Related problems on clinical Related problems on clinical application of plasma lipids assayapplication of plasma lipids assaynProfessor zhou xin nDepartment of Laboratory Medicine,nZhongnan hospital of wuhan university.nDr. Sheng-kai Yan , PhDnDepartment of Laboratory Medicine, nPeking Union Medical College HospitalAll kinds of lipids in plasma were called blood lipidsTotal cholesterol，TC free cholesterolcholesterol esterNeutral fattytriglyceride，(TG)non esterified fatty acid （free fatty acid ，FFA）phospholipid , glucolipidLipids were insoluble in water ,they were transported in the form of lipoproteinPlasma lipidsPlasma lipoproteinLDLLp(a)VLDLIDLIDLHDLstructure oflipoproteinClinical items for lipids detectionntotal cholesterol，TCntriglyceride，TGnhigh density lipoprotein cholesterol，HDL-Cnlow density lipoprotein cholesterol，LDL-Cnapolipoprotein A1，ApoA1apolipoprotein B，ApoBnlipoprotein(a)nThe first four items were routine test ,and should be carried out in healthy examinations Cinical items for lipids analysis (2)nFFAnCerebroside esterceramidenSphingenine SphingomyelinnGalactode-cerebrosideGenotype n ApoE genotype ApoCIII genotypen ApoCII genotype Apo(a) genotype n LDLR genotype VLDLR genotypen HMGCoAR genotype SR genotypeCinical items for lipids analysis (3)PreanalyticalPreanalytical Factors Factors Affecting Lipid Test ResultsAffecting Lipid Test ResultsThe following factors may cause The following factors may cause preanalyticalpreanalytical variations variationsnBiological factors Individual biological variations, gender, age, and race, etc. nLife-style factorsdiet, obesity, smoking, stress, alcohol, and coffee intake, and exercise, etc.Behaviour factors (1) DietnThe food containing abundant unsaturated fatty acid can decrease the level of TC, LDL-C, apoB and TG.nThe food containing abundant saturated fatty acid can elevate TC, LDL-C .nThe food containing abundant fiber can reduce the leval of TC.nThe levels of LDL-C and Lp(a) in vegetarians were lower (37, 35 respectively) than non- vegetarians, while HDL-C were higher than that of 12.Behaviour factors (2) ObesityTG，TC and LDL-C HDL-C Lost weight TG （40） TC（ 10 ） LDL-C （ 10 ） HDL-C （ 10 ） S Smokingmoking TG, LDL-C and Lp(a) apoA and HDL-C HDL-C Behaviour factors (3) Behaviour factors (4)Alcohol abusenHDL-C, apoA,apoA （1.2 oz/d or 34g/d）nPrimry hypertriglyceridemia with mild drinking can lead to the level of TG increased further .nAlcohol has different effects on Lp(a) from other lipids .at the begin Lp(a) 33%six weeks later Lp(a) back to initial levelnProper drinking red wine can decrease the level of Lp(a) . Behaviour factors (5)nCoffeeTC and LDL-C apoA, apoA, apoB and HDL-C seemed not be affected.nTensionTC HospitalizationHDL-C and apoA( 10) 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 obviously. 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.Clinical factorstherapeutic drugs (1)Antihypertensive agentsnfor 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% .nBeta-neg（ receptor blocker ） can increase the level of TG and decrease the leval of HDL-C. EstrogennOral taking contraceptive with progesterone can increase the leval of TC and LDL-C,and decrease the leval of HDL-C .nEstrin treatment can decrease the leval of Lp(a) by 50% .nImmunosuppressive agentsCodelcortone can 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 factorstherapeutic drugs (2)The division of abnormal lipids levelThe 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 destination and intervene the procedure according to the level . suggestionsn Adopt the standards of suggestions on prevention and cure lipid abnormality in china.Risk rateTC and CHD Plasma TCMedical decision level for lipid assay mmol/L(mg/dl)nindex china （1997） NCEP-ATP nSerum TCnSuitble leval 5.20(200) 5.20(200)nmargine increase 5.23-5.69(201-219) 5.20-6.21(200-239)nIncrese 5.72(220)