Lp 5.

metabolismul lipidic
Dr. Craescu Mihaela
 Dislipoproteinemiile(DLP)

• Reprezinta cel mai important factor de

crestere a :

1. riscului cardio- vascular

2. mortalitate
 Definire termeni

1. Lipoproteine- forme de transport a lipidelor in sange

(colesterol şi trigliceride (TG))

Există 5 clase de LP:

chilomicroni (CHY),
VLDL- lipoproteine cu densitate foarte mica
IDL - intermediate density lipoprotein
LDL,- lipoproteine cu densitate mica
HDL - lipoproteine cu densitate mare
 Lipoproteine
a) Chilomicroni- forma majora de transport a triglicerolilor exogeni

b) LDL ( low density lipoproteins)

principala forma de transport a esterilor de colesterol - Rol proaterogen

c) VLDL( very low density lipoproteins)

Transporta lipide endogene in special trigliceroli

d) IDL( intermediate density lipoproteins:

Contine atat trigliceroli cat si esteri de colesterol; Rol pro aterogen

e) HDL(high density lipoproteins)

Transporta colesterol de la tesuturi la organe; Rol antiaterogen
 2. Apoproteine

• Reprezinta partea proteica a lipoproteinelor

• Au rol structural si functional

• Apo B (din LDL)- principala proteina

proaterogena
• Apo A ( din HDL)- proteina antiaterogena
 Hiperlipoproteinemie (HLP)

Crestere
• colesterol
• si trigliceride
peste valori N (>200 mg/dl)
 Dislipoproteinemie(DLP)

• Hiperlipoproteinemie
+
scaderea HDL col (<35mg/dl)

sau

• Scadere izolata a HDL col

 Investigarea DLP

• Teste screening
• Teste analitice
• Teste speciale
 A.Teste screening
Stabilim o tulburare a metabolismului lipidic prin
determinarea:

1. Col total
2. Trigliceride
3. HDL col
Indicatii:
• in boli coronariene ischemice, AVC,angiopatii
periferice+ rude gr.I ale pac. cu boli c-v
• HTA, obezitate, DZ( Pac. cu factori de risc pt ATS)
• Pacienti cu xantoame/ arc cornean
 Determinare col total
• Ultimile cercetari au precizat ca nivelele medii de
col la adulti cuprinse

• 180-200 mg/dl

• Val maxime calculate dupa

• formula: 200mg/dl+ varsta in decenii

• Ex: la 20 ani, val col total e 202mg/dl

• Riscul c-v < la valori mai apropiate de 200 mg/dl
 colesterol
col col
Boli ereditare boli ereditare
(Hcol-emia familiala) a beta lipoP- emia
Boli dobandite an alfa /hipo alfa
(obezitate,
sdr. nefrotic asociata unei tirotoxicoze
ATS, hipotiroidie I hepato- celulara
Icter obstructiv) neoplazii(colon)
malabsorbtii intestinala
 2.Determinare trigliceride
• Val N= 40- 150mg/dl

• Val crescute intalnim:

• hiperlipoP-emii esentiale(tip IIb IV, V)

• DZ, aport crescutgrasimi, alcool, zaharuri
• IR
• Consum corticosteroizi/estrogeni
 3. Determinarea HDL col

• Val N=30-75 mg/dl

• Dozarea HDL col este legata de :
• rolul sau antiaterogenic(HDL 2)
• Nivele < 35mg/dl asociate cu risc crescut de
aterogeneza
boala coronariana ischemica
 HDL col
Scazute Crescute

• Afectiuni ereditare cauze ereditare

• Dobandite: corelate
cu crestere
a longevitatii
• obezitate
• DZ,fumat, sedentarism
• Terapie cu progesteron
 B. Teste analitice
• Precizare tip de DLP
• Apreciere risc c-v
• Determinare:
1. Calcul LDL col
2. Inspectie aspect plasma
3. Calcul indice aterogen
 1. Calcul LDL col
• Formula :
• LDL col= col total- HDL col – TG/5

• Val N= < 130mg/dl

Daca:
• 130-160 mg/dl - risc crescut daca asociat cu
alt f. de risc (fumat, HTA, DZ)
• >160mg/dl - factor de risc independent pt ATS
 LDL col
• Crescut scazut(<30mg/dl)

• HLP ereditare tulburari ereditare

• Dobandite:
• h- tiroidii
• Sdr. nefrotic
 2. Inspectie aspect plasma

• Clar - TG< 250mg/dl

• Opalescent difuz - TG>500mg/dl (cresc VLDL+- IDL)

• Lactescent difuz - TG>1000mg/dl (idem sus)

• Clar+supernatant - TG> 1000 (cresc chilomicronii)

lactescent

• Opalescent difuz +
supernatant lactescent -TG> 1000 (Cresc VLDL+chilomicroni)
 3. Calcul indice aterogen

• HDL col./col. total

• Val N pt. acest indice<4

 C. Teste speciale
• In laboratoare specializate

1. Separarea lipoP
• elecroforeza
• ultracentrifugarea

2. Determinarea apo A si apo B

3. Determinarea lipoP
4. Teste de dg. util. Doar in lab. specializate
• Fenotiparea apo E2, C2
• Testarea activitatii lipo- P-lipazei, receptorilor LDL
 Caz clinic 1
• Copil 10 ani
• Istoric cardio-vascular familial
• Laborator:
• Col tot=364mg/dl
• HDL=80
• LDL col=254
• Aspect plasma =clar
• Dg????
• Hiper-llipo-proteinemie familiala
 Caz clinic 2
• F, 24 ani
• Trat cu estrogeni
• Laborator:
• TG=250
• HDL col=35
• LDL col =165
• Aspect plasma = opalescent
• Dg??//
• HLP-emie
 Caz clinic 3
• B 65 Ani
• MI: poliurie, polidipsie , polifagie
• Laborator:
• Col tot= 235mg/dl
• TG= 300
• HDL col=35
• Col tot/ HDL col= 4,2
• LDL col=145
• Aspect plasma= opalescent
• Glicemie=165mg/dl
• Dg???/
Dg= DZ