Dennison B A, Kikuchi D A, Srinivasan S R, Webber L S, Berenson G S
Department of Pediatrics, Louisiana State University Medical Center, New Orleans 70112-2865.
Pediatrics. 1990 Apr;85(4):472-9.
The use of serum total cholesterol measurement was evaluated as a screening tool to predict elevated levels of low-density lipoprotein cholesterol in 2857 children and adolescents, aged 5 to 17 years, examined in 1981 and 1982. Subjects were from the biracial community of Bogalusa, Louisiana. For selected serum total cholesterol values (150 to 210 mg/dL, 3.88 to 5.43 mmol/L), sensitivities were higher for blacks than whites and higher for females than males, whereas the positive predictive values were higher for whites than blacks and higher for males than females. With the age-, race-, and sex-specific 95th percentiles of serum total cholesterol levels as cutoff points, only 44% to 50% of subjects with elevated low-density lipoprotein cholesterol levels (greater than or equal to 95th percentile) were detected, and approximately 50% of those identified had false-positive results. Lowering the serum total cholesterol cutoff point increased the sensitivity, but decreased the specificity and positive predictive value. At the 75th percentiles of serum total cholesterol levels, sensitivities were 92% to 95% for females and 100% for males and specificities were 78% to 79%, but the false-positive results increased to 81% to 84%. The low cost and ease of obtaining serum total cholesterol measurements contribute to its appeal as a screening tool for hyperlipidemia. However, its poor test characteristics make serum total cholesterol measurement inefficient as a screening tool for detecting elevated levels of low-density lipoprotein cholesterol in children and adolescents.
1981年和1982年，对2857名年龄在5至17岁的儿童和青少年进行了研究，评估血清总胆固醇测量作为预测低密度脂蛋白胆固醇水平升高的筛查工具的效用。研究对象来自路易斯安那州博加卢萨的混血社区。对于选定的血清总胆固醇值（150至210mg/dL，3.88至5.43mmol/L），黑人的敏感性高于白人，女性高于男性，而白人的阳性预测值高于黑人，男性高于女性。以血清总胆固醇水平的年龄、种族和性别特异性第95百分位数为切点，仅检测出44%至50%的低密度脂蛋白胆固醇水平升高（大于或等于第95百分位数）的受试者，并且约50%被识别出的受试者有假阳性结果。降低血清总胆固醇切点可提高敏感性，但会降低特异性和阳性预测值。在血清总胆固醇水平的第75百分位数时，女性的敏感性为92%至95%，男性为100%，特异性为78%至79%，但假阳性结果增加到81%至84%。血清总胆固醇测量成本低且易于获得，这使其作为高脂血症筛查工具具有吸引力。然而，其较差的检测特性使得血清总胆固醇测量作为检测儿童和青少年低密度脂蛋白胆固醇水平升高的筛查工具效率低下。
