Sarangi Rajlaxmi, Bahinipati Jyotirmayee, Pathak Mona, Mahapatra Srikrushna
Department of Biochemistry, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India.
Department of Biostatistics, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India.
J Family Med Prim Care. 2021 Jan;10(1):327-332. doi: 10.4103/jfmpc.jfmpc_1734_20. Epub 2021 Jan 30.
With the change in the National Cholesterol Education Program ATP III guidelines, the risk of developing atherosclerosis has been now focused on total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Different treatment modalities are now targeted at lowering LDL cholesterol values. Hence greater emphasis is now led on the accurate and precise measurement of LDL cholesterol. Beta-quantification, though, is the best reference method for LDL cholesterol estimation, it has the disadvantage of being inconvenient in our routine practice. The new generation direct homogenous assay is now the method of choice. But being more expensive, various calculated methods have now been developed. This study is an attempt to compare different calculated formula with direct cholesterol assessment and to find out the best one.
We compared LDL cholesterol measured by direct homogenous assay with the data mining approach (DM) and another calculated formula [Friedewald's Formula (FF) and Anandaraja Formula (AF)] in 266 samples with age greater than 18 years. Enrolled participants were divided into seven groups based upon their TG levels. Mean, percentage difference, and the correlation coefficient was assessed between calculated and direct LDL. Bland-Altman analysis was done to see the agreement between calculated vs direct LDL. All formulas were assessed among various TG levels with direct LDL by the Wilcoxon sign rank test.
1% level of significance was found between calculated and direct LDL with TG < 600 mg/dl. Mean and the percentage difference between direct and calculated LDL was lowest with the DM approach. Bland-Altman plot shows the best agreement of the DM approach with direct LDL.
This study indicates that the DM approach is closer to direct LDL compared to FF & AF.
随着国家胆固醇教育计划成人治疗组第三次报告（ATP III）指南的变化，动脉粥样硬化的发病风险目前已聚焦于总胆固醇和低密度脂蛋白（LDL）胆固醇水平。现在不同的治疗方式都旨在降低LDL胆固醇值。因此，目前更加强调LDL胆固醇的准确精确测量。虽然β定量法是LDL胆固醇估算的最佳参考方法，但在我们的日常实践中它存在不便之处。新一代直接匀相测定法现在是首选方法。但由于成本较高，现已开发出各种计算方法。本研究旨在比较不同的计算公式与直接胆固醇评估方法，并找出最佳方法。
我们将直接匀相测定法测得的LDL胆固醇与数据挖掘方法（DM）以及另一种计算公式[弗里德瓦尔德公式（FF）和阿南达拉贾公式（AF）]在266例年龄大于18岁的样本中进行了比较。根据甘油三酯（TG）水平将纳入的参与者分为七组。评估计算得出的LDL与直接测量的LDL之间的均值、百分比差异和相关系数。采用布兰德-奥特曼分析来观察计算得出的LDL与直接测量的LDL之间的一致性。通过威尔科克森符号秩检验在不同TG水平下用直接测量的LDL对所有公式进行评估。
在TG<600mg/dl时，计算得出的LDL与直接测量的LDL之间存在1%的显著水平差异。DM方法得出的直接LDL与计算得出的LDL之间均值和百分比差异最低。布兰德-奥特曼图显示DM方法与直接测量的LDL一致性最佳。
本研究表明，与FF和AF相比，DM方法更接近直接测量的LDL。
