马丁法在冠状动脉粥样硬化中估算低密度脂蛋白胆固醇的有用性。
Usefulness of the Martin Method for Estimation of Low-Density Lipoprotein Cholesterol in Coronary Atherosclerosis.
机构信息
Department of Laboratory Medicine, Seoul National University College of Medicine and Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea.
出版信息
Med Princ Pract. 2018;27(1):8-14. doi: 10.1159/000485977. Epub 2017 Dec 4.
OBJECTIVE
This study was conducted to validate the Martin method in coronary atherosclerosis in comparison with the Friedewald equation.
SUBJECTS AND METHODS
A total of 299 participants with a coronary artery calcium score (CACS) ≥300 and a serum triglyceride (TG) level <400 mg/dL at Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea, were enrolled in this study. Low-density lipoprotein cholesterol (LDL-C) was directly measured with a homogeneous assay (DLDL) and estimated by both the Friedewald equation (FLDL) and Martin method (MLDL). Overall concordances between DLDL and LDL-C estimates were calculated as the percent agreement. The McNemar test was used to compare the rate of reclassification of participants with FLDL and MLDL, and to determine which differed significantly from each other.
RESULTS
Overall concordance between DLDL and MLDL was slightly higher than that between DLDL and FLDL (73.2 vs. 70.9%, p < 0.001). The FLDL showed poor performance when the TG level was ≥200 mg/dL, mostly by underestimation, which represented a 64.7% discordance with DLDL. The reclassification rate by MLDL, however, did not exceed 35.3% in all of the TG groups.
CONCLUSIONS
The Martin method to estimate LDL-C using the strata-specific TG:VLDL ratio showed a 2-fold better concordance with LDL-C measured with a direct homogeneous assay in coronary atherosclerosis compared to the Friedewald equation when the TG level was ≥200 mg/dL. This finding suggests that MLDL could be a better alternative for estimating LDL-C compared to FLDL when the TG level is ≥200 mg/dL in coronary atherosclerosis.
目的
本研究旨在通过与 Friedewald 方程比较，验证 Martin 法在冠状动脉粥样硬化中的应用。
对象与方法
本研究共纳入 299 例在韩国首尔国立大学医院保健系统江南中心冠状动脉钙化评分（CACS）≥300 且血清甘油三酯（TG）水平＜400mg/dL 的患者。采用均相法（DLDL）直接测量低密度脂蛋白胆固醇（LDL-C），并通过 Friedewald 方程（FLDL）和 Martin 法（MLDL）进行估计。以一致率计算 DLDL 与 LDL-C 估计值之间的总体一致性。采用 McNemar 检验比较 FLDL 和 MLDL 对患者的重新分类率，并确定彼此之间存在显著差异的方法。
结果
DLDL 与 MLDL 之间的总体一致性略高于 DLDL 与 FLDL 之间的一致性（73.2% vs. 70.9%，p＜0.001）。当 TG 水平≥200mg/dL 时，FLDL 表现不佳，主要表现为低估，与 DLDL 的不一致性达 64.7%。然而，在所有 TG 组中，MLDL 的重新分类率均未超过 35.3%。
结论
在 TG 水平≥200mg/dL 的冠状动脉粥样硬化患者中，与 Friedewald 方程相比，采用基于 TG:VLDL 比值的特定分层 Martin 法估计 LDL-C 与直接均相法测量 LDL-C 的一致性提高了 2 倍。这一发现表明，在 TG 水平≥200mg/dL 的冠状动脉粥样硬化患者中，与 FLDL 相比，MLDL 可能是一种更好的 LDL-C 估计替代方法。
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