门诊患者总胆固醇同步检测低密度脂蛋白胆固醇非必要性分析
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江苏省“科教强卫”医学重点人才项目(ZDRCA2016053),江苏省江苏省“六大人才高峰”项目(WSN-135),江苏省“六个一”工程项目(LGY2016042)


Unnecessary to detect low⁃density lipoprotein cholesterol for the test of blood total cholesterol in outpatients
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    摘要:

    目的:评估门诊患者首次检测血脂时,是否需要同步检测低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDLC),以实现医学检验的分级检测,减少医学检验人员的劳动量和降低医疗费用。方法:回顾性分析,以近4年同步检测总胆固醇(total cholesterol,CHO)、甘油三酯(triglycerides,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDLC)和LDLC的门诊患者作为研究对象。非高密度脂蛋白胆固醇(non-high-density lipoprotein cholesterol,nonHDLC)=CHO-HDLC。指标间相关性采用spearman相关分析。利用受试者工作特征曲线(receiver operating characteristic,ROC)曲线预测LDLC异常与否。结果:LDLC与CHO、nonHDLC相关系数分别为0.843、0.862。CHO和nonHDLC预测升高的LDLC(>3.4 mmol/L和>4.1 mmol/L)的ROC曲线下面积分别为0.941和0.948、0.967和0.970,两者预测性能有显著性差异(P<0.001)。以LDLC>3.4 mmol/L和>4.1 mmol/L为阳性时,最佳阈值nonHDLC分别为3.85 mmol/L和4.33 mmol/L时,启动LDLC检测,nonHDLC预测LDLC阳性结果的敏感性为91.1%和97.6%,特异性为85.4%和87.3%。节约LDLC测试为66.3%和80.6%,LDLC阳性漏检测率为3.33%和0.16%。结论:门诊患者首次检测血脂时,不必检测LDLC。估计65%以上的LDLC不用检测。以nonHDLC预测LDLC阳性优于CHO。

    Abstract:

    Objective:To assess whether the first blood lipid test in outpatients is necessary to detect low-density lipoprotein cholesterol(LDLC) in order to achieve grading test of medical examination,reduce the labor of medical inspectors and reduce medical expenses. Methods:Total cholesterol(CHO),triglycerides(TG),high-density lipoprotein cholesterol(HDLC),and LDLC data were obtained from Laboratory Information System(LIS) based on outpatients in 4 years(2013-2017). CHO,HDLC and LDLC were measured using TBA2000FR biochemical analyzer. nonHDLC was calculated with CHO minus HDLC. Correlation between CHO,nonHDLC and LDLC were analyzed using Spearman’s rank approach. Receiver operating characteristics(ROC) curve analysis was used to evaluate the predictive of CHO and nonHDLC for abnormal LDLC. Results:Both CHO(r=0.843)and nonHDLC(r=0.862)were significantly positively correlated with LDLC. Area under curve of CHO and nonHDLC for predicting abnormal LDLC(>3.40 mmol/L and>4.10 mmol/L)were 0.941 and 0.948,0.967 and 0.970,respectively(P<0.001). Optimal thresholds of prediction abnormal LDLC were 3.85 mmol/L and 4.33 mmol/L for nonHDLC. Based on these optimal thresholds,the sensitivity of nonHDLC to predict LDLC positive results was 91.1% and 97.6%,and the specificity was 85.4% and 87.3%,respectively. Less than 3.33% and 0.16% of tests with abnormal LDLC might be missed,but approximately 66.3% and 80.6% of the LDLC tests could be eliminated. Conclusion:We recommend that LDLC measurement is not necessary for the first test of blood lipids in outpatients. About 65% of LDLC tests would be reduced. Moreover,nonHDLC is a better index than CHO to predict abnormal LDLC.

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张国明,张高明,杨 莉,顾 兵.门诊患者总胆固醇同步检测低密度脂蛋白胆固醇非必要性分析[J].南京医科大学学报(自然科学版),2018,(11):1643-1647

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  • 收稿日期:2017-08-17
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  • 在线发布日期: 2018-12-03
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