Hostetter A L
Department of Pathology, Rockingham Memorial Hospital, Harrisonburg, Virginia, USA.
Am J Clin Pathol. 1995 Apr;103(4):380-5. doi: 10.1093/ajcp/103.4.380.
Screening for serum lipid disorders is recommended by numerous specialty societies to identify patients at risk for coronary heart disease (CHD). The best screening tests will identify patients at highest risk for CHD who would benefit from intervention. This report discusses an appropriate test panel to use as the initial screen on a healthy outpatient population, and the required accuracy and precision of the tests from the Laboratory Medicine perspective. Controversy exists regarding which methods to use and at what age testing should begin. The following parameters will be modified as studies continue and new tests are developed. The recommendations are as follows: (1) Total serum cholesterol (TC) and high density lipoprotein-cholesterol (HDL-C) are presently the recommended screening tests for dyslipidemia in the general population; (2) The National Cholesterol Education Program (NCEP) recommends measuring TC and HDL-C in adults with a single sample at 5-year intervals beginning at age 20; (3) The NCEP recommends measuring TC in children with at least one parent having TC > or = 6.24 mmol/L (> or = 240 mg/dL); (4) The NCEP recommends a lipoprotein analysis consisting of a 12-hour fasting TC, HDL-C, triglyceride, and estimated low density lipoprotein-cholesterol (LDL-C) in adults with the following results: (a) TC > or = 6.24 mmol/L (> or = 240 mg/dL); (b) borderline TC of 5.20-6.23 mmol/L (200-239 mg/dL) and HDL-C < 0.91 mmol/L (< 35 mg/dL) or two or more risk factors; (c) desirable TC of < 5.20 mmol/L (< 200 mg/dL), but HDL-C < 0.91 mmol/L (< 35 mg/dL); (5) The NCEP recommends a lipoprotein analysis in children with documented CHD in a parent or grandparent, or in children that have a TC of > or = 5.20 mmol/L (> or = 200 mg/dL); (6) Two or three separate lipoprotein analyses should be done to confirm the LDL-C result before therapeutic intervention. Specimens should be tested from 1 to 8 weeks apart and the results averaged to account for physiologic variability; (7) Enzymatic methods are preferred for TC determination, and should be standardized and traceable to the reference method and materials at the Centers for Disease Control and Prevention (CDC); (8) The analytic method for TC should have a bias against the reference method of < 3% and a within laboratory reproducibility of < 3% coefficient of variation; (9) Chemical precipitation methods are preferred for HDL-C determination.(ABSTRACT TRUNCATED AT 250 WORDS)
众多专业学会都建议进行血清脂质紊乱筛查，以识别冠心病（CHD）风险患者。最佳的筛查测试应能识别出从干预中获益的、患冠心病风险最高的患者。本报告讨论了一种适用于健康门诊人群初始筛查的测试组合，以及从检验医学角度来看这些测试所需的准确性和精密度。关于使用何种方法以及应从什么年龄开始检测存在争议。随着研究的继续和新测试的开发，以下参数将会修改。建议如下：（1）目前，总血清胆固醇（TC）和高密度脂蛋白胆固醇（HDL-C）是一般人群血脂异常的推荐筛查测试；（2）国家胆固醇教育计划（NCEP）建议，从20岁开始，成年人每5年用单一样本测量一次TC和HDL-C；（3）NCEP建议，父母中至少有一方TC≥6.24 mmol/L（≥240 mg/dL）的儿童测量TC；（4）NCEP建议，对以下结果的成年人进行脂蛋白分析，包括12小时空腹TC、HDL-C、甘油三酯和估算的低密度脂蛋白胆固醇（LDL-C）：（a）TC≥6.24 mmol/L（≥240 mg/dL）；（b）临界TC为5.20 - 6.23 mmol/L（200 - 239 mg/dL）且HDL-C＜0.91 mmol/L（＜35 mg/dL）或有两个或更多风险因素；（c）理想TC＜5.20 mmol/L（＜200 mg/dL），但HDL-C＜0.91 mmol/L（＜35 mg/dL）；（5）NCEP建议，父母或祖父母有确诊冠心病的儿童，或TC≥5.20 mmol/L（≥200 mg/dL）的儿童进行脂蛋白分析；（6）在进行治疗干预前，应进行两到三次单独的脂蛋白分析以确认LDL-C结果。样本应相隔1至8周进行检测，并将结果平均以考虑生理变异性；（7）TC测定首选酶法，且应标准化并可溯源至疾病控制与预防中心（CDC）的参考方法和材料；（8）TC的分析方法相对于参考方法的偏差应＜3%，实验室内重复性变异系数应＜3%；（9）HDL-C测定首选化学沉淀法。（摘要截取自250词）
