补来源：第 16 节第 3、4 条

2026-10-10。两条原来的来源栏都是「作者经验，无直接文献」，证据等级 C。

第 3 条（复查按医生给的间隔做，把每次的指标记在同一个本子上）：C → B，收益量级 中 → 小

查过的地方：

  • Europe PMC 检索 TITLE:"Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis"，命中 PMID 28926573。
  • Europe PMC 检索患者持有记录（patient-held records）的系统综述，命中四篇：Alsalem 2026 BMJ Open（只看用药差错的发现，终点不是健康结局）、Joseph 2021 BMJ Open（原文「no studies reported on health outcomes after using PHRs」）、Sartain 2015（质性研究）、Schoevers 2009。四篇都没有看健康结局的数字，所以「记在一个本子上」本身没有可引的效果证据，备注里写明了这一点。
  • gov.cn 政策文件库（Invoke-WebRequest，searchfield=title；curl 直连该接口这次一律返回「没有找到相关结果」，换 PowerShell 才正常）检索「检查检验结果互认管理办法」，命中国卫医发〔2022〕6 号。
  • 「国家基本公共卫生服务规范」在政策库按标题检索无结果，没再追；条目写的是「按医生给的间隔」，不需要具体随访次数。

关键原文：

  • Tucker 2017，https://doi.org/10.1371/journal.pmed.1002389：「Data for the primary outcomes … were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support.」结论：「Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction」。
  • 国卫医发〔2022〕6 号，https://www.gov.cn/zhengce/zhengceku/2022-02/19/content_5674575.htm：第十三条「医疗机构检查检验结果互认标志统一为HR……如：“全国HR”“京津冀HR”」；第十七条「对于患者提供的已有检查检验结果符合互认条件、满足诊疗需要的，医疗机构及其医务人员不得重复进行检查检验。」第十九条列了可以重查的六种情形（病情变化、结果变化快、手术输血等重大措施前、急诊急救、司法伤残病退鉴定、其他）。

为什么升 B、不升 A：Tucker 是随机试验的个体数据汇总，本身够 A，但只覆盖高血压一种病、终点只到血压，和条目「复查加记录」是间接对应。按 CLAUDE.md 死亡率口径「只有替代终点 = 小」，收益量级由原来凭感觉定的「中」机械改成「小」。互认办法给的是换医院省钱那一半的依据，不改变口径。

说人话改写：原来那句「记日期、指标、药和剂量」留在备注，说人话改成收益栏里有依据的三件事：只量不调药没用、带给医生调药才有用、带互认标志的结果医院不该让重做。

第 4 条（别为了试偏方、保健品停掉正规治疗）：C → B，收益量级维持 大

查过的地方：

  • Europe PMC 检索两篇 Johnson 2018 的标题，拿到摘要原文；Crossref 核了 JNCI 那篇的卷期页（110(1):121-124），Europe PMC 给了 JAMA Oncology 那篇的卷期页（4(10):1375-1381，PMC6233773）。
  • samr.gov.cn 发布会页（第 6 节第 10 条已在用）用无头 Chrome 重抓一次，确认原句仍在。
  • NCCIH 圣约翰草页面，curl 带代理取到，页尾「Last Updated: May 2025」。

关键原文：

  • Johnson 2018 JNCI，https://doi.org/10.1093/jnci/djx145：「We identified 281 patients with nonmetastatic breast, prostate, lung, or colorectal cancer who chose AM, administered as sole anticancer treatment among patients who did not receive conventional cancer treatment (CCT), defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy.」「AM use was independently associated with greater risk of death compared with CCT overall (hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.88 to 3.27) and in subgroups with breast (HR = 5.68, 95% CI = 3.22 to 10.04), lung (HR = 2.17, 95% CI = 1.42 to 3.32), and colorectal cancer (HR = 4.57, 95% CI = 1.66 to 12.61).」摘要没给前列腺癌亚组的数字，条目里也就没写。
  • Johnson 2018 JAMA Oncology，https://doi.org/10.1001/jamaoncol.2018.2487：「Patients who chose CM did not have a longer delay to initiation of CCT but had higher refusal rates of surgery (7.0% [18 of 258] vs 0.1% [1 of 1031]; P < .001), chemotherapy (34.1% [88 of 258] vs 3.2% [33 of 1032]; P < .001), radiotherapy (53.0% [106 of 200] vs 2.3% [16 of 711]; P < .001), and hormone therapy (33.7% [87 of 258] vs 2.8% [29 of 1032]; P < .001). Use of CM was associated with poorer 5-year overall survival compared with no CM (82.2% [95% CI, 76.0%-87.0%] vs 86.6% [95% CI, 84.0%-88.9%]; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) … there was no significant association between CM and survival once treatment delay or refusal was included in the model (hazard ratio, 1.39; 95% CI, 0.83-2.33).」「The results suggest that mortality risk associated with CM was mediated by the refusal of CCT.」
  • 市场监管总局发布会，https://www.samr.gov.cn/tssps/sjdt/tpxw/art/2023/art_4b658b824b1b4b0ba57c09a56cc93aad.html：「《指南》提出，在标签上标注“保健食品不是药物，不能代替药物治疗疾病”警示语」。
  • NCCIH，https://www.nccih.nih.gov/health/st-johns-wort：「St. John’s wort can weaken the effects of many medicines, including crucially important medicines such as: … Cyclosporine, which prevents the body from rejecting transplanted organs … Warfarin, an anticoagulant (blood thinner)」。原说人话和备注里「影响抗凝药、抗排异药在血里的浓度」没有出处，改成按这句写的「减弱作用」，并挪进收益栏，说人话才有依据。

为什么升 B、不升 A：两篇都是美国国家癌症数据库的回顾性跟踪数据，暴露组只有两三百人，只覆盖癌症；没有分组对照，残余混杂不能排除。数字明确、方向一致，够 B。没找到方向相反的研究，不标争议。收益量级：HR 2.50 远超 20%，按阈值仍是「大」。

原来的来源「相关证据见第 6 节」改成备注里的带锚点引用：第 6 节第 10 条（保健品、膏方、滋补品）。另加一处本节内引用：第 1 条（药按医嘱吃满），慢性病停药的总死亡率账在那里。

自检

node tools/check-plain.mjs：676 条全部合格。node tools/check-refs.mjs --check：1388 处全部通过（本轮新增 3 处带锚点引用：第 24 节第 5 条、本节第 1 条、第 6 节第 10 条）。