String highestLevel;


    /**
     * 异常指标数（ATTENTION 及以上）
     */
    private int abnormalCount;


    /**
     * CRITICAL 指标数
     */
    private int criticalCount;


    /**
     * HIGH 指标数
     */
    private int highCount;


    /**
     * 风险标签
     */
    private List<String> riskTags = new ArrayList<String>();


    /**
     * 逐项异常说明与复查建议
     */
    private List<String> advice = new ArrayList<String>();


    /**
     * 建议首诊科室
     */
    private String followUpDepartment;


    public void addRiskTag(String tag) {
        this.riskTags.add(tag);
    }


    public void addAdvice(String line) {
        this.advice.add(line);
    }
}

HealthScreeningRules.java

Section titled “HealthScreeningRules.java”
package com.github.paohaijiao.demo;


import com.github.paohaijiao.xml.param.Param;


/**
 * 场景 33：体检各指标医学分级规则（NORMAL/ATTENTION/HIGH/CRITICAL）
 */
public interface HealthScreeningRules {


    /**
     * 收缩压分级
     */
    String systolicLevel(@Param("systolic") int systolic);


    /**
     * 舒张压分级
     */
    String diastolicLevel(@Param("diastolic") int diastolic);


    /**
     * 空腹血糖分级
     */
    String glucoseLevel(@Param("glucose") double glucose);


    /**
     * 总胆固醇分级
     */
    String cholesterolLevel(@Param("cholesterol") double cholesterol);


    /**
     * BMI 分级（含消瘦提示）
     */
    String bmiLevel(@Param("bmi") double bmi);


    /**
     * 静息心率分级
     */
    String heartRateLevel(@Param("heartRate") int heartRate);


    /**
     * 谷丙转氨酶分级
     */
    int altLevelRank(@Param("alt") int alt);


    /**
     * 血肌酐分级（男女阈值不同）
     */
    String creatinineLevel(@Param("creatinine") int creatinine,
                           @Param("gender") String gender);
}

health-screening.xml

Section titled “health-screening.xml”
<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE javas PUBLIC "-//PAOHAIJIAO//DTD API JAVA 1.0//EN"
        "classpath:paohaijiao/dtd/Jquick-java.dtd">
<javas namespace="com.github.paohaijiao.demo.HealthScreeningRules">


    <java name="systolicLevel" returnClass="java.lang.String">
        <![CDATA[
            str def systolicLevel(int:systolic) {
                if (systolic >= 180) {
                    return "CRITICAL";
                } else if (systolic >= 140) {
                    return "HIGH";
                } else if (systolic >= 130) {
                    return "ATTENTION";
                } else {
                    return "NORMAL";
                }
            }
        ]]>
    </java>


    <java name="diastolicLevel" returnClass="java.lang.String">
        <![CDATA[
            str def diastolicLevel(int:diastolic) {
                if (diastolic >= 110) {
                    return "CRITICAL";
                } else if (diastolic >= 90) {
                    return "HIGH";
                } else if (diastolic >= 85) {
                    return "ATTENTION";
                } else {
                    return "NORMAL";
                }
            }
        ]]>
    </java>


    <java name="glucoseLevel" returnClass="java.lang.String">
        <![CDATA[
            str def glucoseLevel(double:glucose) {
                if (glucose >= 7.0) {
                    return "CRITICAL";
                } else if (glucose >= 6.1) {
                    return "HIGH";
                } else if (glucose >= 5.6) {
                    return "ATTENTION";
                } else {
                    return "NORMAL";
                }
            }
        ]]>
    </java>


    <java name="cholesterolLevel" returnClass="java.lang.String">
        <![CDATA[
            str def cholesterolLevel(double:cholesterol) {
                if (cholesterol >= 6.2) {
                    return "HIGH";
                } else if (cholesterol >= 5.2) {
                    return "ATTENTION";
                } else {
                    return "NORMAL";
                }
            }
        ]]>
    </java>


