Diller P M, Huster G A, Leach A D, Laskarzewski P M, Sprecher D L
Department of Family Medicine, University of Cincinnati, Ohio 45267-0540.
J Pediatr. 1995 Mar;126(3):345-52. doi: 10.1016/s0022-3476(95)70446-9.
(1) To propose definitions for the discretionary screening indicators described by the National Cholesterol Education Program for Children and Adolescents (NCEP-Peds); (2) to examine the relative prevalence of major screening indicators (family history of premature heart disease and parental plasma cholesterol concentration > or = 6.21 mmol/L (240 mg/dl)) and discretionary screening indicators (excessive consumption of fat or cholesterol or both, smoking, diabetes, hypertension, and steroid use) in a family population; and (3) to evaluate the relative value of the major and the discretionary indicators in detecting high serum levels of low-density lipoprotein-cholesterol (LDL-C) (> or = 3.36 mmol/L (> or = 130 mg/dl)).
Control cohort from a case-control study.
Lipid research clinic.
White children and adolescents < 20 years of age from 232 nuclear families who participated in the Cincinnati Myocardial Infarction Hormone Study.
(1) Number of children who have major and discretionary screening indicators; (2) sensitivity and specificity of the major and the discretionary screening indicators in identifying children with LDL-C concentrations > 3.36 mmol/L (130 mg/dl) (high LDL-C).
With cutoff points of the 90th percentile for blood pressure, the 85th percentile for obesity, and the 80th percentile for dietary fat and cholesterol, and self-report for diabetes, smoking, and corticosteroid use, 54% of the 232 children in the cohort had one or more discretionary indicators. Additionally, applying the major screening indicators raised the percentage of children identified to 74%. Twenty-eight percent had both major and discretionary indicators. Having a discretionary screening indicator did not increase the probability of having a major indicator. Applying both discretionary and major screening indicators to the cohort identified 96% of the children who had a high concentration of LDL-C; 30% of the children with high LDL-C levels were discovered solely by the discretionary indicators. Similar sensitivity and specificity were noted between the major and the discretionary indicators. Children with high LDL-C concentrations were more likely to have multiple screening indicators.
Discretionary and major screening indicators suggested by the National Cholesterol Education Program for Children and Adolescents identify different subsets of children at risk of having premature cardiovascular disease. Both major and discretionary indicators contribute to the identification of children with high LDL-C concentrations.
（1）为美国国家胆固醇教育计划儿童及青少年版（NCEP - Peds）中描述的可自由选择的筛查指标提出定义；（2）在一个家庭群体中，检查主要筛查指标（早发性心脏病家族史以及父母血浆胆固醇浓度≥6.21 mmol/L（240 mg/dl））和可自由选择的筛查指标（脂肪或胆固醇或两者过度摄入、吸烟、糖尿病、高血压以及使用类固醇）的相对流行情况；（3）评估主要指标和可自由选择指标在检测低密度脂蛋白胆固醇（LDL - C）血清水平升高（≥3.36 mmol/L（≥130 mg/dl））方面的相对价值。
病例对照研究中的对照队列。
脂质研究诊所。
来自232个核心家庭的20岁以下白人儿童及青少年，他们参与了辛辛那提心肌梗死激素研究。
（1）具有主要和可自由选择筛查指标的儿童数量；（2）主要和可自由选择筛查指标在识别LDL - C浓度>3.36 mmol/L（130 mg/dl）（高LDL - C）儿童方面的敏感性和特异性。
以血压第90百分位数、肥胖第85百分位数、饮食脂肪和胆固醇第80百分位数为界值，以及糖尿病、吸烟和使用皮质类固醇的自我报告为依据，该队列中232名儿童中有54%有一项或多项可自由选择的指标。此外，应用主要筛查指标使被识别出的儿童比例提高到74%。28%的儿童同时具有主要和可自由选择的指标。具有可自由选择的筛查指标并不会增加具有主要指标的可能性。将可自由选择和主要筛查指标应用于该队列，识别出了96%的LDL - C浓度高的儿童；30%的LDL - C水平高的儿童仅通过可自由选择的指标被发现。主要指标和可自由选择指标之间的敏感性和特异性相似。LDL - C浓度高的儿童更有可能有多个筛查指标。
美国国家胆固醇教育计划儿童及青少年版提出的可自由选择和主要筛查指标识别出了有过早发生心血管疾病风险的不同儿童亚组。主要指标和可自由选择指标都有助于识别LDL - C浓度高的儿童。
