北京.2012年7月临床检验新进展讲义之 2012-07-26 鄢盛恺 调脂治疗的靶标：LDL-C、apo B or non-HDL-C？.pptVIP

* Key Points There are four major classifications of lipoproteins present in plasma, shown here in order of their size. As just discussed, VLDL is released from the liver into the plasma. IDL and LDL are products of lipolysis (removal of TGs) of VLDL. That is, as VLDL moves through the bloodstream, tissues selectively pull off the TGs (because FAs are energy and tissues need them). As TGs are pulled off, the VLDL particle shrinks, becoming IDL, and then TG removal from IDL converts it into LDL. HDL is the smallest lipoprotein. Instead of taking cholesterol from the liver to other tissues, it picks up cholesterol from these tissues and brings it to steriodogenic tissues, the liver, or the kidneys. That’s why it is considered the “good” cholesterol. VLDL, IDL, and LDL all contain apoB, and together are considered Non-HDL cholesterol. Let’s take a closer look at the transport of TG and cholesterol on these lipoproteins… Thomas Dayspring MD * * Reference: National Institutes of Health.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). Executive Summary. Bethesda, MD: National Institutes of Health; 2001. NIH Publication No. 01-3670. * Non HDL-C and VLDL-C and Their Risk Predictive Values in CHD. Senior author Scott M. Grundy, chairman of the NCEP ATP III, published this study that analyzed data from the Framingham Heart Study (2693 men and 3101 women) in order to determine if non–HDL-C is a more useful predictor of CHD risk than LDL-C and if VLDL-C is an independent predictor of CHD risk. All patients were aged ≥30 years of age and free of CHD at baseline, and incident CHD was the end point (618 men and 372 women). After multivariate adjustment, within non–HDL-C, no association was found between LDL-C and the risk for incident CHD. In contrast, a strong positive and graded association between non–HDL-C and risk for CHD was observed