Interpretation of Screening for Lipid Disorders in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

doi:10.12114/j.issn.1007-9572.2024.0002

Abstract

Abstract:

Dyslipidemia due to genetic and multifactorial dyslipidemia has a predisposition to early-onset atherosclerotic cardiovascular disease (ASCVD), and consensus and guidelines regarding lipid lowering in adults are well established, but the benefits of lipid screening and treatment in childhood and adolescence for this population are not well established. The United States Preventive Medicine Task Force (USPSTF) issued the Recommendation Statement: Screening for Dyslipidemia in Children and Adolescents based on a systematic review of evidence with meta-analysis conducted in a large number of randomized controlled trials, large cohort studies in European and American countries, with the aim of assessing evidences whether initiation of lipid screening and early initiation of treatment in childhood and adolescence has long-term benefits for this population. This article provides a detailed interpretation of the guideline, which aims to provide reference to clinical healthcare workers to improve the understanding of dyslipidaemia in children and to decide whether to screen them with a view to reducing the incidence of cardiovascular disease in adulthood.

Key words: Dyslipidemias, Child, Adolescent, Screening, United States Preventive Medicine Task Force

摘要：

家族性高胆固醇血症和多因素所致血脂异常是导致儿童期血脂异常的重要原因，而儿童期血脂异常可能导致早发动脉粥样硬化性心血管疾病甚至威胁生命。已有众多指南和声明提出不同的儿童和青少年时期血脂筛查策略。2023年美国预防临床服务指南工作组（USPSTF）针对儿童家族性高胆固醇血症及多因素血脂异常筛查的利弊进行了系统综述，并发布《儿童和青少年血脂异常筛查推荐声明》，目前尚无充足的证据评估针对20岁以下儿童青少年血脂异常筛查的益处或危害，呼吁对此开展进一步深入研究，并建议临床医生根据自己的判断决定是否进行筛查。

关键词: 血脂异常, 儿童, 青少年, 筛查, 美国预防临床服务指南工作组

LIU Wenjun,YAO Mi,JING Guanning, et al. Interpretation of Screening for Lipid Disorders in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement[J]. Chinese General Practice, 2024, 27(15): 1796-1801. DOI: 10.12114/j.issn.1007-9572.2024.0002.
刘文郡,姚弥,荆冠宁等. 2023年美国预防临床服务指南工作组《儿童和青少年血脂异常筛查推荐声明》解读[J]. 中国全科医学, 2024, 27(15): 1796-1801. DOI: 10.12114/j.issn.1007-9572.2024.0002.

Figures/Tables 1

References 31

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USPSTF推荐	内容
要点	对于20岁或以下的儿童和青少年：目前的证据不足以评估血脂异常筛查的利弊平衡
适用人群	适用于没有血脂异常体征或症状的儿童和青少年
更新	与2016年USPSTF的推荐一致
实施建议	·没有足够的证据支持或反对对儿童和青少年进行血脂异常筛查。USPSTF呼吁获得更多的在普通儿童人群中筛查和治疗血脂异常的有效性的长期数据，以预防早发心血管事件或成年期死亡 ·在缺乏证据的情况下，鼓励医生结合临床判断决定是否对儿童和青少年进行血脂异常筛查
临床医生应了解的有关该建议的其他信息	·儿童和青少年的血脂异常有两种主要类型：家族性高胆固醇血症和多因素血脂异常。家族性高胆固醇血症是一种胆固醇代谢的遗传性疾病，会导致生命早期LDL-C水平显著升高。多因素血脂异常比家族性高胆固醇血症更为常见，主要与环境因素有关，例如过量摄入饱和脂肪酸、久坐的生活方式和肥胖 ·家族性高胆固醇血症的证据综述重点关注杂合子家族性高胆固醇血症，因为其是最常见的家族性高胆固醇血症类型。纯合子家族性高胆固醇血症或继发病因（如糖尿病、肾病综合征或甲状腺功能减退症）导致的血脂异常，以及基于早发心血管事件家族史的靶向筛查，不在本综述范围内
该推荐的重要性	·随着时间的推移，累积暴露于异常脂质环境可能导致早期动脉粥样硬化样改变和早发心血管事件或成年期死亡 ·降低血脂水平的干预措施具有可及性，包括改变生活方式（例如改善饮食和运动）、药物（例如他汀类药物）和膳食补充剂（例如植物甾醇或鱼油）
其他工具和资源	·美国国家心脏、肺和血液研究所，儿童和青少年心血管健康和风险降低综合指南专家小组制订循证指南，以协助初级保健专业人员促进心血管健康并识别和管理从婴儿期到青少年时期的特定心血管危险因素（https://www.nhlbi.nih.gov/node/80308） ·美国卫生与公众服务部发布了《美国体育活动指南》，该指南为体育活动如何帮助3岁以上人群促进健康并降低慢性病风险提供了循证建议（https://health.gov/ourwork/nutrition-physical-activity/physical-activity-guidelines） ·美国农业部和卫生与公共服务部发布了《美国居民膳食指南》，为生命各个阶段的饮食提供建议，以建立有助于预防慢性病的健康饮食（https://www.dietaryguidelines.gov/） ·社区预防服务工作组建议采取干预措施，促进整个生命周期的体育运动和健康饮食，包括针对青少年的具体建议（https://www.thecommunityguide.org/）