    <java name="bmiLevel" returnClass="java.lang.String">
        <![CDATA[
            str def bmiLevel(double:bmi) {
                if (bmi >= 32) {
                    return "CRITICAL";
                } else if (bmi >= 28) {
                    return "HIGH";
                } else if (bmi >= 24) {
                    return "ATTENTION";
                } else if (bmi < 18.5) {
                    return "ATTENTION";
                } else {
                    return "NORMAL";
                }
            }
        ]]>
    </java>


    <java name="heartRateLevel" returnClass="java.lang.String">
        <![CDATA[
            str def heartRateLevel(int:heartRate) {
                if (heartRate >= 120) {
                    return "CRITICAL";
                } else if (heartRate >= 100) {
                    return "HIGH";
                } else if (heartRate < 50) {
                    return "HIGH";
                } else if (heartRate <= 55) {
                    return "ATTENTION";
                } else {
                    return "NORMAL";
                }
            }
        ]]>
    </java>


    <java name="altLevelRank" returnClass="int">
        <![CDATA[
            int def altLevelRank(int:alt) {
                if (alt > 120) {
                    return 2;
                } else if (alt > 40) {
                    return 1;
                } else {
                    return 0;
                }
            }
        ]]>
    </java>


    <java name="creatinineLevel" returnClass="java.lang.String">
        <![CDATA[
            str def creatinineLevel(int:creatinine, str:gender) {
                if (gender == "M") {
                    if (creatinine > 115) {
                        return "HIGH";
                    } else if (creatinine > 97) {
                        return "ATTENTION";
                    } else {
                        return "NORMAL";
                    }
                } else {
                    if (creatinine > 80) {
                        return "HIGH";
                    } else if (creatinine > 70) {
                        return "ATTENTION";
                    } else {
                        return "NORMAL";
                    }
                }
            }
        ]]>
    </java>


</javas>

HealthScreeningService.java

Section titled “HealthScreeningService.java”
package com.github.paohaijiao.demo.service;


import com.github.paohaijiao.demo.HealthScreeningRules;
import com.github.paohaijiao.demo.model.HealthScreeningDecision;
import com.github.paohaijiao.demo.model.HealthScreeningReport;


/**
 * 场景 33：体检多指标异常筛查、风险标注与就诊指引
 */
public class HealthScreeningService {


    private final HealthScreeningRules rules;


    public HealthScreeningService(HealthScreeningRules rules) {
        this.rules = rules;
    }


    public HealthScreeningDecision screen(HealthScreeningReport r) {
        HealthScreeningDecision d = new HealthScreeningDecision();
        d.setReportId(r.getReportId());


        String bp = higher(rules.systolicLevel(r.getSystolicBp()),
                rules.diastolicLevel(r.getDiastolicBp()));
        String glucose = rules.glucoseLevel(r.getFastingGlucose());
        String cholesterol = rules.cholesterolLevel(r.getTotalCholesterol());
        String bmi = rules.bmiLevel(r.getBmi());
        String heartRate = rules.heartRateLevel(r.getHeartRate());
        int altRank = rules.altLevelRank(r.getAlt());
        String alt = rankToLevel(altRank);
        String creatinine = rules.creatinineLevel(r.getCreatinine(), r.getGender());


        addItem(d, "血压 " + r.getSystolicBp() + "/" + r.getDiastolicBp() + "mmHg", bp,
                "家庭监测血压，低盐饮食并控制体重", "立即急诊排查高血压急症");
        addItem(d, "空腹血糖 " + r.getFastingGlucose() + "mmol/L", glucose,
                "控制精制糖摄入并增加有氧运动", "尽快到内分泌科明确糖尿病诊断");
        addItem(d, "总胆固醇 " + r.getTotalCholesterol() + "mmol/L", cholesterol,
                "减少饱和脂肪摄入，3 个月后复查血脂", "低脂饮食并到心内科评估调脂治疗");
        addItem(d, "体质指数 " + r.getBmi(), bmi,
                "通过膳食与运动把 BMI 控制在 18.5-24", "到营养/减重门诊干预肥胖");
        addItem(d, "静息心率 " + r.getHeartRate() + " 次/分", heartRate,
                "规律作息，避免浓茶咖啡后复查心电图", "尽快完善动态心电图检查");
        addItem(d, "谷丙转氨酶 " + r.getAlt() + "U/L", alt,
                "避免饮酒与熬夜，复查肝功能", "消化/肝病科排查肝炎、脂肪肝等病因");
        addItem(d, "血肌酐 " + r.getCreatinine() + "μmol/L", creatinine,
                "多饮水避免滥用止痛药，复查肾功能", "肾内科评估肾功能损伤");


