北京大学学报(医学版) ›› 2022, Vol. 54 ›› Issue (2): 217-221. doi: 10.19723/j.issn.1671-167X.2022.02.003

• 论著 • 上一篇    下一篇

单中心就诊2~18岁儿童胆固醇水平异常发生率及病因分析

闫辉1,逄璐2,李雪迎3,杨文双2,蒋世菊2,刘平1,闫存玲2,()   

  1. 1.北京大学第一医院 儿科, 北京 100034
    2.北京大学第一医院 检验科, 北京 100034
    3.北京大学第一医院 医学统计室, 北京 100034
  • 收稿日期:2020-09-07 出版日期:2022-04-18 发布日期:2022-04-13
  • 通讯作者: 闫存玲 E-mail:yancunling@163.com

Incidence and cause of abnormal cholesterol in children aged 2-18 years in a single center

YAN Hui1,PANG Lu2,LI Xue-ying3,YANG Wen-shuang2,JIANG Shi-ju2,LIU Ping1,YAN Cun-ling2,()   

  1. 1. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
    2. Department of Laboratory, Peking University First Hospital, Beijing 100034, China
    3. Department of Statistics, Peking University First Hospital, Beijing 100034, China
  • Received:2020-09-07 Online:2022-04-18 Published:2022-04-13
  • Contact: Cun-ling YAN E-mail:yancunling@163.com

摘要:

目的: 探讨单中心就诊患儿血浆胆固醇水平异常情况及分布规律。方法: 回顾性分析2016年6月至2019年6月在北京大学第一医院有胆固醇检测结果的2~18岁儿童血浆胆固醇水平。总胆固醇(total cholesterol, TC)采用胆固醇氧化酶法,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)采用清除法检测,计数资料比较应用卡方检验。结果: 调查有效数据11 829例,其中男性7 087例, 女性4 742例。TC升高儿童1 822例(15.4%), LDL-C升高儿童1 371例(11.6%),HDL-C降低儿童2 798例(23.7%), 胆固醇水平异常儿童总和4 427例(37.4%)。非常见继发性高脂血症病因就诊儿童7 835人,其中TC升高儿童731例(9.3%), LDL-C升高儿童561例(7.2%), HDL-C降低儿童1 886例(24.1%),胆固醇水平异常儿童总和2 576例(32.9%)。不同疾病就诊儿童中,胆固醇异常发生率差异有统计学意义(P<0.05)。TC升高及LDL-C升高发生率的前三位主要就诊原因均分别为“血脂异常”“泌尿系统疾病”“营养性疾病”。除小儿内科外,其他科室送检的1 257例患儿血脂检测样本中,300例存在胆固醇水平异常(23.8%), 其中高胆固醇血症患儿 70例(5.6%), 高低密度脂蛋白血症患儿44例(3.5%), 低高密度脂蛋白血症患儿224例(17.8%)。在非常见继发性高脂血症病因就诊儿童中,因LDL-C≥140 mg/dL (3.6 mmol/L) 需要进一步排除家族性高胆固醇血症的患儿共365例,占该部分患儿的4.6%。结论: 就诊儿童胆固醇异常发生率高,在原发病诊治的同时加强胆固醇管理不仅有助于控制继发性高胆固醇血症,也为及时发现家族性高胆固醇血症提供可能。

关键词: 高胆固醇血症, 血脂异常, 监测, 儿童

Abstract:

