Casparie M K, Stuyt P M
Academisch Ziekenhuis St Radboud, Kliniek voor Inwendige Ziekten, afd. Algemene Interne Geneeskunde, Nijmegen.
Ned Tijdschr Geneeskd. 1991 Feb 9;135(6):221-5.
The aim of this study was to evaluate the decision of the Dutch Cholesterol Consensus Meeting in 1987 to screen selected groups of persons for the identification of individuals with hypercholesterolemia. During 8 weeks serum cholesterol levels were measured in all 305 newly referred patients to the outpatient clinic of general internal medicine of the University Hospital Nijmegen. Information on age, sex, smoking habits and the selection variables was obtained. Of the patients 4 were referred because of hypercholesterolemia, 11 were excluded because of disease which could influence cholesterol levels. The results of 270 patients were available for evaluation. For statistical analysis the t test and linear and logistic regression analysis were used. Of the patients 87 individuals (32%) would have been candidates for selective screening; in 20 (23%) serum cholesterol levels were increased (greater than or equal to 6.5 mmol/l). Selective screening would have identified 20 of 42 hypercholesterolemic individuals (48%). Age showed a significant correlation with serum cholesterol levels (p less than 0.001); after correction for age, selective screening did not identify more hypercholesterolemic patients (p greater than 0.4). The serum cholesterol level appeared to be higher in the group meeting the selection criteria (p = 0.04). Among these criteria only hypertension was significantly correlated with serum cholesterol levels (p = 0.02) but sensitivity and predictive value for hypercholesterolemia were low. To identify a larger proportion of hypercholesterolemic individuals selective screening does not appear useful. If selective screening is chosen however, it should focus on hypertensive patients, also because the identification of patients with several risk factors is important from a prevention point of view.
本研究的目的是评估1987年荷兰胆固醇共识会议关于筛查特定人群以识别高胆固醇血症患者的决定。在8周内，对奈梅亨大学医院普通内科门诊新收治的所有305例患者进行了血清胆固醇水平测量。获取了有关年龄、性别、吸烟习惯和选择变量的信息。其中4例患者因高胆固醇血症被转诊，11例因可能影响胆固醇水平的疾病被排除。270例患者的结果可供评估。统计分析采用t检验、线性回归分析和逻辑回归分析。在这些患者中，87人（32%）可能是选择性筛查的对象；20人（23%）血清胆固醇水平升高（大于或等于6.5 mmol/l）。选择性筛查本可识别出42例高胆固醇血症患者中的20例（48%）。年龄与血清胆固醇水平显著相关（p<0.001）；校正年龄后，选择性筛查并未识别出更多高胆固醇血症患者（p>0.4）。符合选择标准的人群血清胆固醇水平似乎更高（p = 0.04）。在这些标准中，只有高血压与血清胆固醇水平显著相关（p = 0.02），但对高胆固醇血症的敏感性和预测价值较低。为了识别更大比例的高胆固醇血症患者，选择性筛查似乎并无用处。然而，如果选择选择性筛查，应侧重于高血压患者，这也是因为从预防角度来看，识别具有多种危险因素的患者很重要。