        if (rank(bp) >= 2 && r.isSmokingHistory()) {
            d.addRiskTag("心血管高风险（血压异常合并吸烟史）");
        }
        if (rank(glucose) >= 2 && r.isFamilyHistory()) {
            d.addRiskTag("糖尿病高危人群（空腹血糖异常合并家族史）");
        }


        String highest = "NORMAL";
        for (String level : new String[]{bp, glucose, cholesterol, bmi, heartRate, alt, creatinine}) {
            if (rank(level) > rank(highest)) {
                highest = level;
            }
            if (!"NORMAL".equals(level)) {
                d.setAbnormalCount(d.getAbnormalCount() + 1);
            }
            if ("CRITICAL".equals(level)) {
                d.setCriticalCount(d.getCriticalCount() + 1);
            }
            if ("HIGH".equals(level)) {
                d.setHighCount(d.getHighCount() + 1);
            }
        }
        d.setHighestLevel(highest);


        d.setFollowUpDepartment(resolveDepartment(bp, heartRate, glucose, creatinine, alt, highest));
        appendFollowUpAdvice(d);
        return d;
    }


    private void appendFollowUpAdvice(HealthScreeningDecision d) {
        if (d.getCriticalCount() >= 1) {
            d.addAdvice("存在危急值指标，请于 3 日内到 " + d.getFollowUpDepartment() + " 就诊");
        } else if (d.getHighCount() >= 2) {
            d.addAdvice("多项指标明显异常，请于 2 周内到 " + d.getFollowUpDepartment() + " 复查");
        } else if (d.getHighCount() == 1) {
            d.addAdvice("单项指标明显异常，请于 1 个月内到 " + d.getFollowUpDepartment() + " 复查");
        } else if (d.getAbnormalCount() > 0) {
            d.addAdvice("指标处于临界区间，以生活方式干预为主，6 个月后复评");
        } else {
            d.addAdvice("本次体检各项指标正常，请保持良好生活习惯，按年度常规体检即可");
        }
    }


    private String resolveDepartment(String bp, String heartRate, String glucose,
                                     String creatinine, String alt, String highest) {
        if ("NORMAL".equals(highest)) {
            return "全科/健康管理科";
        }
        if (rank(bp) >= 2) {
            return "心血管内科";
        }
        if (rank(heartRate) >= 2) {
            return "心血管内科";
        }
        if (rank(glucose) >= 2) {
            return "内分泌科";
        }
        if ("HIGH".equals(creatinine)) {
            return "肾内科";
        }
        if ("HIGH".equals(alt)) {
            return "消化内科";
        }
        return "全科/健康管理科";
    }


    private void addItem(HealthScreeningDecision d, String label, String level,
                         String attentionAdvice, String highAdvice) {
        if ("NORMAL".equals(level)) {
            return;
        }
        String prefix;
        if ("CRITICAL".equals(level)) {
            prefix = "【危急】";
        } else if ("HIGH".equals(level)) {
            prefix = "【异常】";
        } else {
            prefix = "【关注】";
        }
        String body = "CRITICAL".equals(level) || "HIGH".equals(level) ? highAdvice : attentionAdvice;
        d.addAdvice(prefix + label + "：" + level + "。" + body);
    }


    private String higher(String a, String b) {
        return rank(a) >= rank(b) ? a : b;
    }


    private String rankToLevel(int rank) {
        if (rank >= 2) {
            return "HIGH";
        }
        if (rank == 1) {
            return "ATTENTION";
        }
        return "NORMAL";
    }


    private int rank(String level) {
        if ("CRITICAL".equals(level)) {
            return 3;
        }
        if ("HIGH".equals(level)) {
            return 2;
        }
        if ("ATTENTION".equals(level)) {
            return 1;
        }
        return 0;
    }
}

