exercitii

Dislipidemiile secundare
Hiperlipoproteinemii secundare
Tipul I DZ
Alcoolism cronic
ASC
Pancreatita cronica
Tipul II Hipotiroidism
Sindrom nefrotic
Icter mecanic (obstructie)
Cresc beta LP (LDL)
Cresc pre beta LP (VLDL)
Creste colesterolul
Tipul III
Cu beta
larga
Colestaza
Icter mecanic
Creste colesterolul
Cresc TG endogene
Tipul IV Diabet zaharat
Pancreatita
Alcoolism cronic
Glicogenoze
Sindrom nefrotic
hipotiroidism
Cresc beta LP (LDL)
Tipul V Alcoolism
Diabet zaharat decompensat
pancreatita
Cresc chilomicronii
Cresc pre beta LP (VLDL)


Dislipidemia din diabetul zaharat
A.Forma clasica (hiperLP tip I
sau IV)
4 MODIFICARI CHEIE:
1. Cresc TG (hipertrigliceridemie)
2. Cresc VLDL si LDL (risc
aterogen)
3. Scad HDL
4. Cresc lipidele totale
postprandial


Dislipidemia din diabetul zaharat-forma
clasica
Cauz a primara: deficienta de insulina/rezistenta la
insulina
Creste sinteza hepatica de VLDL
1. In celulele adipoase creste lipoliza prin:
2. Inhibarea lipazei hormon sensibile ce conduce la;
3. Eliberarea de acizi grasi liberi (AGL) in sange;
4. Creste sinteza hepatica de TG si apoproteina B
pentru a evita degradarea
5. VLDL creste
Scade catabolismul (degradarea) VLDL
1. Inhibarea actiunea LPL-azei
2. Scade degradarea VLDL si/sau chilomicronilor
Rezultatul: creste VLDL (care sunt convertite in LDL),
cresc TG,crsete LDL,scade HDL
Dislipidemia din diabetul
zaharat
B. forma asociat cu cetoacidoza diabetic cu
cresterea VLDL
Cetonemie crescuta
Corpi cetonici in urina
pH acid
C.forma asociat cu hipertrigliceridemia familial
(apare la obezi)=genetic
Tipul I de HLP primare (defect LP lipaza)
Col N/
TG (de obicei>2000 mgdl)
ELFO: chilomicroni
Glicemie normala postterapeutic




Examenul sumar de urina -normal
Densitate=1.002-1.035 g/mL
Osmolaritate=50-1400 mOsm/kg
Urobilinogen=0.2-1.0 Uniti Ehrlich sau mg/dL
Hematii=0-2 - 3 Numr/cmp
Cilindrii eritrocitari=0 / negativ
Leucocite=0-2/ negativ
Cilindrii hialini=0-4
PH=4,5-8
Proteine=0-urme
Glucoz=0 / negativ
Corpi cetonici=0 / negativ
Bilirubin=0 / negative
Snge=0 / negativ
Nitrii=0 / negativ


HLP din alcoolism
Metabolizare alcool----scaderea beta oxidarii AG--
-acumulare de acetat si exces de AG
Excesul de AG----TG endogene-----incorporate in
VLDL
Consum cronic de alcool---scaderea sintezei hep
a Apo----scade incorporarea TG in VLDL----
acumulare TG in ficat----steatoza hepatica
(inacarcare grasa)
Consum moderat de alcool----sinteza Apo AI---
crestere sinteza hepatica de HDL---efect
protector ASC
HLP stress
Activare lipaza hormon
sensibila
(CA stimuleaza sinteza de
cAMP in adipocit)
Scade transportul icelular de
glucoza
Favorizeaza degradarea TG
Cresc AG liberi (in ficat
formeaza TG endogene)
Stimuleaza sinteza unei lipaze
independenta de c AMP
(cortizolul)
Factori
favorizanti:Sedentarism
Dieta bogata ,Alcool
Tutun ,cafea
Creste cortizol, glucagon
CA, insulina
HLP disfunctii tiroidiene
1.Hipertiroidie:
hormoni tiroidieni ---activeaza lipaza hormon
sensibila din adipocite----AG liberi-----incorporare
in VLDL
Scade COL (creste excretia bil +scade sinteza
endogena)
Hiper TG moderata
2. Hipotiroidie:
Cresc toate fractiunile lipidice
HLP din sindromul nefrotic
Creste sinteza de beta globuline (lipoproteine-
Apo):
Creste colesterolul
Creste LDL
Creste VLDL
Caracteristic: HLP se coreleaza cu gradul
hipoproteinemei
Se coreleaza cu hLP secundara II si IV
In IR cresc Tg si scad HDL
HLP DIN COLESTAZA CRONICA
Creste colesterolul (retinut/retentie, nu se
elimina prin bila)
Creste colesterolul intestinal (blocat drenajul
biliar)----dezinhibarea sintezei de colesterol in
peretele intestinal
Staza bilara cronica-----sinteza unei Apo
anormale =ApoX
ApoX migreaza cu IDL----nu mai este
recunoscuta de receptorii LDL care catabolizeaza
colesterolul
=HLP III
Interpretarea valorilor lipidice
serice
Adult
peste 20 de
ani
Normal Granita Risc
crescut
Cholesterol <200 mg/dL 200-239
mg/dL
>240 mg/dL
Triglyceride <150 mg/dL 150-199
mg/dL
200-499
mg/dL
HDL >35 mg/dL <35 mg/dL
LDL <130 mg/dL 130-159
mg/dL
>160 mg/dL
Aspect plasma Clar
VLDL
Cholesterol
(calculat)
<30 mg/dL


