Secchiero Sandra, Sciacovelli Laura, Zardo Lorena, Plebani Mario
Centro di Ricerca Biomedica, Via Ospedale, 18, 31033 Castelfranco Veneto, Treviso, Italy.
Clin Chim Acta. 2003 Jul 15;333(2):221-30. doi: 10.1016/s0009-8981(03)00189-x.
The recommendations of the Second Joint Task Force of European and Other Societies on Coronary Prevention and the third Adult Treatment Panel report (ATPIII) released by the National Cholesterol Education Program are based on accumulating evidence concerning the contribution of lipoproteins and other risk factors in the development of coronary heart disease (CHD). The laboratories play an important role in the successful adoption of these guidelines.
In External Quality Assessment (EQA) programs managed by the Center of Biomedical Research, results and respective reference intervals (RI) are sent as laboratory's medical form. We assessed how well the 200 participants to EQA scheme 2002 for clinical biochemistry reported total cholesterol (TC) and triglycerides (TGs) results according to either European or National Cholesterol Education Program (NCEP) guidelines.
Only 18% of laboratories reported total cholesterol concentrations correctly in terms of desirable, borderline-high, and high risk for the CHD development, 12% reported a single desirable value (180, 190, or 200 mg/dl), and 70% reported the RI (85 laboratories in the whole interval, 34 are the only upper reference limit and 15 are the desirable value in addition to RI). The upper reference limit was 200 mg/dl in 65% of cases, but 32% of laboratories presented higher limits, reaching values as high as 250-260 mg/dl. Only the 3.7% of laboratories reported triglyceride concentrations in terms of risk-oriented ranges for the CHD development, 6.8% the single desirable value, and 89.5% the RI.
Our study demonstrates that the current practice of reporting results for cholesterol and triglycerides does not follow the guidelines, and appropriate changes are required to be made.
欧洲及其他学会关于冠心病预防的第二次联合特别工作组的建议以及美国国家胆固醇教育计划发布的第三次成人治疗小组报告（ATPIII）是基于有关脂蛋白和其他危险因素在冠心病（CHD）发生中作用的越来越多的证据。实验室在成功采用这些指南方面发挥着重要作用。
在由生物医学研究中心管理的外部质量评估（EQA）计划中，结果和各自的参考区间（RI）作为实验室的医学表格发送。我们评估了2002年临床生物化学EQA计划的200名参与者根据欧洲或美国国家胆固醇教育计划（NCEP）指南报告总胆固醇（TC）和甘油三酯（TGs）结果的情况。
就冠心病发生的理想、临界高和高风险而言，只有18%的实验室正确报告了总胆固醇浓度，12%报告了单一的理想值（180、190或200mg/dl），70%报告了参考区间（整个区间有85个实验室，34个仅报告了上限参考值，15个除参考区间外还报告了理想值）。65%的情况下上限参考值为200mg/dl，但32%的实验室给出了更高的限值，高达250 - 260mg/dl。就冠心病发生的风险导向范围而言，只有3.7%的实验室报告了甘油三酯浓度，6.8%报告了单一的理想值，89.5%报告了参考区间。
我们的研究表明，目前胆固醇和甘油三酯结果的报告做法未遵循指南，需要进行适当更改。