HealthScreeningServiceTest.java

Section titled “HealthScreeningServiceTest.java”
package com.github.paohaijiao.demo;


import com.github.paohaijiao.demo.model.HealthScreeningDecision;
import com.github.paohaijiao.demo.model.HealthScreeningReport;
import com.github.paohaijiao.demo.service.HealthScreeningService;
import com.github.paohaijiao.xml.JQuickJava;
import org.junit.Assert;
import org.junit.Before;
import org.junit.Test;


/**
 * 场景 33：体检指标异常筛查与风险标注
 * <p>
 * 6 组形态：全指标正常、四项临界关注、高血压合并吸烟、糖尿病危急合并家族史、
 * 多器官危急值、心动过缓与临界恢复分叉。
 */
public class HealthScreeningServiceTest {


    private HealthScreeningService service;


    @Before
    public void setUp() {
        HealthScreeningRules rules = JQuickJava.create()
                .createApi(HealthScreeningRules.class, "demo/health-screening.xml");
        this.service = new HealthScreeningService(rules);
    }


    /**
     * 年轻男性全部指标正常 → 年度常规体检
     */
    @Test
    public void shouldReturnNormalForHealthyYoungMan() {
        HealthScreeningReport r = base("RPT001", "M", 28);
        r.setSystolicBp(115);
        r.setDiastolicBp(75);
        r.setFastingGlucose(5.0);
        r.setTotalCholesterol(4.5);
        r.setBmi(22);
        r.setHeartRate(70);
        r.setAlt(25);
        r.setCreatinine(70);


        HealthScreeningDecision d = service.screen(r);


        Assert.assertEquals("NORMAL", d.getHighestLevel());
        Assert.assertEquals(0, d.getAbnormalCount());
        Assert.assertEquals("全科/健康管理科", d.getFollowUpDepartment());
        Assert.assertTrue(d.getAdvice().get(0).contains("各项指标正常"));
    }


    /**
     * 血压、血糖、胆固醇、BMI 四项临界 → ATTENTION，生活方式干预
     */
    @Test
    public void shouldMarkFourBorderlineMetrics() {
        HealthScreeningReport r = base("RPT002", "M", 42);
        r.setSystolicBp(132);
        r.setDiastolicBp(86);
        r.setFastingGlucose(5.8);
        r.setTotalCholesterol(5.5);
        r.setBmi(24.5);
        r.setHeartRate(72);
        r.setAlt(30);
        r.setCreatinine(85);


        HealthScreeningDecision d = service.screen(r);


        Assert.assertEquals("ATTENTION", d.getHighestLevel());
        Assert.assertEquals(4, d.getAbnormalCount());
        Assert.assertEquals(0, d.getHighCount());
        Assert.assertTrue(d.getAdvice().get(0).startsWith("【关注】血压"));
        Assert.assertTrue(d.getAdvice().get(d.getAdvice().size() - 1).contains("生活方式干预"));
    }


    /**
     * 血压 152/96、胆固醇 6.5、吸烟史 → 心血管高风险，2 周内心内科
     */
    @Test
    public void shouldTagCardioRiskForHypertensiveSmoker() {
        HealthScreeningReport r = base("RPT003", "M", 51);
        r.setSystolicBp(152);
        r.setDiastolicBp(96);
        r.setFastingGlucose(5.2);
        r.setTotalCholesterol(6.5);
        r.setBmi(27);
        r.setHeartRate(82);
        r.setAlt(35);
        r.setCreatinine(90);
        r.setSmokingHistory(true);


        HealthScreeningDecision d = service.screen(r);


        Assert.assertEquals("HIGH", d.getHighestLevel());
        Assert.assertEquals(3, d.getAbnormalCount());
        Assert.assertEquals(2, d.getHighCount());
        Assert.assertTrue(d.getRiskTags().contains("心血管高风险（血压异常合并吸烟史）"));
        Assert.assertEquals("心血管内科", d.getFollowUpDepartment());
        Assert.assertTrue(d.getAdvice().get(d.getAdvice().size() - 1).contains("2 周内"));
    }


