Sikaris Kenneth A
Sonic Healthcare and Department of Pathology, University of Melbourne, Vic. 3010, Australia.
Clin Biochem Rev. 2014 Feb;35(1):3-14.
Reference intervals are ideally defined on apparently healthy individuals and should be distinguished from clinical decision limits that are derived from known diseased patients. Knowledge of physiological changes is a prerequisite for understanding and developing reference intervals. Reference intervals may differ for various subpopulations because of differences in their physiology, most obviously between men and women, but also in childhood, pregnancy and the elderly. Changes in laboratory measurements may be due to various physiological factors starting at birth including weaning, the active toddler, immunological learning, puberty, pregnancy, menopause and ageing. The need to partition reference intervals is required when there are significant physiological changes that need to be recognised. It is important that laboratorians are aware of these changes otherwise reference intervals that attempt to cover a widened inter-individual variability may lose their usefulness. It is virtually impossible for any laboratory to directly develop reference intervals for each of the physiological changes that are currently known, however indirect techniques can be used to develop or validate reference intervals in some difficult situations such as those for children. Physiology describes our life's journey, and it is only when we are familiar with that journey that we can appreciate a pathological departure.
参考区间理想上是在表面健康的个体上定义的，并且应该与从已知患病患者得出的临床决策界限区分开来。了解生理变化是理解和制定参考区间的先决条件。由于不同亚人群的生理差异，参考区间可能有所不同，最明显的是男性和女性之间，但在儿童期、孕期和老年期也存在差异。实验室测量值的变化可能归因于从出生开始的各种生理因素，包括断奶、活跃的幼儿期、免疫学习、青春期、怀孕、更年期和衰老。当存在需要识别的重大生理变化时，就需要划分参考区间。重要的是，实验室工作人员要意识到这些变化，否则试图涵盖更广泛个体间变异性的参考区间可能会失去其效用。实际上，任何实验室都不可能直接为目前已知的每一种生理变化制定参考区间，然而在一些困难情况下，如针对儿童的情况，可以使用间接技术来制定或验证参考区间。生理学描述了我们生命的历程，只有当我们熟悉了这段历程，我们才能认识到病理性的偏离。
