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LIPOPROTEINE
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Structura lipoproteinelor
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LIPOPROTEINELE
HDL-Colesterol(High-density lipoprotein)
LDL-Colesterol (Low-density lipoprotein)
VLDL-Colesterol (Very low density lipoprotein)
Chilomicroni
Fiecare clas de lipoproteine are dimensiune, structur(compoziie de lipide i apolipoproteine) ifunciediferit.
Cu ct raportul proteine-lipide este mai mic, cu attdensitatea este mai mic.
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CHILOMICRONII
1.nveli de apolipoproteine
2. Nucleu : - 97% trigliceride
- 3 % esteri de colesterol.
LPL
Intestinal Limfatic Plasm Chi
remnants
Chi remnantsendocitai hepatic.
LPL - lipoprotein lipaza
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VLDL - COLESTEROL1.nveli de apolipoproteine
2. Nucleu - 75% trigliceride
- 25% esteri de colesterol.
LPL
Hepatic Plasma IDL (intermediate deansity
lipoproteins)
HL
IDL : - endocitat hepatic LDL
- se tranform n LDL.
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LDL COLESTEROL
IDL apolipoproteine- trigliceridele rmase n urma hidrolizei VLDL- esterii de colesterol din VLDL.
Trigliceride
IDL HDL 2
Esteri de colesterol
LDL- colesterol.
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LDL-colesterol
1. nveli - apolipoproteine.2. Nucleu : - 88% esteri de colesterol
- 12% trigliceride.
La nivelul celulelor nucleate exist receptoriipentru LDL (70% la nivelul hepatic ).
n celule, apolipoproteinele sunt desfcute naminoacizi, iar esterii de colesterol n
colesterol liber.
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HDL-COLESTEROL
Hepatic, intestinal se sintetizeaz HDL.
HDL preia colesterolul n exces de la celule.
HDL poate fi metabolizat de ficat, apolipoproteineletransformndu-se n aminoacizi iar esterii decolesterol n colesterol liber.
Colesterolul liber - depozitat la nivel hepatic subform de esteri de
colesterol
- sinteza acizilor biliari,
- eliminat direct n bil
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Fiziologia lipoproteinelor plasmatice
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Apo
Nastere B48 CII CIII E B100 AI AII
CHILOMICRONI intestin + + + + +
VLDL ficat + + + +IDL ficat + +LDL ficat +
HDLficat
+ + + + +
TRASPORT
ANTEROGRAD
ApoB
TRASPORT RETROGRADApoA
Structura principalelor lipoproteine
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Apo-proteineClasa majora
deApo-proteine
Funcia
Apo A A I
A II
Trasportul retrograd alcolesterolului (LCAT)
Apo B B 48
B 100
Legarea de LDL-R i clearence-uldin circulaie
Apo C C IIC III
Activarea LPL
Apo E Legarea de Remnant Receptorhepatic i clearence-ul resturilor
de chilomicroni i LDL
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Clasificarea FredricksonTip Lipoproteina
crescut
Lipidul crescut Defectul
Ia Chilomicroni Trigliceride LpL
Ib Chilomicroni Trigliceride Apo CII
IIa LDL Colesterol LDL-RIIb LDL i VLDL Colesterol LDL-R i Apo B-100
III -VLDL Colesterol itrigliceride
Apo E
IV VLDL Colesterol itrigliceride
VLDL supraproduciesau subutilizere
V VLDL i
chilomicroni
Colesterol i
trigliceride
Deficien LpL sau HL
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Indicatii de recoltare Antecedente heredo-colaterale de boala coronarian
prematur :
- tatl sau alt membru de sex masculin rud grad 1 cu IMA saumoarte subit sub vrsta de 55 ani
- mama sau alt membru de sex feminin rud grad 1 cu IMA saumoarte subit sub vrsta de 65 ani.
Triada lipidic :Trigliceride crescuteLDL crescutHDL sczut.
Ali factori :Diabet zaharat
Obezitate central (ATP III 102/90; IDF 94 / 80)Vrsta naintat
Hipertensiune arterial
Fumat
Cresterea PAI-1, CRP
Hiperhomocisteinemie
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Condiii de recoltare
Lipoproteine:
Explorarea de realizez dupa repausalimentar de 12 - 14 ore.
Cu 24-48 de ore nainte de dozare esteinterzis consumul de alcool.
Apolipoproteine:
este util pentru aprecierea riscului deateroscleroz.
Dozarea se face dup repaus alimentar de 12-14 ore.
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Fraciuni lipidice plasmatice
determinate uzual n clinic
Colesterol total
LDL-Colesterol
HDL-Colesterol
Trigliceride
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Valori normaleNormal
(mg/dl)
Risc la
limit(mg/dl)
Risc nalt de afectare
Cardiovascular(mg/dl)
Colesterol
total< 200 200 - 239 > 240
LDL colesterol < 130 130 - 159 > 160
HDL
colesterol
> 45 35 - 45 < 35, la barbati
< 45, la femei.Trigliceride < 150 150 - 200 > 200
AACE Guideline Medical Guidelines for Clinical Practice for the Diagnosis and
treatment of Dyslipidemiaand Prevention of Atherogenesis - Amended Version - 2002
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Valori normale
Normal Normalinalt /aproapenormal
Risc lalimit
Risc inalt Riscfoarteinalt
Colesteroltotal < 200 200 - 239 > 240
LDLcolesterol
< 100 100 129 130 159 160 189 190
HDL
colesterol
40 - 60 < 40
Trigliceride 500
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) -NIH Publication No. 01-3670 May
2001.
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Cauze de dislipidemie
Genetice
Dobandite (Secundare altor afeciuni)
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Cauze genetice de dislipidemie
HDL VLDL LDL TG Defect genetic
Hipercolesterolemiafamilial
++ N LDL-R
Deficit de ApoB ++ N anomalii ApoB
Familial mixt 1/3 1/3 exces ApoB1/3
Hipercolesterolemiapoligenic
+ poligenic
Hipertrigliceridemiafamilial
+ 200-1000
scade activitatea LpL
Hipertrigliceridemiasever
++ >1000 LpL
Hipoalfalipoproteinemia familiala
< 30 B
< 35 F
scade Apo AI
Dis-
betalipoproteinemia
+ + + anomalii ApoE
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Cauze de dislipidemie
Genetice
Dobandite (Secundare altor
afeciuni)
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Colesterolul total i LDL crescute :
hipotiroidism(scade numr receptori LDL, scade
colesterol hepatic, se stimuleaz HMG-coAreductaza).
afeciuni biliare obstructive
afeciunihepatice cronice scade catabolismulLDL colesterol.
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Trigliceride i VLDL crescute (1):
sindrom nefrotic ( proteinurie, scade presiuneacoloid-osmotica ceea ce stimuleaz sintezele
proteice hepatice, inclusiv de apoproteine i
lipopproteine) Diabet zaharat (deficit de insulin deficit de
lipoproteinlipaz, lipoliza accentuat,
hipertrigliceridemie, supraproducie de VLDL).
Obezitate (aport caloric crescut, insulinorezistenperiferic)
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Trigliceride i VLDL crescute (2)
Consum excesiv dealcool(inhib beta-oxidareaacizilor grai, exces de trigliceride intracelular, deci
supraproducie de VLDL).
Hipotiroidism(scade activitatea lipoproteinlipazei)
Sarcin