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以Friedewald formula推估低密度脂蛋白膽固醇濃度在台灣的準確度研究

Study on the Accuracy of Using the Friedewald Formula in Predicting Serum Low Density Lipoprotein Level in Taiwan

摘要


高血脂症治療的最新版指引ATP Ⅲ (Adult Treatment Panel Ⅲ),除對控制低密度脂蛋白膽固醇(LDL)以減低冠心病發生的風險的重要性再次強調外,亦提及在初次評估高血脂症病人時便必須包括完整血脂肪濃度資料的必要性。在臨床執業上都是依Friedewald formula (LDL=(T-CHO)-HDL-(TG/5))來加以推算低密度脂蛋白膽固醇的濃度,並據此作為診斷,治療時追蹤評估的依據。可是基於過去已觀測到的不準確性,這一公式在使用上確有其限制。但因著本國健保給付規定,大多數基層醫師執業時仍是利用Friedewald formula來間接取得病人的完整血脂肪濃度資料。,若要在台灣應用此公式推得的數值作為實際臨床執業上的指標時,則需先確定Friedewald formula在台灣臨床使用上的準確度,過去並無本土研究去驗證此公式。本研究即針對上述的問題作探討。我們收集2003年份第一季,台灣某國立大學附設醫院健檢病房病人之病歷號,按號碼排序後取前99位,收集其完整的血脂肪檢查數值。包括總膽固醇濃度,高密度脂蛋白膽固醇濃度,低密度脂蛋白膽固醇濃度,三酸甘油酯濃度等數據。接著使用Friedewald formula求得每一位病患的低密度脂蛋白膽固醇估計值,再將估計的低密度脂蛋白膽固醇值和實際經Colorimetric method測得的低密度脂蛋白膽固醇值做pairedttest,其t值等於11.94,雙尾檢定p值為<0.001。根據上述結果,我們認為Friedewald formula在台灣臨床使用上的準確度確實存有不能忽略之誤差。

關鍵字

無資料

並列摘要


According to the latest version of NCEP ATP-Ⅲ guideline, controlling low density lipoprotein level to reduce the risk of cardiovascular diseases (CVD) has been emphasized and suggests to collect a complete lipid profile during the initial assessment of patient with hyperlipidemia But, because of the limitation of technology, the common practice has heavily relied on the calculated LDL level from Friedewald formula. Even today, the Friedewald formula is still being used to calculate the LDL level as stipulated in National Health Insurance (NHI) regulation regardless of the recent technology improvement has been made. Past studies had revealed some questionable accuracies of Friedewald formula in the clinical context of Taiwan. Our study was designed to examine the accuracy and its applicability of Friedewald formula in Taiwan. We collected 99 patients' complete lipid profile including total cholesterol level, LDL level, HDL level, and TG level as measured by colorimetric method in laboratory From these data, we estimated individual's LDL level as calculated from Friedewald formula. Then, we examined the two LDL levels by paired T-test. The result showed T value of 11.94, and the P value is less than 0.001. We therefore concluded that we should pay special attention to the inaccuracy of estimated LDL level from Friedewald formula and reconsider its applicability in the clinical practice of Taiwan.

並列關鍵字

Friedewald formula LDL accuracy study

被引用紀錄


佘雨潔(2010)。以近紅外光譜檢測血脂含量之可行性〔碩士論文,中原大學〕。華藝線上圖書館。https://doi.org/10.6840%2fCYCU.2010.00021

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