Objective: To investigate the abnormality and distribution of plasma cholesterol levels in single-center hospitalized children. Methods: The blood lipid levels of children aged 2-18 years who had blood lipid test results in Peking University First Hospital from June 2016 to June 2019 were etrospectively analyzed. Cholesterol oxidase method was used for total cholesterol, and high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were detected by clearance method. The counting data were compared with chi-square test. Results: The survey had involved 11 829 children (7 087 were boys and 4 742 were girls). 1 822 (15.4%) children were with elevated total cholesterol, 1 371 (11.6%) children with elevated low-density lipoprotein cholesterol, and 2 798 (23.7%) children with high-density lipoprotein cholesterol reduction. The total number of the children with abnormal cholesterol levels was 4 427 (37.4%). Among the 7 835 children who visited hospital due to the disease not commonly inducing dyslipidemia, 731 (9.3%) had elevated TC, 561 (7.2%) had elevated LDL-C, 1 886 (24.1%) had decreased HDL-C, and 2 576 (32.9%) had abnormal cholesterol levels. Among the children with different diseases, the difference in the incidence of abnormal cholesterol was statistically significant. The top three main groups of the children with increased total cholesterol and low-density lipoprotein cholesterol were “dyslipidemia”, “urinary tract disease”, and “nutritional disease”; The top three main groups of the children with reduced high-density lipoprotein cholesterol were “respiratory diseases”, “dyslipidemia”, “hematological diseases and malignant tumors”. Among the 1 257 blood li-pid test results sent by other departments, 300 cases had abnormal cholesterol levels (23.8%). Among them, there were 70 children with hypercholesterolemia (5.6%), 44 children with increased low-density lipoprotein cholesterol (3.5%), and 224 children with reduced high-density lipoprotein cholesterol (17.8%). There were 365 (4.6%) children with low-density lipoprotein cholesterol ≥140 mg/dL (3.6 mmol/L) who needed to further exclude familiar hypercholesterolemia among the children who visited hospitals due to the disease not commonly inducing dyslipidemia. Conclusion: Children in hospitals have a high incidence of cholesterol abnormalities. Doctors need to pay more attention to the cholesterol diagnosis and management regardless of the discipline, which not only helps to control secondary hypercholesterolemia, but also provides the possibility of detecting familial hypercholesterolemia in time.

Key words: Hypercholesterolemia, Dyslipidemia, Screen, Children

中图分类号: 

  • R725.4

表1

不同疾病种类胆固醇水平异常情况"

