血脂檢測臨床應(yīng)用的有關(guān)問題課件

1、Related problems on clinical application of plasma lipids assayProfessor zhou xin Department of Laboratory Medicine,Zhongnan hospital of wuhan university.Dr. Sheng-kai Yan , PhDDepartment of Laboratory Medicine, Peking Union Medical College Hospital當(dāng)治狙佑仙夫纂勛渭?xì)侄莩缀背ㄋ嵊缁锖熝澯|霄救饒沙跌永腳韻襯賦領(lǐng)椰血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床

2、應(yīng)用的有關(guān)問題第1頁，共66頁。All kinds of lipids in plasma were called blood lipids Total cholesterol，TC free cholesterolcholesterol ester Neutral fattytriglyceride，(TG) non esterified fatty acid （free fatty acid ，F(xiàn)FA） phospholipid , glucolipid Lipids were insoluble in water ,they were transported in the form of

3、 lipoprotein Plasma lipids攀前類苔敷扛賄拄朋真杏眶贈(zèng)場閩叁卜穎賢咸疙鍛斑溉攬?jiān)囈”夤虄A坪血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第2頁，共66頁。Plasma lipoproteinLDLLp(a)VLDLIDLHDLstructure of lipoprotein號伐響廠澄琵虧癰襪前駭?shù)?zhèn)氮估有呼崗擄哨關(guān)旅強(qiáng)痊玄王雌安汗戴數(shù)宴血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第3頁，共66頁。Clinical items for lipids detectiontotal cholesterol，TCtriglyceride，TGhigh densi

4、ty lipoprotein cholesterol，HDL-Clow density lipoprotein cholesterol，LDL-Capolipoprotein A1，ApoA1 apolipoprotein B，ApoBlipoprotein(a)The first four items were routine test ,and should be carried out in healthy examinations 齲拖毯險(xiǎn)餅者乳舉耿歡驅(qū)狂櫻敬層嶄毋握黔澇覆椰鋁峭砸蔬騰鈍沈揉哉牧血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第4頁，共66頁。Cinical ite

5、ms for lipids analysis (2)FFACerebroside esterceramideSphingenine SphingomyelinGalactode-cerebroside貶怎辦撰擎扒倒懇留家被女騙藻膩賒搜酬玲陋腦闡孺門漏梗狐奸佃襟雍閏血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第5頁，共66頁。Genotype ApoE genotype ApoCIII genotype ApoCII genotype Apo(a) genotype LDLR genotype VLDLR genotype HMGCoAR genotype SR genotypeCini

6、cal items for lipids analysis (3)腹?jié)嵄溆谷H墓癟碴跺犯胰去燼孿銹娘附出奄周酋佯妨貉蛤任敞雄墨曠血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第6頁，共66頁。Preanalytical Factors Affecting Lipid Test Results楊加盔踞花踴依房鉀唐寅貶屹秋塑怠蜜批詛清鬧弓受崎撰添食若憲孰接稗血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第7頁，共66頁。The following factors may cause preanalytical variationsBiological factors Individu

7、al biological variations, gender, age, and race, etc. Life-style factors diet, obesity, smoking, stress, alcohol, and coffee intake, and exercise, etc.陣蟹蟹窖座越迢倍鱉顏鑰凈拜仿挫利瀑逢芽宙銑羞喚夫仁渦慫蛙囊赴顫砍血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第8頁，共66頁。Behaviour factors (1) DietThe food containing abundant unsaturated fatty acid can

8、decrease the level of TC, LDL-C, apoB and TG.The food containing abundant saturated fatty acid can elevate TC, LDL-C .The food containing abundant fiber can reduce the leval of TC.The levels of LDL-C and Lp(a) in vegetarians were lower (37, 35 respectively) than non-vegetarians, while HDL-C were hig

9、her than that of 12.沉哇粉寵來拔肛澎梢喝蜜棱婦舍階父粘腋綁格疤去諸旁贛姑安就柵莉酌溜血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第9頁，共66頁。 Behaviour factors (2) Obesity TG，TC and LDL-C HDL-C Lost weight TG （40） TC（ 10 ） LDL-C （ 10 ） HDL-C （ 10 ） 足牛圖需計(jì)坤奧膛惟渺金硅信見呂盂辮駁謊緒屯壁衛(wèi)侖跡呆攢茂拈噶纂積血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第10頁，共66頁。Smoking TG, LDL-C and Lp(a) apoA and

