中国儿童青少年血脂异常诊断切点的比较研究

目的比较不同切点诊断的血脂异常对心血管代谢危险因素的预测能力,探讨适用于我国儿童青少年血脂异常诊断的适宜切点。方法利用2017年"儿童青少年心血管与骨健康促进项目"北京市基线调查数据进行分析,采用不同切点诊断血脂异常。通过受试者工作特征曲线分析不同切点诊断的血脂异常对高血压、肥胖、体脂率偏高和空腹血糖受损的预测能力。结果共纳入14390名儿童青少年进行分析,研究人群高TC、高LDL-C、低HDL-C和高TG通过"中国参考标准"诊断的检出率分别为2.7%、2.7%、14.4%和3.7%,经"中国专家共识"诊断的检出率分别为5.0%、3.7%、13.3%和3.5%。相比"中国专家共识","中国参考标准"提高了低HDL-C和高TG在男孩中的检出率,而降低了在女孩中的检出率。"中国参考标准"诊断的低HDL-C和高TG血症预测肥胖和体脂率偏高的受试者工作特征曲线下面积在男孩中高于"中国专家共识"(P<0.001),而在女孩中低于"中国专家共识"(P<0.001)。结论"中国参考标准"提高了在男孩中预测肥胖或体脂率偏高的真阳性率,减少了其在女孩中的假阳性率,建议对儿童青少年血脂异常诊断切点采用全国代表性样本和前瞻性研究进一步验证。

A comparative study on diagnostic cut points of dyslipidemia in children and adolescents in China

Objective To compare the power of dyslipidemia diagnosis by different sets of cut points in the prediction of cardiovascular metabolic risk factors and identify the appropriate cut points for the diagnosis of dyslipidemia in children and adolescents in China.Methods Data were obtained from the baseline survey of'School-based Cardiovascular and Bone Health Promotion Program'in Beijing in 2017.Dyslipidemia was diagnosed by using two set of cut points.Receiver operating characteristic curve analysis was conducted to assess the power of dyslipidemia diagnosis by the two set of cut points to predict the prevalence of hypertension,obesity,high fat mass percentage and impaired fasting glucose.Results A total of 14390 children and adolescents were in included in the study.The prevalence rates of high TC,high LDL-C,low HDL-C,and high TG in the participants were 2.7%,2.7%,14.4%,and 3.7%according to'Chinese Reference Standard',and 5.0%,3.7%,13.3%,and 3.5%according to'China Expert Consensus'.Low HDL-C and high TG defined by the'Chinese Reference Standard'had better performance for the prediction of high fat mass percentage and obesity in boys,but worse performance in girls(P<0.001).Conclusions Using'China Reference Standard'can increase the true positive rate in the prediction of obesity or high fat mass percentage in boys,and reduce the false positive rate in girls.The cut points for the diagnosis of dyslipidemia in Chinese children and adolescents need to be further validated by using national representative sample and in longitudinal study.