    /**
     * 空腹血糖 7.2 危急 + 家族史 → 糖尿病高危，3 日内内分泌科
     */
    @Test
    public void shouldFlagCriticalGlucoseWithFamilyHistory() {
        HealthScreeningReport r = base("RPT004", "F", 47);
        r.setSystolicBp(125);
        r.setDiastolicBp(80);
        r.setFastingGlucose(7.2);
        r.setTotalCholesterol(5.0);
        r.setBmi(25.5);
        r.setHeartRate(75);
        r.setAlt(30);
        r.setCreatinine(72);
        r.setFamilyHistory(true);


        HealthScreeningDecision d = service.screen(r);


        Assert.assertEquals("CRITICAL", d.getHighestLevel());
        Assert.assertEquals(1, d.getCriticalCount());
        Assert.assertTrue(d.getRiskTags().contains("糖尿病高危人群（空腹血糖异常合并家族史）"));
        Assert.assertEquals("内分泌科", d.getFollowUpDepartment());
        Assert.assertTrue(d.getAdvice().get(d.getAdvice().size() - 1).contains("3 日内"));
    }


    /**
     * 血压 182/112、血糖 8.1、ALT 130、肌酐 130、心率 105 → 多器官危急，首诊心内科
     */
    @Test
    public void shouldPrioritizeCardiologyForMultipleCriticalValues() {
        HealthScreeningReport r = base("RPT005", "M", 58);
        r.setSystolicBp(182);
        r.setDiastolicBp(112);
        r.setFastingGlucose(8.1);
        r.setTotalCholesterol(4.8);
        r.setBmi(26);
        r.setHeartRate(105);
        r.setAlt(130);
        r.setCreatinine(130);


        HealthScreeningDecision d = service.screen(r);


        Assert.assertEquals("CRITICAL", d.getHighestLevel());
        Assert.assertEquals(2, d.getCriticalCount());
        Assert.assertEquals(3, d.getHighCount());
        Assert.assertEquals("心血管内科", d.getFollowUpDepartment());
        Assert.assertTrue(d.getAdvice().get(0).contains("立即急诊排查高血压急症"));
        Assert.assertTrue(d.getAdvice().contains("【异常】谷丙转氨酶 130U/L：HIGH。消化/肝病科排查肝炎、脂肪肝等病因"));
    }


    /**
     * 心率 46 为 HIGH 首诊心内科；恢复到 54 后整体仅 BMI 消瘦关注
     */
    @Test
    public void shouldHandleBradycardiaAndRecovery() {
        HealthScreeningReport r = base("RPT006", "F", 34);
        r.setSystolicBp(118);
        r.setDiastolicBp(72);
        r.setFastingGlucose(4.9);
        r.setTotalCholesterol(4.6);
        r.setBmi(17.8);
        r.setHeartRate(46);
        r.setAlt(22);
        r.setCreatinine(65);


        HealthScreeningDecision d1 = service.screen(r);
        Assert.assertEquals("HIGH", d1.getHighestLevel());
        Assert.assertEquals(1, d1.getHighCount());
        Assert.assertEquals("心血管内科", d1.getFollowUpDepartment());
        Assert.assertTrue(d1.getAdvice().get(1).contains("尽快完善动态心电图检查"));


        r.setHeartRate(54);
        HealthScreeningDecision d2 = service.screen(r);
        Assert.assertEquals("ATTENTION", d2.getHighestLevel());
        Assert.assertTrue(d2.getAdvice().get(d2.getAdvice().size() - 1).contains("生活方式干预"));
    }


    private HealthScreeningReport base(String id, String gender, int age) {
        HealthScreeningReport r = new HealthScreeningReport();
        r.setReportId(id);
        r.setPersonName("测试受检人");
        r.setGender(gender);
        r.setAge(age);
        r.setSystolicBp(120);
        r.setDiastolicBp(80);
        r.setFastingGlucose(5.0);
        r.setTotalCholesterol(4.5);
        r.setBmi(22);
        r.setHeartRate(72);
        r.setAlt(25);
        r.setCreatinine(gender.equals("M") ? 80 : 65);
        r.setSmokingHistory(false);
        r.setFamilyHistory(false);
        return r;
    }
}