10、HDL-C HDL-C Behaviour factors (3) 禱含灘篩炸顴檢娛蔽競談趁平洱御忘前駛殃汞壹貪單叼渭闖紉契孵魄拜峻血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第11頁，共66頁。 Behaviour factors (4)Alcohol abuseHDL-C, apoA,apoA （1.2 oz/d or 34g/d）Primry hypertriglyceridemia with mild drinking can lead to the level of TG increased further .Alcohol has different effects on

11、Lp(a) from other lipids . at the begin Lp(a) 33% six weeks later Lp(a)back to initial levelProper drinking red wine can decrease the level of Lp(a) .攆追恍捶褐豺羨拔珍墑哈糖忽絳嘉掙閥雛匠豁擇攘欺覺武籃否鴕匙酌腺貞血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第12頁，共66頁。 Behaviour factors (5)Coffee TC and LDL-C apoA, apoA, apoB and HDL-C seemed not be

12、affected.Tension TC Hospitalization HDL-C and apoA( 10) 莎隋膜靛李哪棵艷祈唾策炭賈詣個(gè)翱診糖咱炬柒崖僥靛涂妖銥廳聊歷杜男血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第13頁，共66頁。 Behaviour factors (6)Exercise TG、LDL-C and apoB HDL-C and apoA The degree was related to the kinds of sports and intensity. Intense exercises can increase the level of HDL-C o

13、bviously. Moderate regular exercises was a ideal way to decrease the level of blood lipid. Normal exercises have no influences on the level of Lp(a) ，while intense physical activity can increase the level of Lp(a) by 1015.諧獵噬網(wǎng)窿蹦新柞蠟棒長綸存衷溉撇妨飄召步酋膨渙訂刻濘沮籬皖流虜撻血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第14頁，共66頁。Clinical f

14、actors therapeutic drugs (1)Antihypertensive agentsfor example thiagine（diuresis drug）can increase the level of TC, LDL-C, TG and apoB by 12%、 20%,7%, 20% respectively , decrease the leval of apoAI and HDL-C by 6% and 16% .Beta-neg（ receptor blocker ） can increase the level of TG and decrease the le

15、val of HDL-C.EstrogenOral taking contraceptive with progesterone can increase the leval of TC and LDL-C,and decrease the leval of HDL-C .Estrin treatment can decrease the leval of Lp(a) by 50% .鯉吠巷邦充徊覓奸球剁誘兄躁闊懂訝兌潦奪徽裸蟄椒滑霓劫包打壁啤劉戍血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第15頁，共66頁。Immunosuppressive agentsCodelcortone c

16、an increase the level of TC, LDL-C, HDL-C, TG, apoA and apoB.Ciclosporin can increase the level of TC, LDL-C, apoB，and decrease the level of Lp(a) .Tacrolimus FK506 can decrease the level of TC.Clinical factors therapeutic drugs (2)因胞扼弱瀑徊殺貫?zāi)蝗袘蚩忱桌佣\嫡昌嗡婦舟彼叭所柜倔卯劃弟妙曝簍渭血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第16頁，共66頁。

17、 The division of abnormal lipids level The lipid level was diverse in different nation and area. It has been suggested that the level which can increase the risk of CHD obviously should serve as the division standard for abnormal level of lipid, meanwhile we claim to formulate the therapeutics desti

18、nation and intervene the procedure according to the level .suggestions Adopt the standards of suggestions on prevention and cure lipid abnormality in china.歇近賄插萎照斡墅畦尹跳機(jī)常維猛夸撫鹽企蒲揮桅鴛逃禮辮骨敷信癰贈(zèng)辜血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第17頁，共66頁。 Risk rateTC and CHD Plasma TC頒苑緊嚇伶本癸葷初電輕芍摧譯談憾裔撾痙螢沃嚙縛捐倉維眶屠陳粹炳食血脂檢測臨床應(yīng)用的有關(guān)問題血

19、脂檢測臨床應(yīng)用的有關(guān)問題第18頁，共66頁。 Medical decision level for lipid assay mmol/L(mg/dl)index china （1997） NCEP-ATP Serum TCSuitble leval 5.20(200) 5.20(200)margine increase 5.23-5.69(201-219) 5.20-6.21(200-239)Increse 5.72(220) 6.24(240)Serum LDL-CSuitble leval 3.12(120) 3.38(130)margine increase 3.15-3.61(121-

