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ENGLISH ABSTRACT
针对儿童年龄依赖指标建立连续参考区间的必要性及方法学进展
严若华
彭晓霞
彭亚光
李昆
倪鑫
作者及单位信息
·
DOI： 10.3760/cma.j.cn114452-20230524-00257
Necessity and methodological progress on the establishment of continuous reference intervals for pediatric age-dependent indicators
Yan Ruohua
Peng Xiaoxia
Peng Yaguang
Li Kun
Ni Xin
Authors Info & Affiliations
Yan Ruohua
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Peng Xiaoxia
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Peng Yaguang
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Li Kun
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Ni Xin
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
·
DOI： 10.3760/cma.j.cn114452-20230524-00257
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摘要

准确、适用的参考区间可为疾病诊断、疗效评价及健康监测提供重要依据。许多临床检验指标存在年龄依赖趋势，对此类指标的结果判读应考虑年龄因素的影响。然而，划分年龄亚组的参考区间在实际应用中存在局限性，而连续参考区间不仅可以为精准判读检验结果提供参考，还可以为动态监测其变化趋势提供基线。该文基于本研究团队在儿童参考区间方面进行的研究，介绍建立连续参考区间的不同算法及其适用条件与实现步骤，为我国连续参考区间的建立提供方法学参考与实现途径。

儿童;参考区间;非参数法;半参数法
ABSTRACT

Accurate and applicable reference intervals can provide important information for disease diagnosis, efficacy evaluation, and health monitoring. Age-dependent trends exist for many clinical laboratory indicators, and the interpretation of such indicators should consider the effect of age carefully. However, age-specific reference intervals have certain limitations in clinical application. Continuous reference intervals can not only help accurate interpretation of laboratory test results, but also provide a baseline value for dynamic monitoring of their changing trends. Based on the researches on pediatric reference intervals from our team, this paper introduces different algorithms for establishing continuous reference intervals, and their applicable conditions and implementation steps. The aim of this paper is to provide methodological guidance for the establishment of continuous reference intervals, so as to improve the quality of laboratory reports and the accuracy of clinical diagnosis in China.

Child;Reference interval;Non-parametric method;Semi-parametric method
Peng Xiaoxia, Email: nc.defmoabc.hcbaixoaixgnep
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引用本文

严若华,彭晓霞,彭亚光,等. 针对儿童年龄依赖指标建立连续参考区间的必要性及方法学进展[J]. 中华检验医学杂志,2023,46(08)：872-878.

DOI:10.3760/cma.j.cn114452-20230524-00257

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参考区间指95%正常个体测量值会落入的分布范围［ 1 ］，是临床诊疗或流行病学调查中用于筛查“异常”的参考标准。如果个体测量值位于参考区间外，则会被标记为“异常”，并在此基础上，决定是否需要进一步检查或治疗。因此，参考区间的准确性和适用性对健康评估、疾病诊断、治疗监测和预后判断等医疗保健活动均具有重要意义。
许多临床检验指标具有年龄依赖趋势，如血清肌酐水平随着儿童生长发育而持续升高，在20岁达到峰值，随后维持在稳定水平，但从60岁开始又进一步升高［ 2 ］。针对此类具有年龄依赖趋势的指标，为不同年龄段人群建立统一的参考区间显然无法准确反映该指标随年龄的变化规律，在临床实践中表现出诸多不适用［ 3 ］。然而，划分年龄亚组建立参考区间又可能在年龄临界点附近对“异常”的评判出现分歧，给临床判读带来困惑。
本文基于本研究团队在儿童参考区间方面进行的研究，介绍建立连续参考区间的不同算法及其适用条件与实现步骤，为我国连续参考区间的建立提供方法学参考与实现途径。
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备注信息
A
彭晓霞，Email：nc.defmoabc.hcbaixoaixgnep
B
严若华, 彭晓霞, 彭亚光, 等. 针对儿童年龄依赖指标建立连续参考区间的必要性及方法学进展[J]. 中华检验医学杂志, 2023, 46(8): 872-878. DOI: 10.3760/cma.j.cn114452-20230524-00257.
C
所有作者声明无利益冲突
D
北京市科技新星计划 (Z211100002121053)
国家卫生计生委医政医管局委托项目 (2017374)
国家自然科学基金 (72174128)
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