基于位置、尺度、形状的广义可加模型构建中老年人高敏心肌肌钙蛋白T参考值  

Investigation of reference values for high-sensitivity cardiac troponin T in middle-aged and elderly populations by GAMLSS:A cross-sectional study

作　　者：张茜[1] 周伟燕[2] 陈慧毅 王萌[1] 刘文松 王丽娟[1] 张嘉琦 李传保[1] Zhang Qian;Zhou Weiyan;Chen Huiyi;Wang Meng;Liu Wensong;Wang Lijuan;Zhang Jiaqi;Li Chuanbao(Department of Clinical Laboratory,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;National Center for Clinical Laboratories,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Hospital/National Center of Gerontology,Beijing 100730,China;Department of Biological Products,Chinese Pharmacopoeia Commission,Beijing 100061,China)

机构地区：[1]北京医院检验科、国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院、国家老年医学中心,国家卫生健康委临床检验中心,中国医学科学院老年医学研究院,北京100730 [3]国家药典委员会生物制品处,北京100061

出　　处：《中华老年医学杂志》2025年第2期156-161,共6页Chinese Journal of Geriatrics

基　　金：国家高水平医院临床研究基金项目(BJ-2022-118);首都医学发展科研基金项目(2024-2-4059)。

摘　　要：目的探讨中老年人高敏心肌肌钙蛋白T(hs-cTnT)增龄变化特征,并建立hs-cTnT第99百分位数参考上限(99th URL)的参考值。方法横断面研究。收集北京医院2018年1月至2023年12月门诊患者的hs-cTnT检测数据,选取45~85岁,排除患心脏疾病及影响心脏的慢性疾病患者,最终纳入5677人,年龄(65±10)岁。多元线性回归评估中老年人的性别和年龄对hs-cTnT浓度的影响程度,并利用基于位置、尺度、形状的广义可加模型(GAMLSS)绘制中老年人不同性别hs-cTnT的百分位数曲线,以建立中老年人的99th URL参考值。结果多元线性回归分析表明年龄和性别对中老年人hs-cTnT水平均有影响(β_(60-69岁)=1.399,β_(≥70岁)=5.306,β_(性别)=-2.650,均P<0.001)。男性和女性hs-cTnT数据均服从Box-Cox-Cole-Green(BCCG)分布,根据性别分别拟合对应hs-cTnT的25th、50th、75th和99th百分位数曲线,男性及女性hs-cTnT的不同百分位数值随增龄均呈增高趋势,各个年龄组男性99th值均高于女性。结论基于GAMLSS法建立中老年人hs-cTnT连续参考区间,为我国中老年人的参考值提供理论依据,对临床诊疗提供一定的指导作用。Objective to investigate age-related changes in high-sensitivity cardiac troponin T(hs-cTnT)levels among middle-aged and elderly individuals,and to establish reference values for the 99th percentile upper reference limit(99th URL)of hs-cTnT within this demographic.Methods This research is designed as a cross-sectional study.Hs-cTnT test results were collected from outpatients at Beijing Hospital between January 2018 and December 2023.The final sample included 5,677 outpatients aged 45 to 85 years(65±10),all of whom were free from cardiovascular diseases and other chronic heart-related conditions.Multiple linear regression was utilized to assess the impact of gender and age group on hs-cTnT concentrations within the middle-aged and elderly populations.Furthermore,a generalized additive model for location,scale,and shape(GAMLSS)was employed to generate percentile curves of hs-cTnT by gender in this cohort,with the aim of determining the 99th URLs for both middle-aged and elderly individuals.Results Multiple linear regression analyses indicated that both gender and age significantly influenced hs-cTnT levels in middle-aged and elderly populations(β_(60-69 years)=1.399,β_(≥70 years)=5.306,β_(gender)=-2.650,all Pvalues<0.001).The hs-cTnT data for both males and females conformed to Box-Cox-Cole-Green(BCCG)distributions,with percentile curves fitted at the 25th,50th,75th,and 99th percentiles according to gender.The percentile values of hs-cTnT in both males and females demonstrated a progressive increase with advancing age.Notably,males exhibited higher 99th percentile values than females across all age groups.Conclusions The GAMLSS approach is employed to establish continuous reference intervals for hs-cTnT in the middle-aged and elderly population.This effort aims to provide a theoretical foundation for reference values specific to this demographic in China and to offer guidance for clinical diagnosis and treatment.

关 键 词：高敏肌钙蛋白 参考值 中老年人 基于位置、尺度、形状的广义可加模型 

分 类 号：R541[医药卫生—心血管疾病] R446.1[医药卫生—内科学]