Family History Evaluation as a Predictive Screen for Childhood Hypercholesterolemia
Family History Evaluation as a Predictive Screen for Childhood Hypercholesterolemia
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家族史评估作为儿童高胆固醇血症的预测筛查
DOI：
10.1111/j.1749-6632.1991.tb43764.x
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发表时间：
1989
影响因子：
5.2
通讯作者：
P. McGUIRE
中科院分区：
文献类型：
--
作者：
T. Griffin;K. Christoffel;H. Binns;P. McGUIRE
本研究旨在评价家族史因素作为儿童高胆固醇血症筛查标准的有效性。当他们在八家诊所中的一家接受常规护理时，1005名青春期前儿童接受了随机的血清胆固醇检测。父母和祖父母在55岁之前的心血管危险因素和动脉粥样硬化并发症的病史也被获得。在最初的一组中，274名儿童的总胆固醇水平大于或等于175 mg/dL，其中175名儿童在隔夜禁食后返回复测。共有88名儿童被发现低密度脂蛋白胆固醇(LDL-C)值在年龄和性别上大于或等于第90个百分位数。母亲和父亲的高胆固醇血症史与低密度脂蛋白胆固醇升高显著相关(优势比分别为7.3和2.9)，但敏感性极低(0.09，0.15)，尽管阳性预测值为0.42，0.22。祖父母猝死、外周血管疾病和痛风的病史与升高的低密度脂蛋白相关，但对所有这些因素的敏感性和阳性预测值都低于0.22。最常被推荐作为儿童胆固醇筛查标准的家族史因素并没有确定所有低密度脂蛋白升高儿童中的一半，也没有选择性地确定受影响最严重的儿童。增加关于儿童肥胖存在的信息，并不会导致低密度脂蛋白-C检测的显著改善，而不仅仅是家庭病史因素所实现的改善。结论是，如果需要彻底识别低密度脂蛋白胆固醇升高的幼儿，包容性人群筛查而不是基于家族病史的战略将是最有效的方法。
A study was conducted to evaluate the efficacy of family history factors as screening criteria for childhood hypercholesterolemia. When they were seen for routine care at one of eight office practices, 1005 prepubertal children underwent random serum cholesterol determinations. Parental and grandparental histories of cardiovascular risk factors and atherosclerotic complications prior to 55 years of age were also obtained. Of the initial group, 274 children had total cholesterol levels greater than or equal to 175 mg/dL, and 175 of these children returned for retesting after an overnight fast. A total of 88 children were found to have low-density lipoprotein-cholesterol (LDL-C) values greater than or equal to 90th percentile for age and sex. Maternal and paternal histories of hypercholesterolemia were significantly associated with elevated LDL-C (odds ratio = 7.3 and 2.9, respectively), but had extremely low sensitivities (0.09, 0.15) despite modest positive predictive values (0.42, 0.22). Grandparental histories of sudden death, peripheral vascular disease, and gout were associated with elevated LDL-C, but sensitivities and positive predictive values for all of these factors were less than 0.22. Family history factors most commonly recommended as criteria for cholesterol screening in children did not identify half of all the children with elevated LDL-C and did not selectively identify the most severely affected children. Adding information concerning the presence of childhood obesity did not result in appreciable improvement in LDL-C detection beyond that achieved by family history factors alone. It was concluded that if thorough identification of young children with elevated LDL-C is desired, inclusive population screening rather than a family history-based strategy would be the most effective approach.