USPSTF推荐	内容
要点	对于20岁或以下的儿童和青少年：目前的证据不足以评估血脂异常筛查的利弊平衡
适用人群	适用于没有血脂异常体征或症状的儿童和青少年
更新	与2016年USPSTF的推荐一致
实施建议	·没有足够的证据支持或反对对儿童和青少年进行血脂异常筛查。USPSTF呼吁获得更多的在普通儿童人群中筛查和治疗血脂异常的有效性的长期数据，以预防早发心血管事件或成年期死亡 ·在缺乏证据的情况下，鼓励医生结合临床判断决定是否对儿童和青少年进行血脂异常筛查
临床医生应了解的有关该建议的其他信息	·儿童和青少年的血脂异常有两种主要类型：家族性高胆固醇血症和多因素血脂异常。家族性高胆固醇血症是一种胆固醇代谢的遗传性疾病，会导致生命早期LDL-C水平显著升高。多因素血脂异常比家族性高胆固醇血症更为常见，主要与环境因素有关，例如过量摄入饱和脂肪酸、久坐的生活方式和肥胖 ·家族性高胆固醇血症的证据综述重点关注杂合子家族性高胆固醇血症，因为其是最常见的家族性高胆固醇血症类型。纯合子家族性高胆固醇血症或继发病因（如糖尿病、肾病综合征或甲状腺功能减退症）导致的血脂异常，以及基于早发心血管事件家族史的靶向筛查，不在本综述范围内
该推荐的重要性	·随着时间的推移，累积暴露于异常脂质环境可能导致早期动脉粥样硬化样改变和早发心血管事件或成年期死亡 ·降低血脂水平的干预措施具有可及性，包括改变生活方式（例如改善饮食和运动）、药物（例如他汀类药物）和膳食补充剂（例如植物甾醇或鱼油）
其他工具和资源	·美国国家心脏、肺和血液研究所，儿童和青少年心血管健康和风险降低综合指南专家小组制订循证指南，以协助初级保健专业人员促进心血管健康并识别和管理从婴儿期到青少年时期的特定心血管危险因素（https://www.nhlbi.nih.gov/node/80308） ·美国卫生与公众服务部发布了《美国体育活动指南》，该指南为体育活动如何帮助3岁以上人群促进健康并降低慢性病风险提供了循证建议（https://health.gov/ourwork/nutrition-physical-activity/physical-activity-guidelines） ·美国农业部和卫生与公共服务部发布了《美国居民膳食指南》，为生命各个阶段的饮食提供建议，以建立有助于预防慢性病的健康饮食（https://www.dietaryguidelines.gov/） ·社区预防服务工作组建议采取干预措施，促进整个生命周期的体育运动和健康饮食，包括针对青少年的具体建议（https://www.thecommunityguide.org/）