Fractiunile LP
Valori de referinta:

Chilomicroni: 0-2%;
Betalipoproteine (LDL): 39-69% ;
Pre-betalipoproteine (VLDL): 5-
23% ;
Alfa-lipoproteine (HDL): 22-53%
Tipul
HLP

LP
caracteristica
Denumire
Modificari lipidice
Modificari LP ELFO
I Chilomicronii Hipertrigliceridemie
Col N/
TG (de obicei>2000
mgdl)
Lactescent
Chilomicroni
LDL : N
VLDL: N
HDL: N/
II a LDL Hipercolesterolemie
Colest. (300-600mg/dl)
TG: N
clar
LP-LDL
Chilomicroni 0
VLDL: N
HDL: N/
II b LDL i VLDL Hiperlipidemie mixt
Colest 300-600mg/dl)
TG (<= 400 mg/dl)
Clar/usor tulbure
LP-LDL
preLP-VLDL
Chilomicroni 0
HDL: N/
HIPERLIPOPROTEINEMIILE PRIMARE
Tipul
HLP

LP
caracteristica
Denumire
Modificari lipidice
Modificari LP ELFO
III IDL Hiperlipidemie mixt
Colest. 300-600mg/dl)
TG (200-1000 mg/dl)
Clar/usor tulbure/lactescent
LP-LDL
pre LP-VLDL
Chilomicroni 0
HDL: N/
IV VLDL Hipertrigliceridemie
Col N/
TG (500-1500 mg/dl)
tulbure
preLP-VLDL
Chilomicroni 0
LDL: N
HDL: N/
V VLDLi
chilomicronii
Hipertrigliceridemie
Colest. (250 -500mg/dl)
TG(500-1500 mg/dl)
Chilomicroni
preLP- LDL: N
HDL: N/

VI HDL Hipercolesterolemie
HIPERLIPOPROTEINEMIILE PRIMARE
Hiperlipoproteinemii primare

1. Betalipoproteinele (LDL):
cresc in : hiperlipoproteinemia (dislipidemii) de
tip IIa, IIb
scad in tipul IV.
2. Pre - beta lipoproteinele (VLDL):
cresc in dislipidemiile de tip IIb, IV, V.
3. Alfa lipoproteinele (HDL)
scad in dislipidemiile de tip IIa, IIb, III, IV.
4. Chilomicronii
absenti in serul normal
sunt prezenti in dislipidemiile de tip I, V.
Ex 1.
LT (lipide totale)=1450 mg/dl
Col=240 mg/dl
TG=650 mg/dl
Alfa LP (HDL)=29%
Pre beta (VLDL)=35 %
betaLP (LDL)=40%
Chilomicroni=2%
Aspectul plasmei racite=lactescent
EX 2
LT (lipide totale)=1100 mg/dl
Col=450 mg/dl
TG=150 mg/dl
Alfa LP (HDL)=17%
Pre beta (VLDL)=11%
betaLP (LDL)=75%
Chilomicroni=2%
Aspectul plasmei racite=clar

Ex 3
LT (lipide totale)=1900 mg/dl
Col=410 mg/dl
TG= 280 mg/dl
Alfa LP (HDL)=20%
Pre beta (VLDL)= 35%
betaLP larga (LDL)=80%
Chilomicroni=absent
Aspectul plasmei racite=lactescent
Ex 4
LT (lipide totale)=1800 mg/dl
Col=430 mg/dl
TG=270 mg/dl
Alfa LP (HDL)=10%
Pre beta (VLDL)=25%
betaLP (LDL)=64%
Chilomicroni=1%
Aspectul plasmei racite=usor opalescent
Ex 5
LT (lipide totale)=1800 mg/dl
Col=210mg/dl
TG=550 mg/dl
Alfa LP (HDL)=10%
Pre beta (VLDL)=8%
betaLP (LDL)=43%
Chilomicroni= 39%
Aspectul plasmei racite=smantanos
Ex 6
LT (lipide totale)=2000 mg/dl
Col=350 mg/dl
TG=980 mg/dl
Alfa LP (HDL)=10%
Pre beta (VLDL)=40%
betaLP (LDL)= 41 %
Chilomicroni= 35%
Aspectul plasmei racite=lactescent , smantanos
Ex 7
Lipide totale)=2500 mg/dl
Col=260 mg/dl
TG=1200 mg/dl
Alfa LP (HDL)=17%
Pre beta (VLDL)=45%
betaLP (LDL)=35%
Chilomicroni=2%
Glicemie ajeun=250 mg/dl
Corpi cetonici urinari ++
Ph sanguin=7,27

Ex 8
Lipide totale)=1100 mg/dl
Col=350 mg/dl
TG=290 mg/dl
Alfa LP (HDL)=30%
Pre beta (VLDL) si betaLP (LDL)
inseparabile= 85%
Chilomicroni=2%
GGT=55 UI

CLINIC -Xantelasma
Xantelasm
Arc cornean + xantelasm palpebral

Xantoame tendinoase
Xantoame
tendinoas
e