Gagliano N J, Emans S J, Woods E R
Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA.
J Adolesc Health. 1993 Mar;14(2):104-8. doi: 10.1016/1054-139x(93)90093-5.
Guidelines for screening populations for hypercholesterolemia are controversial. In pediatric patients, screening has been targeted to those with a family history of hypercholesterolemia or early myocardial infarction. Because specific guidelines for adolescents have not been developed, we undertook a study of cholesterol screening in 224 consecutive patients (mean age, 14.8 +/- 2.2 years; range, 11-20 years). In this study, 33 (14.7%) adolescents had levels above 185 mg/dL; 71 (32.7%) of the patients reported a positive family history for early myocardial infarction or elevated lipids. A positive family history obtained from the adolescent patient had a 36% sensitivity, 69% specificity, 17% positive predictive value, and an 87% negative predictive value compared with elevated cholesterol level. A positive history reported by the parent had a 65% sensitivity, 46% specificity, 16% positive predictive value, and an 89% negative predictive value. A positive family history obtained from either parent or adolescent had a 45% sensitivity, 69% specificity, 19% positive predicative value, and 89% negative predictive value. Family history by the adolescent was significantly different from parental history (p < 0.001). Family history is a poor predictor for cholesterol level in adolescents.
针对人群进行高胆固醇血症筛查的指南存在争议。在儿科患者中，筛查对象主要是有高胆固醇血症家族史或早期心肌梗死家族史的患者。由于尚未制定针对青少年的具体指南，我们对224例连续患者（平均年龄14.8±2.2岁；范围11 - 20岁）进行了胆固醇筛查研究。在这项研究中，33名（14.7%）青少年的胆固醇水平高于185mg/dL；71名（32.7%）患者报告有早期心肌梗死或血脂升高的家族史阳性。与胆固醇水平升高相比，青少年患者报告的家族史阳性具有36%的敏感性、69%的特异性、17%的阳性预测值和87%的阴性预测值。父母报告的家族史阳性具有65%的敏感性、46%的特异性、16%的阳性预测值和89%的阴性预测值。父母或青少年报告的家族史阳性具有45%的敏感性、69%的特异性、19%的阳性预测值和89%的阴性预测值。青少年报告的家族史与父母报告的家族史有显著差异（p<0.001）。家族史对青少年胆固醇水平的预测能力较差。