运行与实测

Section titled “运行与实测”

在工程根目录执行：

Terminal window
mvn test -Dtest=HealthScreeningServiceTest

测试覆盖形态（6 个 @Test 方法，覆盖全正常、临界簇、组合标签、危急值、多器官危急、恢复分叉）：

测试方法 业务形态 关键断言/期望决策
shouldReturnNormalForHealthyYoungMan RPT001 28 岁男性：血压 115/75、血糖 5.0、胆固醇 4.5、BMI 22、心率 70、ALT 25、肌酐 70 最高级 NORMAL、异常数 0、科室“全科/健康管理科”，首条建议含“各项指标正常”
shouldMarkFourBorderlineMetrics RPT002 42 岁男性：132/86、血糖 5.8、胆固醇 5.5、BMI 24.5（肌酐 85 仍在男性 NORMAL 档） ATTENTION、异常数 4、HIGH 数 0，首条建议以“【关注】血压”开头，末条含“生活方式干预”
shouldTagCardioRiskForHypertensiveSmoker RPT003 51 岁男性：血压 152/96 HIGH、胆固醇 6.5 HIGH、BMI 27 关注、吸烟史 HIGH、异常数 3、HIGH 数 2，含标签“心血管高风险（血压异常合并吸烟史）”、科室心血管内科、末条含“2 周内”
shouldFlagCriticalGlucoseWithFamilyHistory RPT004 47 岁女性：空腹血糖 7.2 CRITICAL、BMI 25.5 关注、糖尿病家族史 CRITICAL、CRITICAL 数 1，含标签“糖尿病高危人群（空腹血糖异常合并家族史）”、科室内分泌科、末条含“3 日内”
shouldPrioritizeCardiologyForMultipleCriticalValues RPT005 58 岁男性：血压 182/112、血糖 8.1 双 CRITICAL；心率 105、ALT 130、肌酐 130 三项 HIGH；BMI 26 关注 CRITICAL、CRITICAL 数 2、HIGH 数 3、科室心血管内科，首条含“立即急诊排查高血压急症”，并含“【异常】谷丙转氨酶 130U/L：HIGH。消化/肝病科排查肝炎、脂肪肝等病因”
shouldHandleBradycardiaAndRecovery RPT006 34 岁女性：心率 46（低于 50）HIGH、BMI 17.8 消瘦关注；同份报告心率改 54 首次 HIGH、HIGH 数 1、心血管内科，建议第 2 条含“尽快完善动态心电图检查”；恢复后最高级 ATTENTION、末条含“生活方式干预”

技术亮点

Section titled “技术亮点”
  • 医学阈值 XML 外置、随指南热更新：八项指标的分档线（含血糖 5.6/6.1/7.0、BMI 18.5/24/28/32 等）全部写在 health-screening.xml，指南改版或体检套餐调整时改 XML 重建代理即可，不动体检系统主程序。
  • 一指标一方法、双向异常独立表达：BMI 同时覆盖肥胖与消瘦、心率同时覆盖过速与过缓，各自独立成方法；ALT 以整数秩 0/1/2 返回再由 Java 映射，脚本只负责客观分档，可逐项调参与审计。
  • 组合风险因子在编排层贴标签：血压异常合并吸烟史、血糖异常合并家族史两条交叉规则由 Service 持有，风险标签与指标分级解耦，新增流行病学因子无需改动任何指标脚本。
  • 血压双值取高、科室按优先级短路：收缩压/舒张压经 higher 合并为一项计数；科室路由按心血管、内分泌、肾内、消化顺序短路，危急值多器官异常时首诊科室稳定可预期。
  • 整数秩比较与性别阈值参数化：Service 内用 0-3 秩比较四档级别；血肌酐通过 @Param("gender") 把性别按名注入脚本，男女两套阈值在同一方法内分支，无重复接口。
  • ASM 代理、Java 8 无重型依赖：接口动态代理单例复用、无外部进程与数据库，可直接嵌入区域公卫平台、医院体检系统等 JDK 8 与信创 JDK 环境。
Section titled “相关链接”