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.
J Pediatr. 1990 Sep;117(3):358-63. doi: 10.1016/s0022-3476(05)81073-x.
We compared the efficacy of two screening tests, measurement of apolipoprotein B (apo B) levels and measurement of serum total cholesterol levels, in detecting elevated low-density lipoprotein cholesterol (LDL-C) values in children. We studied 2850 children, aged 5 to 17 years, who had fasting lipid, lipoprotein, and apolipoprotein levels measured as part of the Bogalusa Heart Study. The test characteristics of apo B were superior to those of serum total cholesterol in screening children to detect elevated levels of LDL-C (greater than or equal to 95th percentile) and moderately elevated LDL-C levels (greater than or equal to 80th percentile). Unusually high or low values of high-density lipoprotein cholesterol are responsible for most of the misclassification that occurs when measurement of total cholesterol is used as a screening test for identifying children with elevated levels of LDL-C. This confounding effect of high-density lipoprotein cholesterol was eliminated when measurement of apo B levels was used as a screening test. Because the apo B test is more specific at a given sensitivity than the total cholesterol test, the apo B test can cost more and still be less expensive as a screening strategy. As the methods for determining apolipoprotein levels become standardized and readily available, the measurement of apolipoproteins could be developed into superior screening tests for the identification of patients with dyslipidemias.
我们比较了两种筛查试验，即载脂蛋白B（apo B）水平测定和血清总胆固醇水平测定，在检测儿童低密度脂蛋白胆固醇（LDL-C）水平升高方面的效果。我们研究了2850名5至17岁的儿童，他们作为博加卢萨心脏研究的一部分，进行了空腹血脂、脂蛋白和载脂蛋白水平的测量。在筛查儿童以检测LDL-C水平升高（大于或等于第95百分位数）和中度升高的LDL-C水平（大于或等于第80百分位数）方面，apo B的检测特性优于血清总胆固醇。当使用总胆固醇测量作为筛查试验来识别LDL-C水平升高的儿童时，大多数错误分类是由高密度脂蛋白胆固醇的异常高值或低值引起的。当使用apo B水平测量作为筛查试验时，高密度脂蛋白胆固醇的这种混杂效应被消除了。因为在给定的灵敏度下，apo B试验比总胆固醇试验更具特异性，所以作为一种筛查策略，apo B试验成本可能更高，但仍然更便宜。随着测定载脂蛋白水平的方法变得标准化且易于获得，载脂蛋白的测量可以发展成为用于识别血脂异常患者的更优筛查试验。