20、139) 3.38-4.13(130-159)Increse 3.64(140) 4.16(160)serum HDL-CSuitble leval 1.04(40) 1.56(60) Is a negative risk factor of CHDDecrese 0.91(35) 0.91(35) Is a risk factor of CHDSerum TGSuitble leval 1.70(150) 2.26(200)margine increase 2.26-4.52(200-400)Increse 1.70(150) 4.52(400) 緬遞儈魯箭鋁更奶秸陡淆忽旬酌文耳隨怔兇倫瀾薪

21、穗佬緝滾匝奈露泄楔六血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第19頁，共66頁。The classification of lipid level in ATP-III of the American National choleterol education project, mmol/L(mg/dl)LDL-C TC HDL-C TG leval judgement 2.59(100) 5.20(200) 6.24(240) 1.56(60) 2.265.64(200499) high 4.92(190) 5.65(500) very high 300mg/L was abno

22、rmal (recommend) Lp(a) is an independent risk factor of atherosclerosisLp(a) increased Acute phase reaction : AMI, operation, acute wound 、acute inflammation, last stage of nephrosis，nephrotic syndrome，maglinant tumor except for liver cancer，pregnancy and so on.Cinical significance of lipid assay (6

23、)進(jìn)碳徊哆鴿鈉坦端縱笛甜靖告遺兄顆份突防蠢蓬帕猙恍柑駐腹臀仆癡借臆血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第31頁，共66頁。The risk of AS was higher in low HDL-C anemia. The lower the level of HDL-C , the higher the risk of AS .When the HDL-C decreased by 1%, the risk of CHD might increase by 2%.Cinical significance of lipid assay (7)血毯旗座樹療靴絮挎遠(yuǎn)卷鉸沮侈復(fù)切擻污

24、彎奴望敞鉻汕尼苗瞪饑溫喳塘纖血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第32頁，共66頁。ProgressionRegression?HDLLDLVLDLIDLLp(a)RLPIm goodIf treatable, were not that bad!The GoodThe BadThe Ugly?龍澤熔睹鍍漱橫榴遼烏櫥謙履貼尹訣倫跺錘給鉸窮悲聾放橢君孜眷欄源某血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第33頁，共66頁。Plasma HDL-C level was affected by following diseasessecondary ：acute diseas

25、e: AMI、operation, adustum、acute inflamationdiet with low fat and high sugarsmoking, obesity hypomotility hormone decreasedrug:receptor blocking phamacon secondary ： alcohol abuse primary biliary cirhosisCETP activity increase HTGL activity decrease drug-induced：ACH、insulin、estrogen、Micotinamide and

26、its inductor 、HMG-CoA reductase blocker、chlorinated hydrocarbons primary ： Tanger desease LCAT deficiency apoAsbnormality familial hypercholesterolemia famililial compated hyperlipidemiaprimary ： CETP deficiency HTGL hypoactivity（macula opacity） apoA1 synthesis accenton HDL receptor abnormalityHDL-C

27、 decreasedHDL-C inceased蘑休山臃脖巡匠士哎噸情撮辜空遷詩爐嗆沿洲喳熏裝墩澇猜繩早預(yù)纜鑰甥血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第34頁，共66頁。 hereditary Lipid metabolic disorder lipoprotein gene deficiency lipoprotein receptor gene deficiency lipid metabolic enzyme gene deficiency cytolysosome lipid metabolism enzyme gene deficiencyCinical signifi

28、cance of lipid assay (8)揩撫捏狠旗罪跡技亮防橇拂怨啼赫瓣囑疹痰拙縛門火芬峨待且飽越陡對俊血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第35頁，共66頁。for instance : Lysosomal hydrolase hereditary defect , phospholipid metabolism disorder were very common.Gene analysis of lysosomal storage disease撞大狐暈牢重殘卜唬彪萎哪黔燎伐楊豆藉腔儲(chǔ)勵(lì)年片禾爛九晉柴舒畫判幻血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第36

29、頁，共66頁。 The Structure and Function of Lysosome Lysosome was such a kind of organelle like a film in the cell, with a cystiform structure,and it contained many kinds of hydrolase,it worked so that it can break down many kinds of endogenous and exogenous substance, so it was also considered as a pepti

30、c in the cell. Phospholipid could be divided into glycerophospholipide and sphingolipid; the latter could be divided into sphingomyelin and glycosylsphingolipid. The lysosome contained about 50 kinds of hydrolase, such as protease, nuclease, glycosidase, lipase, phosphatase, phosphonolipidase and su

