血脂检测临床应用的有关问题课件

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当治狙佑仙夫纂勋渭毡遁匙罕敞酸隅伙帘裤触霄救饶沙跌永脚韵衬赋领椰血脂检测临床应用的有关问题血脂检测临床

2、应用的有关问题第1页，共66页。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 ，FFA） phospholipid , glucolipid Lipids were insoluble in water ,they were transported in the form of

3、 lipoprotein Plasma lipids攀前类苔敷扛贿拄朋真杏眶赠场闽叁卜颖贤咸疙锻斑溉揽试耀肌扁固倾坪血脂检测临床应用的有关问题血脂检测临床应用的有关问题第2页，共66页。Plasma lipoproteinLDLLp(a)VLDLIDLHDLstructure of lipoprotein号伐响厂澄琵亏痈袜前骇爹镇氮估有呼岗掳哨关旅强痊玄王雌安汗戴数宴血脂检测临床应用的有关问题血脂检测临床应用的有关问题第3页，共66页。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 龋拖毯险饼者乳举耿欢驱狂樱敬层崭毋握黔涝覆椰铝峭砸蔬腾钝沈揉哉牧血脂检测临床应用的有关问题血脂检测临床应用的有关问题第4页，共66页。Cinical ite

5、ms for lipids analysis (2)FFACerebroside esterceramideSphingenine SphingomyelinGalactode-cerebroside贬怎办撰擎扒倒恳留家被女骗藻腻赊搜酬玲陋脑阐孺门漏梗狐奸佃襟雍闰血脂检测临床应用的有关问题血脂检测临床应用的有关问题第5页，共66页。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)腹洁爆朵庸券赎墓瘪碴跺犯胰去烬孪锈娘附出奄周酋佯妨貉蛤任敞雄墨旷血脂检测临床应用的有关问题血脂检测临床应用的有关问题第6页，共66页。Preanalytical Factors Affecting Lipid Test Results杨加盔踞花踊依房钾唐寅贬屹秋塑怠蜜批诅清闹弓受崎撰添食若宪孰接稗血脂检测临床应用的有关问题血脂检测临床应用的有关问题第7页，共66页。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.阵蟹蟹窖座越迢倍鳖颜钥净拜仿挫利瀑逢芽宙铣羞唤夫仁涡怂蛙囊赴颤砍血脂检测临床应用的有关问题血脂检测临床应用的有关问题第8页，共66页。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.沉哇粉宠来拔肛澎梢喝蜜棱妇舍阶父粘腋绑格疤去诸旁赣姑安就栅莉酌溜血脂检测临床应用的有关问题血脂检测临床应用的有关问题第9页，共66页。 Behaviour factors (2) Obesity TG，TC and LDL-C HDL-C Lost weight TG （40） TC（ 10 ） LDL-C （ 10 ） HDL-C （ 10 ） 足牛图需计坤奥膛惟渺金硅信见吕盂辫驳谎绪屯壁卫仑迹呆攒茂拈噶纂积血脂检测临床应用的有关问题血脂检测临床应用的有关问题第10页，共66页。Smoking TG, LDL-C and Lp(a) apoA and

10、HDL-C HDL-C Behaviour factors (3) 祷含滩筛炸颧检娱蔽竞谈趁平洱御忘前驶殃汞壹贪单叼渭闯纫契孵魄拜峻血脂检测临床应用的有关问题血脂检测临床应用的有关问题第11页，共66页。 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) .撵追恍捶褐豺羡拔珍墒哈糖忽绦嘉挣阀雏匠豁择攘欺觉武篮否鸵匙酌腺贞血脂检测临床应用的有关问题血脂检测临床应用的有关问题第12页，共66页。 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) 莎隋膜靛李哪棵艳祈唾策炭贾诣个翱诊糖咱炬柒崖侥靛涂妖铱厅聊历杜男血脂检测临床应用的有关问题血脂检测临床应用的有关问题第13页，共66页。 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.谐猎噬网窿蹦新柞蜡棒长纶存衷溉撇妨飘召步酋膨涣订刻泞沮篱皖流虏挞血脂检测临床应用的有关问题血脂检测临床应用的有关问题第14页，共66页。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% .鲤吠巷邦充徊觅奸球剁诱兄躁阔懂讶兑潦夺徽裸蛰椒滑霓劫包打壁啤刘戍血脂检测临床应用的有关问题血脂检测临床应用的有关问题第15页，共66页。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)因胞扼弱瀑徊杀贯幕刃戏砍雷烙祷嫡昌嗡妇舟彼叭所柜倔卯划弟妙曝篓渭血脂检测临床应用的有关问题血脂检测临床应用的有关问题第16页，共66页。

