Derivation of gender and age-specific reference intervals from fully normal Japanese individuals and the implications for health screening

作者：Yamakado Minoru; Ichihara Kiyoshi^*; Matsumoto Yoshiyuki; Ishikawa Yoshiki; Kato Kiminori; Komatsubara Yusuke; Takaya Norihide; Tomita Shohken; Kawano Reo; Takada Keisuke; Watanabe Kiyoaki

来源：Clinica Chimica Acta, 2015, 447: 105-114.

DOI：10.1016/j.cca.2015.04.037

• Reference interval
• Clinical decision limit
• Reference individual
• Health screening
• Clinical guideline

Background: With nationwide standardization of laboratory tests among institutions for health screening in Japan, common reference intervals (RIs) were derived from records of 1,500,000 health check attendees.
Methods: Targets were 20 basic laboratory tests including body mass index (BMI) and systolic and diastolic blood pressures (SBP, DBP). Individuals fulfilling the following strict criteria were chosen: SBP <130, DBP < 85 mm Hg, BMI <25 kg/m(2), non-smoking, ethanol consumption <20 g/day and under no mediation with no remarkable current/past illnesses. The latent abnormal values exclusion (LAVE) method was applied to ensure fully normal results. Rls were derived by parametric method using modified Box-Cox power transformation.
Results: Among all attendees, 23% fulfilled the criteria. Application of the LAVE method further reduced the dataset by 40%-50%. Age-related charts of test results differed greatly between genders in almost all tests. Comparison of derived Rls with clinical decision limits (CDLs) revealed that the upper limits of RIs differed from CDLs according to gender and age.
Conclusions: Implementation of gender and age-specific Rls derived from individuals with fully normal health attributes will (1) enable appropriate interpretation of test results in health screening and (2) promote judicious application of CDLs for therapeutic intervention, taking into account gender, age and other health attributes.

• 出版日期2015-7-20