非空腹血液样本LDL-C检测的临床应用价值  

Clinical value of LDL-C determination in non-fasting blood samples

作　　者：沈盈 徐晓萍[1] 张乐乐[1] 杜勇平[2] 孟超[3] SHEN Ying;XU Xiaoping;ZHANG Lele;DU Yongping;MENG Chao(Department of Clinical Laboratory,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Geriatrics,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院检验科,上海200127 [2]上海交通大学医学院附属仁济医院心内科,上海200127 [3]上海交通大学医学院附属仁济医院老年科,上海200127

出　　处：《检验医学》2022年第11期1049-1056,共8页Laboratory Medicine

摘　　要：目的通过分析4种低密度脂蛋白胆固醇(LDL-C)计算公式(Friedewald公式、Martine公式、Sampson公式和Vujovic公式)与LDL-C直接检测值(记为D-LDL-C)的一致性,探讨非空腹血脂检测的临床应用价值。方法选取心血管疾病(CVD)患者110例,比较其空腹血脂水平与普通餐后2 h血脂水平的差异。另选取CVD和/或糖尿病(DM)患者291例、健康体检者259名,检测其非严格空腹状态(空腹时间<4 h)下的总胆固醇(TC)、三酰甘油(TG)、LDL-C、高密度脂蛋白胆固醇(HDL-C)及小而密低密度脂蛋白胆固醇(sd-LDL-C),计算非高密度脂蛋白胆固醇(non-HDL-C)。用4种LDL-C计算公式计算LDL-C,采用Spearman相关分析评价多靶点LDL-C水平上,D-LDL-C与LDL-C计算值在临床评估中的一致性。结果110例CVD患者餐后2 h的TC、HDL-C、LDL-C、non-HDL-C水平低于空腹水平(P<0.05),sd-LDL-C、TG水平与空腹水平差异无统计学意义(P>0.05)。与空腹血脂水平比较,男性餐后2 h的TG水平平均升高0.11 mmol/L(P<0.05)、LDL-C水平平均下降0.13 mmol/L(P<0.05);女性TC、LDL-C和non-HDL-C水平分别降低0.22、0.14、0.19 mmol/L(P<0.05),TG变化不明显(P>0.05)。Spearman相关分析结果显示,4种公式的LDL-C计算值与D-LDL-C均呈正相关(r值分别为0.922、0.953、0.949、0.944,P<0.05)。当TG≤2.26 mmol/L时,Friedewald公式LDL-C计算值与D-LDL-C的偏差最小;当TG>2.26 mmol/L时,Martine公式的偏差最小。选取不同的LDL-C临床干预临界值(2.6、3.4、4.9 mmol/L),对于动脉粥样硬化性心血管病(ASCVD)低危者,当TG>2.3 mmol/L时,Martine公式、Sampson公式、Vujovic公式的LDL-C计算值评估ASCVD风险与D-LDL-C的一致性分别为83.8%、83.8%、82.5%,优于Friedewald公式(72.5%);对于ASCVD高危/极高危者,当TG<2.3 mmo/L时,基于4种公式LDL-C计算值的临床评估结果与基于D-LDL-C的临床评估结果的符合率均≥95%;当TG为2.3~5.6 mmo/L时,Martine公式与D-LDL-C的符合率最高(88.8%);当TG>5.6 mmol/L,4种公式与D-LDObjective To analyze the consistency of 4 calculated low-density lipoprotein cholesterol(LDL-C)levels(Friedewald formula,Martine formula,Sampson formula and Vujovic formula)with the direct determination of LDL-C(D-LDL-C)in non-fasting serum,and to evaluate the clinical value of LDL-C determination in non-fasting serum lipids.Methods Totally,110 cardiovascular disease(CVD)patients were enrolled,and the changes of fasting and postprandial 2 h serum lipids were compared.In addition,291 patients with CVD and/or diabetes mellitus(DM)and 259 healthy subjects were enrolled.Non-fasting serum lipids(fasting time<4 h)were determined,which included total cholesterol(TC),triglyceride(TG),LDL-C,highdensity lipoprotein cholesterol(HDL-C)and small and dense low-density lipoprotein cholesterol(sd-LDL-C),and non-high-density lipoprotein cholesterol(non-HDL-C)was calculated.Spearman correlation analysis was used for D-LDL-C with calculated LDL-C levels,and the consistency was evaluated by different LDL-C cut-off points.Results For CVD patients,the levels of TC,HDL-C,LDL-C and non-HDL-C were lower after 2 h of routine meal(P<0.05),and there was no statistical significance in sd-LDL-C and TG levels whether postprandial or fasting condition(P>0.05).For males,postprandial TG was increased as 0.11 mmol/L on average(P<0.05),and LDL-C was decreased as 0.13 mmol/L(P<0.05).For females,the levels of TC,LDL-C and non-HDL-C were decreased as 0.22,0.14 and 0.19 mmol/L,respectively(P<0.05),and the change of TG level was not obvious(P>0.05).Spearman correlation analysis showed that the calculated LDL-C levels of Friedewald formula,Martine formula,Sampson formula and Vujovic formula were positively correlated with D-LDL-C(r=0.922,0.953,0.949 and 0.944,P<0.05).When TG≤2.26 mmol/L,the mean absolute deviation(MAD)between calculated LDL-C by Friedewald formula and D-LDL-C was minimum,and when TG>2.26 mmol/L,the deviation showed calculated LDL-C by Martine formula was minimum.For atherosclerotic cardiovascular disease(ASCVD)lowrisk cases,different L

关 键 词：低密度脂蛋白胆固醇 非空腹血脂 FRIEDEWALD公式 Martine公式 Sampson公式 Vujovic公式 心血管疾病 

分 类 号：R446.1[医药卫生—诊断学]