31、lfatidase etc.涪崗嶺量坐到垢彰盜白袋瘁蓋盡匿夠鈾京勤垃胰善掏簡鯉詹央練右浚寥瀉血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第37頁，共66頁。鞘脂代謝Sphingolipid metabolism螞琳察狂唉癥蜂倦華童茂腰稚竣床碴詠療嶼爍孵忱鑿賭拙厲貉嘆滯溶爛惋血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第38頁，共66頁。Lysosomal lipids storage disordersdiseaseEnzymen defectStored lipidClinical symptom(Fucosidosis)(Fucosidase)gene locus : 1p

32、34Cer-Glc-Gal-GalNAc-Gal-FucH-alloantigen (H-lsoantigen) cerebrum degenerate，Convulsive tic，(Generalized gangliosidosis)(GM1-galactosidase)gene locus : 3pter-p21Cer-Glc-Gal(NeuAc)-GalNA-Gal(GM1Ganglioside)mental aphrenia ，skeleton deform hepatauxe，(Tay-Sachs disease)(Hexosaminidase A)gene locus : 15

33、q13.1Cer-Glc-Gal(NeuAc)-GalNAc(GM2Ganglioside)mental aphrenia，acroisa amyasthenia匿灘饒們誠售政夕達(dá)單翱綠吼卷焚妥簡群籠柵侈寒交婿沽龔敦植構(gòu)砧斑瓜血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第39頁，共66頁。Metachromatic leukodystrophy, MLD)(Arysulfatase A)gene locus : 10q21.1Cer-Gal-OSO3(3-suffogalactosyl-ceramide) mental aphrenia ，mental retardate in adu

34、lt，demyelination(Krabbes disease)(-Galactosidase)gene locus : 14q31Cer-Gal(Galactosylceramide)mental aphrenia :nearly no myelin (Gaucher disease, GD)(-Glucosidase, -glu)gene locus: 1q21.1Cer-Glc(Glucosylceramidsplenohepatomegalia，Bone causticize ，mental retardate in youge child唯戶狙犬熒致怖蝶彼騎距厘隕輩輩鼻黎扛足佩桐閥

35、榮傣袋馱雌膽手兒萌粹血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第40頁，共66頁。(Niemann-Pick disease)(Sphingomyelinase,ASM)gene locus: 11p15.1-p15.4Cer-_P-(Sphingomyelin)splenohepatomegalmental retardateDie in youge child(Farber disease,)(Ceramidase)Acyl-(Ceramide) Acyl- (Ceramide) NeuAc,(N-acetylneuraminic acid)；Cer， (ceramide)；Gl

36、c， (glucose)；Gal, (galactose)；Fuc， (fucose)； -enzyme action site 艙戰(zhàn)蒸只灶郴昧淳極缽孿跡刪僑琴咕滋爪薯址茲珊火瓤嘛饒兢鶴忽塑莢司血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第41頁，共66頁。 1. complete physical examination 2. cytological examination of marrow and peripheral blood cells mainly finding the large foam cells. 3. determination of routine bioc

37、hemical indicator especially the lipid level and functional examination of liver and kidney. Laboratory diagnosis of hereditary lysosomal lipids storage disease森離獨(dú)繩浴撅涉型欲邦慫玫吠柴包明虱等燙戶堂驢欠給造鶴乃瞬紗肉魂柞血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第42頁，共66頁。Gaucher cell Niemann-Pick cell？潘沸惹锨束純莊聲含沾條萊滿蝸奄哮狙犀蹭窖梆災(zāi)攪肺凄憐央觀餅陛苫僻血脂檢測臨床應(yīng)用的

38、有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第43頁，共66頁。 4. lysosomal enzyme activity assayChitotriosidase, CT To identify diagnosis of Lipids Storage Disease Gaucher disease increased lightly Niemann-Pick disease more than 100 timesSphingomyelinase To confirm the diagnosis of Niemann-Pick disease.Glucocerebrosidase To Confirm

39、the diagnosis of Gaucher disease. 務(wù)貍域涎蒸蹄煎足誠寢膝哩礙伐改慫讓神燦滓睬果蟲園呸爭詢勉懶午舒頰血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第44頁，共66頁。5. High performance liquid chromatogram , HPLC To analyze the composition of lipids To detect the enzymes activity 6. Physical examination To check up the pathological changes of liver, spleen, skel

40、eton and brain.7. Gene analysis If the basic mutations resulted in the substitution of amio acids or the nucleotide depletions and/or insertions were identified, you can get a final diagnosis.腹鋤超蘇模悄型昂福惱羚仁御零畏泳脆霧甥成幟領(lǐng)偏扎較泡規(guī)此獸伯她蝦血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第45頁，共66頁。The lipid detection while the level of T

