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Dislipidemii
Dislipidemii
Definiie
Totalitatea tulburrilor cantitative i calitative
ale lipidelor plasmatice (C, TG, HDLc)
Prevalena >30%
Factor major de risc pentru ATS
Normalul lipidic: CT <200 mg%
TG <150 mg%
HDLc 40-45 mg%
45-50 mg%
Chilomicroni
VLDL
IDL
LDL
HDL
Lp (a)
Structura lipoproteinelor
Apolipoprotein
Strat unic
de FL i CL
Core: CE i TG
Clasificarea lipoproteinelor
Clasa
TG
Chilomicroni
80-95 2-7 3-9
VLDL
55-80 5-15 10-20
IDL 20-50 20-40 15-25
LDL 5-15 40-50 20-25
HDL 5-10 15-25 20-30
Lp(a)
5-15 40-50 20-25
*=diferena pn la 100% este reprezentat de Apo
Metabolismul lipoproteinelor
Alimente
Lumen
intestinal
TG
TG
Receptori LDL
AGL
CE
Glicerol
LDL
Colesterol
TG
Perete intestinal
TG
Apo
B48, CII,
CIII, E
TG
Chilo
Apo
B48, CII,
CIII, E
AGL
Apo
B100, CII,
CIII, E
LPL
TG
CE
CE
Colesterol
CE
AGL
Apo
B100
Colesterol
Receptori LDL
i LRP
HTGL
Apo
AI, AII
IDL
HDL
TG
Receptori
LDL
CE
LPL
TG
CE
Receptori
LDL, LRP
Apo
B100, CII,
CIII, E
AGL
VLDL
TG
Remn
AGL
Clasificarea dislipidemiilor
n funcie de natura anomaliei
Hipercolesterolemii (HC)
Genetice (primare, familiale)
Secundare
HC familial
HC prin deficit de apoB100
HC poligenic
Hipotiroidism
Sindrom nefrotic
Colestaz
Hipertrigliceridemii (HTG
Genetice (primare, familiale) Secundare
Deficit de LPL
DZ controlat nesatisfctor,
Secundare
Disbetalipoproteinemia (HLP
familial tip III)
Hiperlipidemia familial combinat
Sindrom nefrotic
Hipotiroidism
Boal Cushing
Diuretice
DZ controlat nesatisfctor
Hipertrigliceridemii
Hiperlipidemii mixte
moderate:
severe:
C
200-299 mg%
300 mg%
TG
200-400 mg%
400 mg%
Diagnostic
1. Tablou clinic
2. Aspectul serului sau plasmei
3. Dozarea CT, TG, HDLc
4. Calcularea LDLc
5. Alte metode (de cercetare)
1. Tablou clinic
Xantelasm
Arc cornean
Xantoame tuberoase
Xantoame tendinoase
Xantoame tendinoase
Xantoame eruptive
Lipemia retinalis
2. Aspectul serului
sau plasmei
Tub 1: plasm normal
Tub 2: HTG
Tub 3: plasma cu exces de VLDL
i chilomicroni (inel cremos la
suprafa)
3. Dozarea lipidelor
CT:
>200 mg%
TG:
>150 mg%
HDLc:
<40 mg%
<45 mg%
5. Alte metode
(folosite rar n practic)
electroforez
ultracentrifugare
dozarea apoproteinelor
Riscul coronarian
LDL <130 mg%
fr risc semnificativ
risc mediu
risc mare
Plci de aterom
Factor de protecie
HDL-colesterol crescut (>60 mg%)
Tratamentul dislipidemiilor
Obiectiv
LDL
HDL
prezena/absena bolilor cardiovasculare
ali factori de risc
<100
(<70 mg%)
Categoria de pacieni
Cu risc coronarian moderat:
-Fr istoric familial de CI
-Fr ali factori de risc
-Aduli tineri cu hipercolesterolemie familial
-Aduli cu HCF fr ali factori de risc
Mijloace terapeutice
Dieta
Medicaia hipolipemiant
1. Fibrai
2. Statine ( ezetimide)
3. Alte (rini chelatoare de acizi biliari, acid nicotinic)
Dieta
Nutrient
Treapta 1
Treapta 2
Grsimi
saturate
Proteine
Colesterol
<300 mg/zi
<200 mg/zi
Glucide
Statine
Doza (mg/zi)
atorvastatin (Sortis, cp 10 mg, 20 mg) 10-80
simvastatin (Zocor, cp 10 mg, 20 mg)
10-40
10-40
20 mg, 40 mg)
Statine
HMG-CoA
HMG-CoA-reductaza
Acid mevalonic
Colesterol
Fibrai
Doza (mg/zi)
fenofibrat (Lipanthyl 100 mg/cp)
300 mg
600-1200 mg
100 mg
Strategia terapeutic
(n funcie de LDLc)
Diet
Medicaie
Scop
Fr CI
0-1 f. risc
Fr CI
>2 f. risc
CI
Sindromul metabolic
Criteriile OMS (1998)
hiperglicemie (AGJ/ STG/ DZ ) sau insulinorezisten