Yamakado Minoru
Rinsho Byori. 2016 Mar;64(3):270-7.
Reference intervals (RIs) were derived from records of 1,499,288 individuals who underwent ningen dock examination in 188 institutes which belong to Japan Society of Ningen Dock in 2012.
Targets were 27 basic laboratory tests, including the body mass index (BMI) and systolic and diastolic blood pressures (SBP, DBP). Individuals fulfilling strict criteria were chosen: SBP < 130, DBP < 85 mmHg, BMI < 25 Kg/m2, non-smoking, ethanol consumption < 20 g/day, under no medication, with no remarkable current/past illness. The latent abnormal values exclusion (LAVE) method was applied to ensure normal results. RLs were derived using a parametric method with modified Box-Cox power transformation.
Among all attendees, 23% fulfilled the criteria. Application of the LAVE method further reduced the dataset by 40-50%. RIs without distinction of the sex and age were SBP, DBP, TP, TB, MCV, WBC, and Plt. Sex-specific RIs were BMI, CRE, UA, TG, HDL-C, ALT, GGT, Glu, RBC, Hb, and Ht. Age-specific RIs in either sex were Alb, AST, HbA1c, TC, LDL-C, FW-LDL-C, nonHDL-C, and ALP. An age-specific RI without distinction of the sex was eGFR. Comparison of derived RIs with clinical decision limits (CDLs) revealed that the upper limits of RIs differed from CDLs according to the sex and age.
Implementation of sex- and age-related RIs derived from individuals with fully normal ningen dock results will enable the appropriate interpretation of test results in health screening, and promote the effective application of CDLs for therapeutic intervention, taking into account the sex, age, and other health attributes.
参考区间（RIs）来源于2012年在日本健康体检协会所属的188家机构接受健康体检的1,499,288人的记录。
目标检测项目为27项基本实验室检查，包括体重指数（BMI）、收缩压和舒张压（SBP、DBP）。选择符合严格标准的个体：收缩压<130、舒张压<85 mmHg、BMI<25 Kg/m²、不吸烟、乙醇摄入量<20 g/天、未服药、无明显当前/既往疾病。应用潜在异常值排除（LAVE）方法确保结果正常。参考区间采用改良Box-Cox幂变换的参数方法得出。
在所有参与者中，23%符合标准。LAVE方法的应用进一步使数据集减少了40 - 50%。不分性别和年龄的参考区间为收缩压、舒张压、总蛋白、总胆红素、平均红细胞体积、白细胞计数和血小板计数。按性别划分的参考区间为BMI、肌酐、尿酸、甘油三酯、高密度脂蛋白胆固醇、谷丙转氨酶、谷氨酰转肽酶、血糖、红细胞计数、血红蛋白和血细胞比容。无论男女按年龄划分的参考区间为白蛋白、谷草转氨酶、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇、致动脉粥样硬化低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和碱性磷酸酶。不分性别的按年龄划分的参考区间为估算肾小球滤过率。将得出的参考区间与临床决策限（CDLs）进行比较，结果显示参考区间的上限因性别和年龄而异。
采用健康体检结果完全正常的个体得出的与性别和年龄相关的参考区间，将有助于在健康筛查中对检测结果进行恰当解读，并促进临床决策限在治疗干预中的有效应用，同时考虑到性别、年龄和其他健康属性。