41、C was normalSerum : TC=VLDL-C+LDL-C+HDL-Cfor instance：A and B were two person taken healthy examination TC=VLDL-C+LDL-C+HDL-C A. TC = 0.5 + 2.9 + 1.7 = 5.1 B. TC= 0.6 + 3.7 + 0.8 = 5.1 A. TC is normal HDL-C 0.9mmol/L LDL-C3.12 B. TC is normal HDL-C3.12So B have a higher risk of AS than A.請積濺尚碉病遙完談驟最

42、助谷需道運(yùn)尉搜欺啄帆寡指痰孵咋區(qū)戒蚜網(wǎng)貴寬血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第46頁，共66頁。Lipoproteins which resulted in AS CM and VLDL remnants Modified LDL Small dense LDL Lp(a)咱乖降供褐乞墑座套嵌禮翌作舜鷹犢頹攘莊欲曙稀咎撐劇高化昆紊頗牛付血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第47頁，共66頁。LiverArteryTransportation of TCPhysiological functions of HDL and LDLTransportation of

43、 TC汛伊鐮戍演板漬謹(jǐn)劣表卸刃敝船加然需顧丹醇渦祖富玫終柱史少鍬撿壩山血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第48頁，共66頁。 Non-HDL-C In ATP, non-HDL-C was recommend to regard as a second treatment target for high TG patient.When the chief treatment target arrived, while the level of TG was still high(TG 2.26 mmol/L ), non-HDL-C should be assisted in

44、 minitoring therapeutic efficiencyIn ATP, Patient , TG was in marginal (1.702.25mmol/L ), was suggested to change life style ,and neednt to calculate non-HDL-C .婪刀演壩疼浦柴裂蛹循形弊罷侵切凜日黔金其歪粥蕊遵爪梅法勵(lì)剛腹采沾血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第49頁，共66頁。The standard value and target value for hyperlipidimia received treatme

45、nt (China 1997)AS (-) TC 5.72 mmol/LOther risk （ 220.0mg/dl ） factor(-) Ldl-c 3.64 mmol/L （ 140.0mg/dl ）AS (-) TC 5.2 mmol/L Other risk （ 200.0mg/dl ）factor(+) Ldl-c 3.12 mmol/L （ 120.0mg/dl ）AS (+) TC 4.68 mmol/L （ 180.0mg/dl ） Ldl-c 3.64 mmol/L （ 100.0mg/dl ）Drug therapyDietTarget valueTC 6.24 mmo

46、l/L（ 240.0mg/dl ） Ldl-c 4.16 mmol/L （ 160.0mg/dl ） TC 5.72 mmol/L（ 220.0mg/dl ） Ldl-c 3.64 mmol/L （ 140.0mg/dl ） TC 5.20 mmol/L（ 200.0mg/dl ） Ldl-c 3.12 mmol/L （ 120.0mg/dl ） TC 5.72 mmol/L（ 220.0mg/dl ） Ldl-c 3.64 mmol/L （ 140.0mg/dl ） TC 5.2 0mmol/L（ 200.0mg/dl ） Ldl-c 3.12 mmol/L （ 140.0mg/dl ） T

47、C 4.68 mmol/L（ 180.0mg/dl ） Ldl-c 2.60 mmol/L （ 100.0mg/dl ）扶招壕筏汰凱穆直輕怯俺略掇蚤山示丸免猶蛇鈾磨撕禮扦拭亞俘燎沮咳廊血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第50頁，共66頁。The target value of TLC and drug therapy in different kind of CHD (ATP 2001)Risk classification LDL-C LDL-C LDL-C target value onset of TLC considering drug treatmentCHD or

48、 other danger sign 20%） 100mg/dl 100.0mg/dl ） 2.59.3.36mmol/Lconsidering if drug treatment needed2 risk factor 3,36 mmol/L 3,36 mmol/L 10 years-risk 10%-20% ( 3,36 mmol/L)10 years-risk 20% 130mg/dl 130mg/dl 10 years-risk 10% ( 4,14 mmol/L ) 01 risk factor 20%）100mg/dl ，(can select objective： 70mg/dl

49、)especially patient with very high risk )100mg/dl100mg/dl(100mg/dl ;may regard medicine)milddling risk：2risk agent（10 years risk is 1020）130mg/dl( can select objective：100mg/dl130mg/dl#130mg/dl(100-129md/dL; ;may regard medicine)milddling risk ：2risk agent（10 year risk10%）130mg/dl130mg/dl160mg/dllow

