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93 Dislipidemii 20
93 Dislipidemii 20
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%
Clase ale lipoproteinelor
Forme circulante ale lipidelor
Chilomicroni
VLDL
IDL
LDL
HDL
Lp (a)
Structura lipoproteinelor
Apolipoprotein
Strat unic
de FL i CL
Core: CE i TG
Clasificarea lipoproteinelor
Clasa Coninut lipidic (%)*
TG C FL
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
TG AI, AII
IDL
CE
Chilo HDL
Apo TG TG Apo
B48, CII, Receptori B100, CII,
CIII, E Colesterol LDL Receptori CIII, E
CE
CE LDL, LRP
TG LPL
Apo
LPL
B100, CII, AGL
AGL CIII, E CE
VLDL
Receptori LDL
Apo
TG TG
i LRP
B48, CII,
CIII, E CE
Remn
AGL AGL
Hipercolesterolemii (HC)
HC familial Hipotiroidism
HC prin deficit de apoB100 Sindrom nefrotic
HC poligenic Colestaz
Hipertrigliceridemii (HTG
Genetice (primare, familiale) Secundare
Hipertrigliceridemii
de grani: 150-199 mg%
moderate: 200-399 mg%
severe: 400 mg%
Hiperlipidemii mixte
C TG
moderate: 200-299 mg% 200-400 mg%
severe: 300 mg% 400 mg%
Diagnostic
1. Tablou clinic
4. Calcularea LDLc
Xantelasm
Arc cornean
Arc cornean + xantelasm palpebral
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
Tg <400 mg%
LDLc = C- HDLc- Tg/5 (mg%)
LDLc = C- HDLc- Tg/2.2 (mmol/l)
Tg >400 mg%
Non-HDLc = C-HDLc
5. Alte metode
(folosite rar n practic)
electroforez
ultracentrifugare
dozarea apoproteinelor
Riscul coronarian
Dieta
Medicaia hipolipemiant
1. Fibrai
2. Statine ( ezetimide)
3. Alte (rini chelatoare de acizi biliari, acid nicotinic)
Dieta
Nutrient Treapta 1 Treapta 2
Grsimi
<10% din calorii <7% din calorii
saturate
Proteine 10-20% din calorii 10-20% din calorii
Acetat Statine
HMG-CoA
HMG-CoA-reductaza
Acid mevalonic
Colesterol
Fibrai
Doza (mg/zi)
TG >150 mg%
TA 130/ 85 mmHg