Áp dụng một số công thức tính toán LDL-cholesterol trong thực hành=Application of different equations for LDL-cholesterol calculation in clinical

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Tác giả: Thu Hà Hoàng, Thị Hội Lê, Thị Thu Thùy Phan

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.72-79

Bộ sưu tập: Metadata

ID: 243808

Thêm vào giỏ

LDL-Cholesterol is commonly prescribed for the diagnosis and monitoring of dyslipidemia and for estimating the risk of cardiovascular disease. LDL-C can be quantified directly or calculated. Equations that have been implemented in regional countries were studied their application in practice. Objective: To compare the results of LDL-C obtained by direct quantification and calculated using 10 different equations. Subjects and Methods: This descriptive study involved the basic lipid profile of patients at Saint Paul Hospital (Hanoi). LDLC was calculated using 10 equations and compared to direct quantification to assess correlations, differences, and concordance in normal and abnormal lipid levels. Results: The study included 7,071 patients with an average age of 64.55±12.84 years. Among them, 38.3% were aged 60-70 years, 33.5% were over 70 years old, and 59.1% were female. All 10 LDL-C equations showed a strong correlation with directly quantified LDL-C. Compared to direct quantification, in total, the Martin/Hopkins equation had bias of 5.18%, within the acceptable range according to EFLM 2024. The Friedewald, Martin/Hopkins, Sampson, Chen, DeLong, and Puavilai equations showed differences within the acceptable range when Triglycerides were <
1.7 mmol/L, and the Friedewald had the smallest bias (4.62%). For Triglyceride levels range of 1.7–4.5 mmol/L, the Martin/Hopkins, Sampson, Chen, DeLong, and Cordova equations had differences within the acceptable range, the Martin/Hopkins had the smallest bias (3.88%). When Triglycerides >
4.5 mmol/L, only the Cordova equation had an acceptable difference (2.14%). The correct classification ratio for LDL-C target treatment groups, calculated by the Friedewald, Martin/Hopkins, Sampson, Chen, DeLong, Puavilai, and Cordova equations, were relatively high at TG levels <
2.3 mmol/L (ranging from 69.4% to 100%) but decreased significantly when TG >
2.3 mmol/L and LDL-C <
1.4 mmol/L. With high TG >
4.5 mmol/L, the Cordova equation provided the most accurate classification at LDL-C levels ≥ 3 mmol/L. Conclusion: The Friedewald, Martin/Hopkins, Sampson, Chen, DeLong, and Puavilai equations can be used for calculating LDL-C. Friedewald is the best equation when Triglycerides <
1.7 mmol/L, Martin/Hopkins is optimal for Triglycerides between 1.7–4.5 mmol/L, and Cordova is applicable when Triglycerides >
4.5 mmol/L.LDL-Cholesterol thường được chỉ định để chẩn đoán và theo dõi điều trị rối loạn lipid máu, ước tính nguy cơ bị bệnh tim mạch. Có thể định lượng LDL-C hoặc tính toán. Chúng tôi lựa chọn một số công thức đã được thực hiện ở các nước trong khu vực để nghiên cứu áp dụng. Mục tiêu nghiên cứu: So sánh kết quả xét nghiệm LDL-C bằng phương pháp định lượng và tính toán theo 10 công thức. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả bộ xét nghiệm lipid cơ bản của bệnh nhân Bệnh viện đa khoa Xanh Pôn Hà Nội. LDL-C được tính toán theo 10 công thức và so sánh với định lượng trực tiếp, tìm tương quan, sự khác biệt và sự phù hợp khi lipid bình thường và bất thường. Kết quả: 7071 bệnh nhân, tuổi trung bình 64,55±12,84 trong đó nhóm 60 -70 tuổi chiếm 38,3%, trên 70 tuổi là 33,5%, nữ chiếm 59,1%. 10 công thức tính LDL-C đều có tương quan chặt chẽ với LDL-C định lượng. So sánh với LDL-C định lượng, trong toàn bộ mẫu thì công thức Martin/Hopkins có khác biệt 5,18%, trong mức cho phép theo EFLM 2024. Các công thức Friedewald, Martin/Hopkins, Sampson, Chen, DeLong, Puavilai có khác biệt trong mức cho phép khi Triglycerid <
1,7 mmol/L trong đó Friedewald có khác biệt nhỏ nhất (4,62%). Trong khoảng Triglycerid 1,7 – 4,5 mmol/L, các công thức Martin/Hopkins, Sampson, Chen, DeLong, Cordova có khác biệt trong mức cho phép trong đó Martin/Hopkins có khác biệt nhỏ nhất (3,88%). Khi Triglycerid >
4,5 mmol/L chỉ công thức Cordova có khác biệt chấp nhận được (2,14%). Tỷ lệ phân loại đúng phân nhóm LDLC theo mục tiêu điều trị tính theo công thức Friedewald, Martin/Hopkins, Sampson, Chen, DeLong, Puavilai, Cordova đạt mức khá cao ở nồng độ TG <
2,3 mmol/L (69,4% đến 100%) và giảm mạnh ở nhóm TG >
2,3 mmol/L và LDL-C <
1,4 mmol/L. Với TG cao >
4,5 mmol/L công thức Cordova cho phân loại phù hợp nhất ở mức LDL-C ≥ 3 mmol/L. Kết luận: Có thể sử dụng các công thức Friedewald, Martin/Hopkins, Sampson, Chen, DeLong, Puavilai để tính LDLC. Friedewald là công thức tốt nhất khi Triglycerid <
1,7 mmol/L, Martin/Hopkins tốt nhất khi Triglycerid trong khoảng 1,7- 4,5 mmol/L và Cordova là công thức sử dụng được khi Triglycerid >
4,5 mmol/L

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