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LMS方法评估女性中糖类抗原125参考区间的年龄适用性

  • 摘要: 目的:利用LMS方法建立女性糖类抗原125(CA125)的连续百分位数曲线,评估其现行参考区间的年龄适用性。方法:收集2016年1月至2016年12月进行健康体检的女性数据,使用Turkey法剔除数据中的离群值后,利用偏度-中位数-变异系数(LMS)方法拟合CA125的连续百分位数曲线。根据LMS曲线分布确定年龄分组切点,并利用Z检验对该切点予以验证。结果:剔除离群值1 015例后,共29 992例数据纳入分析。现行参考区间(35 U/mL)对应样本人群的百分位数为P99.5,CA125水平在女性15~40岁和60~95岁两个年龄区间基本平稳分布,而在40~60岁年龄区间内呈现较大降幅。15~40岁与60~95岁两个年龄区间CA125水平的中位数分别为17.8、11.5 U/mL,P99.5分别为35.5、29.5 U/mL;40~45岁、45~50岁、50~55岁、55~60岁CA125水平的中位数分别为12.9、11.7、9.7、8.7 U/mL,P99.5分别为35.3、35.4、33.5、28.9 U/mL。以50岁作为CA125参考区间的年龄分组切点,组间CA125水平差异有统计学意义(Z=54.76,P<0.001,Z*=4.9)。结论:CA125水平在女性中随年龄增大而变化较大,现行全年龄段使用0~35 U/mL作为参考区间可能并不适用,有必要根据CA125水平的年龄分布特点分组建立参考区间。

     

    Abstract: Objective:To establish the continuous percentile curve of carbohydrate antigen 125 (CA125) by coefficient of skewness-median-coefficient of variation (LMS) method, so as to evaluate the age-specific applicability of current reference interval.Methods:CA125 measurements of healthy women enrolled from January to December 2016 were collected. The continuous percentile curve for CA125 value was fitted by using LMS method after the outliers were removed through Turkey method. The age stratification was performed according to the curve and verified by Z-test. Results:A total of 29 992 individuals were finally enrolled after 1015 outliers were eliminated. The current reference interval of CA125 (35 U/mL) was corresponded to the 99.5th percentile. A large decline of CA125 level was observed in those individuals between 40 to 60 years old, and no remarkable change of CA125 was observed in other ages. For those aged from 15 to 40 and those aged from 60 to 95, the median of CA125 level was 17.8 U/mL and 11.5 U/mL, while the 99.5th percentile was 35.5 U/mL and 29.5 U/mL; for those aged from 40 to 45, 45 to 50, 50 to 55 and 55 to 60, the median and 99.5th percentile were 12.9, 11.7, 9.7, 8.7 U/mL and 35.3, 35.4, 33.5, 28.9 U/mL, both showing downward trend. The CA125 level showed significantly difference between groups with 50 as cut-off value of age (Z=54.76, P<0.001, Z*=4.9).Conclusions:Current upper reference limit of CA125 level (35U/mL) has been approved to be inappropriate for all ages, because CA125 is significantly affected by age. It is necessary to establish the reference interval of CA125 level for different age according to the character of age distribution.

     

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