减少脂质面板的误差额度,以提高心血管风险分层的准确性
Justine Cole1, Maureen Sampson1, Hendrik E van Deventer2
1Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
Clinical chemistry
|August 25, 2023
概括
目前的脂质面板测试指南允许显著的心血管疾病风险错误分类. 提高试验准确度和精度可以减少这些错误,从而改善患者管理.
科学领域:
- 临床化学 临床化学
- 心血管疾病风险评估心血管疾病风险评估
- 医学诊断 医学诊断 医学诊断
背景情况:
- 标准脂质面板对于评估动脉样硬化心血管疾病风险至关重要.
- 目前国家胆固醇教育计划 (NCEP) 的性能建议已经过时 (近30年),可能不符合现代测试能力.
- 低于最佳的分析性能和生物变异性可能导致错误的风险评估和治疗决策.
研究的目的:
- 评估心血管疾病风险错误分类的程度,使用当前的NCEP绩效建议.
- 探索增强分析绩效目标对减少错误分类率的影响.
主要方法:
- 利用了NHANES数据库中的8506个人的脂质面板数据.
- 根据2018年美国多元社会指南将受试者分为四个风险组.
- 模拟分析偏差,不准确性和生物变异性,以评估错误分类的影响.
- 系统地减少偏见和不准确性,以量化潜在的改进.
主要成果:
- 根据目前的NCEP建议,高达10%的个人被错误地分为不同的心血管风险组.
- 在比例偏差和3%的不精确度的1%改善,在测试减少了错误分类高达10%.
- 平均序列测量可以减轻生物变异性的影响.
结论:
- 目前NCEP对脂质测定的性能建议允许不可接受的风险错误分类,可能导致心血管疾病管理不当.
- 允许的分析误差的代降低可以显著提高心血管风险评估的准确性.
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