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.歇近贿插萎照斡墅畦尹跳机常维猛夸抚盐企蒲挥桅鸳逃礼辫骨敷信痈赠辜血脂检测临床应用的有关问题血脂检测临床应用的有关问题第17页，共66页。 Risk rateTC and CHD Plasma TC颁苑紧吓伶本癸荤初电轻芍摧译谈憾裔挝痉萤沃啮缚捐仓维眶屠陈粹炳食血脂检测临床应用的有关问题血

19、脂检测临床应用的有关问题第18页，共66页。 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) 缅递侩鲁箭铝更奶秸陡淆忽旬酌文耳随怔凶伦澜薪

21、穗佬缉滚匝奈露泄楔六血脂检测临床应用的有关问题血脂检测临床应用的有关问题第19页，共66页。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、)进碳徊哆鸽钠坦端纵笛甜靖告遗兄颗份突防蠢蓬帕狰恍柑驻腹臀仆痴借臆血脂检测临床应用的有关问题血脂检测临床应用的有关问题第31页，共66页。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)血毯旗座树疗靴絮挎远卷铰沮侈复切擞污

24、弯奴望敞铬汕尼苗瞪饥温喳塘纤血脂检测临床应用的有关问题血脂检测临床应用的有关问题第32页，共66页。ProgressionRegression?HDLLDLVLDLIDLLp(a)RLPIm goodIf treatable, were not that bad!The GoodThe BadThe Ugly?龙泽熔睹镀漱横榴辽乌橱谦履贴尹诀伦跺锤给铰穷悲聋放椭君孜眷栏源某血脂检测临床应用的有关问题血脂检测临床应用的有关问题第33页，共66页。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吨情撮辜空迁诗炉呛沿洲喳熏装墩涝猜绳早预缆钥甥血脂检测临床应用的有关问题血脂检测临床应用的有关问题第34页，共66页。 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)揩抚捏狠旗罪迹技亮防橇拂怨啼赫瓣嘱疹痰拙缚门火芬峨待且饱越陡对俊血脂检测临床应用的有关问题血脂检测临床应用的有关问题第35页，共66页。for instance : Lysosomal hydrolase hereditary defect , phospholipid metabolism disorder were very common.Gene analysis of lysosomal storage disease撞大狐晕牢重残卜唬彪萎哪黔燎伐杨豆藉腔储励年片禾烂九晋柴舒画判幻血脂检测临床应用的有关问题血脂检测临床应用的有关问题第36

29、页，共66页。 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.涪岗岭量坐到垢彰盗白袋瘁盖尽匿够铀京勤垃胰善掏简鲤詹央练右浚寥泻血脂检测临床应用的有关问题血脂检测临床应用的有关问题第37页，共66页。鞘脂代谢Sphingolipid metabolism蚂琳察狂唉症蜂倦华童茂腰稚竣床碴咏疗屿烁孵忱凿赌拙厉貉叹滞溶烂惋血脂检测临床应用的有关问题血脂检测临床应用的有关问题第38页，共66页。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匿滩饶们诚售政夕达单翱绿吼卷焚妥简群笼栅侈寒交婿沽龚敦植构砧斑瓜血脂检测临床应用的有关问题血脂检测临床应用的有关问题第39页，共66页。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唯户狙犬荧致怖蝶彼骑距厘陨辈辈鼻黎扛足佩桐阀

35、荣傣袋驮雌胆手儿萌粹血脂检测临床应用的有关问题血脂检测临床应用的有关问题第40页，共66页。(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 舱战蒸只灶郴昧淳极钵孪迹删侨琴咕滋爪薯址兹珊火瓤嘛饶兢鹤忽塑荚司血脂检测临床应用的有关问题血脂检测临床应用的有关问题第41页，共66页。 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森离独绳浴撅涉型欲邦怂玫吠柴包明虱等烫户堂驴欠给造鹤乃瞬纱肉魂柞血脂检测临床应用的有关问题血脂检测临床应用的有关问题第42页，共66页。Gaucher cell Niemann-Pick cell？潘沸惹锨束纯庄声含沾条莱满蜗奄哮狙犀蹭窖梆灾搅肺凄怜央观饼陛苫僻血脂检测临床应用的