50、 risk：01 risk agent160mg/dl160mg/dl190mg/dl(160-190mg/dl；;may regard medicine decresing LDL)食呢訊百瞅穴種蛆販贊豎付寂膘鄰圾偶涸翠防凌姑帚福霉逢勇俱諄皇返短血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第52頁，共66頁。 pay attention to several problems泅培激淹必個(gè)恬嘿丁疾列輩趙旗伶檔頃夕對趟楞徒堤撰編懷札報(bào)勇伍隴苯血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第53頁，共66頁。Several incorrect conceptsHDL-C HDL HD

51、L-C is merely a part of HDL，but can reflect the HDL in the bloodnLDL-C LDLLDL-C is merely a part of LDL，but can reflect the LDL in the blood漫鑒渤鱗或五五碧撲舞蠻假毋諷囂茁松耶撣拆恨嬰附集薊涪還蜒算仿佰崖血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第54頁，共66頁。Reasonable selection and application of lipid itemsClinical routine lipids assay should incl

52、ude at least four items: TC, TG,HDL-C and LDL-C.Merely measured TC and TG cant reflect basic lipids levelSome cases were not suitable to calculate LDL-C by Friedewald formula CM existed in plasma； TG 4.52mmol/L (400mg/dl)； Abnormal beta-lipoprotein existed type hyperlipidemia (HLP)(1)優(yōu)崩音轎況捻焙克愧醚帖橙橇律逾

53、衍杏碉狐簧皺饒危慮煎筑淳滲悔鴕劉傾血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第55頁，共66頁。Reasonable selection and Application of lipid items(2)Cases needed to measure plasma ApoAI and ApoB ：Unsure if there were any risk factors in the patient with cardiovascular or cerebrovascular disease, but the routine lipids items were normal.The

54、youth and middle-aged men suffering from cardiovascular or cerebrovascular disease.Persons have the family histoty of early onset of AS.Family member with low ApoAI and high ApoB .杰冒蒂愿旱殼碰寡房綱延睛情鋤疙檔珍蜒泣癱抉掌彈凈圣廣凌鵝荷頗獰筆血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第56頁，共66頁。Reasonable selection and Application of lipid items(

55、3)Cases needed to measure plasma Lp(a)Unsure if there were any risk factors in the patient with cardiovascular or cerebrovascular disease, but the routine lipids items were normal.The youth and middle-aged men suffering from cardiovascular or cerebrovascular disease.Patients with the family histoty

56、of early onset of AS.Family member with high Lp(a) .丑淄嫡啡艇掐藉收謠窗惋男緣泡圭爪調(diào)或秉婚龐害屋侵詹誓仙址疚撒壩俘血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第57頁，共66頁。 HDL-C represented the metabolism status of cholesterol and transported by HDL. ApoAI can reflect the capacity of HDL, but increasing or decreasing of ApoAI was not in proportion t

57、o HDL-C.To measure the level of ApoAI and HDL-C at one time was helpful to analyze the pathologic and physical status. ApoAI or HDL-C can not represent HDL , they were all necessary to be measured.HDL-C and ApoAI shoud not replace with each other 潮妙充執(zhí)趣庚軀丈漓槐僑媳疲宮攬勢研賤擻氟常撐瘧附沫帚筍疫拷駭嘛屑血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用

58、的有關(guān)問題第58頁，共66頁。LDL-C and ApoB shoud not substitute for each otherIn general , the level of ApoB can represent LDL,and it was a positive correlation with LDLC.LDL was a kind of lipoprotein which contained different size of particles and diverse compositions, and it can be divided into LDL1 ( type A)

59、and LDL2 (type B).In hypertriglycerdemia, the level of the small dense LDL may increase, LDL-C may be normal but apoB elevated obviously, so the two items cant be substitute for each other.參疑領(lǐng)孽衛(wèi)沙撲凸牲胎弛燴榨惱久巍膠墜習(xí)誕疏人虛述土護(hù)旬鈾赴媚畸牌血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床應(yīng)用的有關(guān)問題第59頁，共66頁。 Risk factors diagnostic criteriaLipid index can be served to estimate the risk of CHD, but they wre not diagnostic criteria.We should avoid to use risk factors for diagnostic criteria.芹壹綠巒顏靠邦穎控孝充洞懇槽髓毅勾也閱粱異坊沃屢航奏笛簡螺扎禮熄血脂檢測臨床應(yīng)用的有關(guān)問題血脂檢測臨床