估算法和测量法在血清残余脂蛋白胆固醇评估中的比较

Comparative analysis of estimated and measured remnant lipoprotein cholesterol in serum

目的观察估算法与测量法检测血清残余脂蛋白胆固醇(RLP-C)的差异。方法选取671例动脉粥样硬化性心血管病(AsCVD)患者和325例对照者为研究对象,采用酶法定量检测血清RLP-C,再用Bland-Altman法和组内相关系数(ICC)法评估RLP-C定量测定值与Friedewald方程估算值的一致性。结果Bland-Altman法的结果显示:7.0%个体(70/996)位于95%一致性界限外。相对于定量测定法,Friedewald方程估算法的平均阳性偏倚为0.2 mmol/L[95%CI(0.18~0.23)]。ICC法的结果显示,ICC=0.551[95%CI(0.192~0.732),P<0.001]。Friedewald方程估算的RLP-C与RLP-C测量值存在正相关关系(r=0.4,P<0.001)。此外,随着TG及RLP-C_(e)浓度逐渐升高,估算值与测量值的差异越来越大,其平均阳性偏倚为0.2 mmol/L(P<0.001)。结论测量法与方程估算法一致性欠佳,在临床实践中能否替代使用有待进一步验证。

Objective To investigate the differences between estimated and measured remnant lipoprotein cholesterol(RLP-C)in serum.Methods A total of 671 patients with atherosclerotic cardiovascular disease(AsCVD)and 325 controls were included.Evaluation of the consistency between quantitative RLP-C(RLP-C_(m))measured by enzymatic measurement system and estimated RLP-C(RLP-C_(e))by Friedewald equation was performed respectively by BlandAltman plots and intraclass correlation efficient(ICC).Results BlandAltman plot showed that 7.0%(70/996)of points were located outside the 95%limits of agreement.The mean positive bias of RLP-C_(e) estimated by Friedewald equation was 0.2 mmol/L compared to RLP-C_(m)(95%CI:0.18 to 0.23)which was higher than RLP-C_(m) per 1.0 mmol/L.ICC method showed that ICC=0.551[(95%CI:0.192 to 0.732),P<0.001],which indicated a poor consistency between the two method.The results of RLP-C estimated by Friedewald equation was significantly correlated with RLP-C_(m)(r=0.4,P<0.001).However,the difference between RLP-C_(e) and RLP-C_(m) was increased with an average positive bias of 0.2 mmol/L(P<0.001)when TG and RLP-C_(e) were increasing.Conclusion Poor consistency between the methods of enzymatic quantitation and Friedewald equation estimation for measurements of remnant lipoprotein cholesterol in serum was showed,and whether it can be replaced each other in clinical practice should be further verified.