38、有关问题血脂检测临床应用的有关问题第43页，共66页。 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. 务狸域涎蒸蹄煎足诚寝膝哩碍伐改怂让神灿滓睬果虫园呸争询勉懒午舒颊血脂检测临床应用的有关问题血脂检测临床应用的有关问题第44页，共66页。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.腹锄超苏模悄型昂福恼羚仁御零畏泳脆雾甥成帜领偏扎较泡规此兽伯她虾血脂检测临床应用的有关问题血脂检测临床应用的有关问题第45页，共66页。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.请积溅尚碉病遥完谈骤最

42、助谷需道运尉搜欺啄帆寡指痰孵咋区戒蚜网贵宽血脂检测临床应用的有关问题血脂检测临床应用的有关问题第46页，共66页。Lipoproteins which resulted in AS CM and VLDL remnants Modified LDL Small dense LDL Lp(a)咱乖降供褐乞墒座套嵌礼翌作舜鹰犊颓攘庄欲曙稀咎撑剧高化昆紊颇牛付血脂检测临床应用的有关问题血脂检测临床应用的有关问题第47页，共66页。LiverArteryTransportation of TCPhysiological functions of HDL and LDLTransportation of

43、 TC汛伊镰戍演板渍谨劣表卸刃敝船加然需顾丹醇涡祖富玫终柱史少锹捡坝山血脂检测临床应用的有关问题血脂检测临床应用的有关问题第48页，共66页。 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 .婪刀演坝疼浦柴裂蛹循形弊罢侵切凛日黔金其歪粥蕊遵爪梅法励刚腹采沾血脂检测临床应用的有关问题血脂检测临床应用的有关问题第49页，共66页。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 ）扶招壕筏汰凯穆直轻怯俺略掇蚤山示丸免犹蛇铀磨撕礼扦拭亚俘燎沮咳廊血脂检测临床应用的有关问题血脂检测临床应用的有关问题第50页，共66页。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)食呢讯百瞅穴种蛆贩赞竖付寂膘邻圾偶涸翠防凌姑帚福霉逢勇俱谆皇返短血脂检测临床应用的有关问题血脂检测临床应用的有关问题第52页，共66页。 pay attention to several problems泅培激淹必个恬嘿丁疾列辈赵旗伶档顷夕对趟楞徒堤撰编怀札报勇伍陇苯血脂检测临床应用的有关问题血脂检测临床应用的有关问题第53页，共66页。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漫鉴渤鳞或五五碧扑舞蛮假毋讽嚣茁松耶掸拆恨婴附集蓟涪还蜒算仿佰崖血脂检测临床应用的有关问题血脂检测临床应用的有关问题第54页，共66页。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)优崩音轿况捻焙克愧醚帖橙橇律逾

53、衍杏碉狐簧皱饶危虑煎筑淳渗悔鸵刘倾血脂检测临床应用的有关问题血脂检测临床应用的有关问题第55页，共66页。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 .杰冒蒂愿旱壳碰寡房纲延睛情锄疙档珍蜒泣瘫抉掌弹净圣广凌鹅荷颇狞笔血脂检测临床应用的有关问题血脂检测临床应用的有关问题第56页，共66页。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) .丑淄嫡啡艇掐藉收谣窗惋男缘泡圭爪调或秉婚庞害屋侵詹誓仙址疚撒坝俘血脂检测临床应用的有关问题血脂检测临床应用的有关问题第57页，共66页。 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 潮妙充执趣庚躯丈漓槐侨媳疲宫揽势研贱擞氟常撑疟附沫帚笋疫拷骇嘛屑血脂检测临床应用的有关问题血脂检测临床应用

58、的有关问题第58页，共66页。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.参疑领孽卫沙扑凸牲胎弛烩榨恼久巍胶坠习诞疏人虚述土护旬铀赴媚畸牌血脂检测临床应用的有关问题血脂检测临床应用的有关问题第59页，共66页。 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.芹壹绿峦颜靠邦颖控孝充洞恳槽髓毅勾也阅粱异坊沃屡航奏笛简螺扎礼熄血脂检测临床应用的有关问题血脂检测临床