Disease classification n TC≥5.18 mmol/L,
n (%)
LDL-C≥
3.37 mmol/L, n (%)
HDL-C≤
1.04 mmol/L, n (%)
Cholesterol level
abnormal, n (%)
Cholesterol level
normal, n (%)
Dyslipidemia 25 11 (44.0) 11 (44.0) 11 (44.0) 17 (68.0) 8 (32.0)
Nutritional diseases 107 17 (15.9) 12 (11.2) 33 (30.8) 47 (43.9) 60 (56.1)
Respiratory diseases 395 15 (3.8) 19 (4.8) 194 (49.1) 210 (53.2) 185 (46.8)
Digestive system
diseases
334 24 (7.2) 26 (7.8) 82 (24.6) 106 (31.7) 228 (68.3)
Urinary system
diseases
2 659 954 (35.9) 712 (26.8) 522 (19.6) 1 350 (50.8) 1 309 (49.2)
Nervous system
disease
2 555 272 (10.7) 194 (7.6) 529 (20.7) 781 (30.6) 1 774 (69.4)
Cardiovascular diseases 833 67 (8.0) 48 (5.8) 211 (25.3) 277 (33.3) 556 (66.7)
Definitively diagnosed
metabolic diseases and
mitochondrial diseases
683 63 (9.2) 47 (6.9) 186 (27.2) 239 (35.0) 444 (65.0)
Endocrine disease 190 16 (8.4) 11 (5.8) 56 (29.5) 70 (36.8) 120 (63.2)
Immune system
diseases
138 13 (9.4) 8 (5.8) 42 (30.4) 51 (37.0) 87 (63.0)
Blood system diseases
and malignant tumors
324 45 (13.9) 32 (9.9) 106 (32.7) 141 (43.5) 183 (56.5)
Others 1 470 87 (5.9) 72 (4.9) 302 (20.5) 393 (26.7) 1 077 (73.3)
Unknown diagnosis 716 62 (8.7) 39 (5.4) 159 (22.2) 218 (30.5) 498 (69.6)
Unwritten diagnosis 1 400 176 (12.6) 140 (10.0) 365 (26.1) 527 (37.6) 873 (62.4)
Total 11 829 1 822 (15.40) 1 371 (11.6) 2 798 (23.7) 4 427 (37.4) 7 402 (62.6)
[1] 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会心血管学组, 中华医学会心血管病学分会动脉粥样硬化学组, 等. 儿童青少年血脂异常防治专家共识[J]. 中华儿科杂志, 2009, 47(6):426-428.
[2] Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adole-scents: summary report[J]. Pediatrics, 2011, 128(Suppl 5):213-256.
[3] American Academy of Pediatrics. Committee on Nutrition. American Academy of Pediatrics. Committee on Nutrition. Cholesterol in childhood[J]. Pediatrics, 1998, 101(1 Pt 1):141-147.
doi: 10.1542/peds.101.1.141
[4] Okada T, Murata M, Yamauchi K, et al. New criteria of normal serum lipid levels in Japanese children: the nationwide study[J]. Pediatr Int, 2002, 44(6):596-601.
doi: 10.1046/j.1442-200X.2002.01634.x
[5] Harada-Shiba M, Ohta T, Ohtake A, et al. Guidance for pediatric familial hypercholesterolemia 2017[J]. J Atheroscler Thromb, 2018, 25(6):539-553.
doi: 10.5551/jat.CR002 pmid: 29415907
[6] Rallidis L, Naoumova RP, Thompson GR, et al. Extent and severity of atherosclerotic involvement of the aortic valve and root in familial hypercholesterolaemia[J]. Heart, 1998, 80(6):583-590.
pmid: 10065027
[7] Bornaun H, Öner N, Nişli K, et al. Assessment of lipid profile and some risk factors of atherosclerosis in children whose parents had early onset coronary artery disease[J]. Arch Argent Pediatr, 2017, 115(1):50-54.
doi: 10.5546/aap.2017.eng.50 pmid: 28097840
[8] Hingorani AD, Futema M, Humphries S. Child-parent familial hypercholesterolemia screening in primary care[J]. N Engl J Med, 2017, 376(5):499-500.
[9] Filgueiras MS, Vieira SA, Ribeiro AQ, et al. Family history is associated with the presence of pre-school children[J]. Rev Paul Pediatr, 2019, 37(1):41-48.
doi: 10.1590/1984-0462/;2019;37;1;00005
[10] Ahmad ZS, Andersen RL, Andersen LH, et al. US physician practices for diagnosing familial hypercholesterolemia: data from the CASCADE-FH registry[J]. J Clin Lipidol, 2016, 10(5):1223-1229.
doi: 10.1016/j.jacl.2016.07.011
[11] Ding W, Cheng H, Yan Y, et al. 10-year trends in serum lipid levels and dyslipidemia among children and adolescents from several schools in Beijing, China[J]. J Epidemiol, 2016, 26(12):637-645.
doi: 10.2188/jea.JE20140252
[12] Kouda K, Iki M, Fujita Y, et al. Trends in serum lipid levels of a 10- and 13-year-old population in Fukuroi City, Japan (2007—2017)[J]. J Epidemiol, 2020, 30(1):24-29.
doi: 10.2188/jea.JE20180164
[13] 王政和, 邹志勇, 阳益德, 等. 2012年中国7省份6~17岁儿童青少年血脂异常流行情况及相关因素分析[J]. 中华预防医学杂志, 2018, 52(8):798-801.
[14] Pratt RE, Kavey RE, Quinzi D. Combined dyslipidemia in obese children: response to a focused lifestyle approach[J]. J Clin Lipidol, 2014, 8(2):181-186.
doi: 10.1016/j.jacl.2014.01.003
[15] Dowla S, Aslibekyan S, Goss A, et al. Dyslipidemia is associated with pediatric nonalcoholic fatty liver disease[J]. J Clin Lipidol, 2018, 12(4):981-987.
doi: 10.1016/j.jacl.2018.03.089
[16] Wiegman A, Gidding SS, Watts GF, et al. Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment[J]. Eur Heart J, 2015, 36(36):2425-2437.
doi: 10.1093/eurheartj/ehv157 pmid: 26009596
[17] Robinson JG. Management of familial hypercholesterolemia: a review of the recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia[J]. J Manag Care Pharm, 2013, 19(2):139-149.
[1] 张宏,董继元,王建军,范临夏,曲强,刘洋. 兰州市臭氧对儿童哮喘的短期影响及其季节性差异[J]. 北京大学学报(医学版), 2022, 54(2): 227-235.
[2] 冯莎蔚,国慧,王勇,赵一姣,刘鹤. 乳牙数字化参考牙冠模型的初步构建[J]. 北京大学学报(医学版), 2022, 54(2): 327-334.
[3] 王子靖,李在玲. 有幽门螺杆菌感染家族史儿童胃部菌群的特点[J]. 北京大学学报(医学版), 2021, 53(6): 1115-1121.
[4] 刘雅菲,宋琳琳,邢茂炜,蔡立新,王东信. 全身麻醉下小儿开颅术术中心脏前负荷动态指标的一致性分析[J]. 北京大学学报(医学版), 2021, 53(5): 946-951.
[5] 霍阳,周兵,何红彦,赵龙,张雪丽,李静,左玉花,郑宇,任正洪,韩芳,张俊. 腕表式睡眠监测仪与多导睡眠监测的睡眠参数比较和相关性分析[J]. 北京大学学报(医学版), 2021, 53(5): 942-945.
[6] 杨羽,王胜锋,詹思延. 社交媒体数据在药品上市后安全性监测的应用[J]. 北京大学学报(医学版), 2021, 53(3): 623-627.
[7] 陈曼曼,杨招庚,苏彬彬,李艳辉,高迪,马莹,马涛,董彦会,马军. 中山市儿童青少年青春期身高生长突增规律[J]. 北京大学学报(医学版), 2021, 53(3): 506-510.
[8] 张绍兴,姚子明,栾胜,王丽,徐颖. 使用多参数压敏式便携睡眠监测系统检测阻塞型睡眠呼吸暂停伴低通气综合征[J]. 北京大学学报(医学版), 2021, 53(3): 608-612.
[9] 杨雪,孙伟,王哲,姬爱平,白洁. 儿童和青少年牙外伤急诊患者临床分析[J]. 北京大学学报(医学版), 2021, 53(2): 384-389.
[10] 张子一,夏斌,徐明明,李毅萍,唐瞻贵,陈泳清. 湖南韶山地区儿童口腔卫生干预效果评价[J]. 北京大学学报(医学版), 2020, 52(5): 913-918.
[11] 陈小贤,钟洁,闫文娟,张红梅,姜霞,黄芊,薛世华,刘星纲. 树脂冠修复乳前牙的临床效果评价[J]. 北京大学学报(医学版), 2020, 52(5): 907-912.
[12] 陈嘉惠,胡大宇,贾旭,牛薇,邓芙蓉,郭新彪. 大气臭氧短期监测指标与健康年轻人肺功能和气道炎症的关联[J]. 北京大学学报(医学版), 2020, 52(3): 492-499.
[13] 李军,顾芳,李在玲,吕愈敏. 北京单中心回顾性分析儿童肠镜临床特点及疾病谱12年演变[J]. 北京大学学报(医学版), 2019, 51(5): 819-823.
[14] 孙文强,赵舟,高卿,韩增强,杨威,廉波,刘刚,陈生龙,陈彧. 非体外循环冠状动脉旁路移植术中桥血管血流对术后近中期预后的影响[J]. 北京大学学报(医学版), 2019, 51(5): 851-855.
[15] 陶春燕,李红霞,李雪迎,唐朝枢,金红芳,杜军保. 体位性心动过速综合征儿童及青少年在直立试验中血流动力学变化[J]. 北京大学学报(医学版), 2019, 51(3): 414-421.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究(英文稿)[J]. 北京大学学报(医学版), 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报(医学版), 2009, 41(2): 125 -128 .
[3] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报(医学版), 2009, 41(2): 217 -220 .
[4] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报(医学版), 2009, 41(3): 297 -301 .
[5] 万有, , 韩济生, John E. Pintar. 孤啡肽基因敲除小鼠电针镇痛作用增强[J]. 北京大学学报(医学版), 2009, 41(3): 376 -379 .
[6] 张燕, 韩志慧, 钟延丰, 王盛兰, 李玲玲, 郑丹枫. 骨骼肌活组织检查病理诊断技术的改进及应用[J]. 北京大学学报(医学版), 2009, 41(4): 459 -462 .
[7] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报(医学版), 2009, 41(5): 599 -601 .
[8] 赵奇, 薛世华, 刘志勇, 吴凌云. 同向施压测定自酸蚀与全酸蚀粘接系统粘接强度[J]. 北京大学学报(医学版), 2010, 42(1): 82 -84 .
[9] 钱秋谨, 杨莉, 王玉凤. 儿童注意缺陷多动障碍的研究进展[J]. 北京大学学报(医学版), 2007, 39(3): 323 -328 .
[10] 丰雷, 程嘉, 王玉凤. 注意缺陷多动障碍儿童的运动协调功能[J]. 北京大学学报(医学版), 2007, 39(3): 333 -336 .