{"id":11934,"date":"2020-05-06T00:16:12","date_gmt":"2020-05-05T21:16:12","guid":{"rendered":"https:\/\/www.synevo.ro\/shop\/colesterol-ldl\/"},"modified":"2026-02-19T01:05:11","modified_gmt":"2026-02-18T23:05:11","slug":"colesterol-ldl","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/colesterol-ldl\/","title":{"rendered":"\u0425\u043e\u043b\u0435\u0441\u0442\u0435\u0440\u0438\u043d \u041b\u041f\u041d\u041f"},"content":{"rendered":"<p style=\"text-align: justify;\"><b><i><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Informa\u021bii generale \u0219i recomand\u0103ri<\/span><\/span><\/i><\/b><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">LDL este lipoproteina care con\u021bine cea mai mare cantitate de colesterol (60-70% din colesterolul seric total). LDL rezult\u0103 \u00een principal din degradarea VLDL, transportorul major al trigliceridelor. Deoarece LDL are un timp de \u00eenjum\u0103t\u0103\u021bire mai mare (3-4 zile) dec\u00e2t precursorul s\u0103u VLDL, este mai prevalent \u00een circula\u021bie dec\u00e2t acesta. <\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Acizii gra\u0219i liberi circulan\u021bi formeaz\u0103 \u00een ficat trigliceride care sunt cuplate cu apoproteine \u0219i colesterol, urm\u00e2nd a fi exportate \u00een s\u00e2nge ca lipoproteine VLDL.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">LDL colesterol este implicat \u00een transportul colesterolului c\u0103tre \u021besuturi,\u00a0\u00een principal\u00a0\u00een sistemul arterial, ceea ce explic\u0103 inciden\u021ba crescut\u0103 a aterosclerozei \u0219i a bolii coronariene la pacien\u021bii cu niveluri serice crescute ale acestei lipoproteine<sup>1;2<\/sup>. Astfel, determinarea LDL este specific\u0103 pentru estimarea riscului cardiovascular \u0219i stabilirea deciziei terapeutice<sup>3;4<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">\u00cen condi\u021bii fiziologice, raportul LDL-colesterol \/ HDL-colesterol are valoarea de 2.9 la femei \u0219i 3.3 la b\u0103rb\u0103\u021bi. Riscul dezvolt\u0103rii unei boli coronariene cre\u0219te semnificativ dac\u0103 valoarea acestui raport dep\u0103\u0219este 3.5 la femei \u0219i 3.8 la b\u0103rba\u021bi<sup>5<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><b><i><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Metode<\/span><\/span><\/i><\/b><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">\u00cen laboratoarele Synevo se utilizeaz\u0103 dou\u0103 metode de determinare a LDL-colesterol:<\/span><\/span><\/p>\n<ul style=\"text-align: justify;\">\n<li><i><span style=\"text-decoration: underline;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">metoda direct\u0103 enzimatic\u0103 colorimetric\u0103<\/span><\/span><\/span><\/i><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Aceast\u0103 metod\u0103 automat\u0103 se bazeaz\u0103 pe solubilizarea micelar\u0103 selectiv\u0103 a LDL-colesterolului cu ajutorul unui detergent neionic \u0219i a interac\u021biunii dintre un compus de natur\u0103 zaharidic\u0103 \u0219i lipoproteine (VLDL \u0219i chilomicroni). Atunci c\u00e2nd un detergent este inclus \u00een metoda enzimatic\u0103 de determinare a colesterolului (colesterol esteraza, colesterol oxidaza, reac\u021bia de cuplare) reactivit\u0103\u021bile relative ale colesterolului din frac\u021biunile de lipoproteine cresc \u00een urm\u0103toarea ordine: HDL &lt; chilomicroni &lt; VLDL &lt; LDL. \u00cen prezen\u021ba ionilor de Mg++ compusul zaharidic determin\u0103 o reducere marcat\u0103 a reac\u021biei enzimatice de m\u0103surare a colesterolului in VLDL \u0219i chilomicroni. Astfel, utilizarea combinat\u0103 a unui compus zaharidic \u0219i a unui detergent neionic faciliteaz\u0103 determinarea selectiv\u0103 a LDL-colesterolului \u00een ser. <\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Aceast\u0103 metod\u0103 a fost standardizat\u0103 fa\u021b\u0103 de <i>metoda de beta-cuantificare a LDL-colesterolului<\/i> (ultracentrifugare combinat\u0103 cu precipitare) considerat\u0103 gold-standard. De asemenea, metoda \u00eendepline\u0219te cerin\u021bele NCEP (National Cholesterol Education Program) de a avea o eroare analitic\u0103 total\u0103 \u2264 12%<sup>6<\/sup>. <\/span><\/span><\/p>\n<ul style=\"text-align: justify;\">\n<li><span style=\"color: #000000;\"><span style=\"font-size: medium;\"><i><span style=\"text-decoration: underline;\">metoda indirect\u0103<\/span><\/i> prin care LDL-colesterol este determinat, din valoarea colesterolului total, trigliceridelor \u0219i HDL-colesterolului conform formulei lui Friedewald:<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">LDL-colesterol = colesterol total \u2013 (HDL-colesterol) \u2013 (VLDL-colesterol)<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">VLDL-colesterol = trigliceride\/5<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Formula nu se aplic\u0103 \u00een cazul unor valori ale trigliceridelor &gt;400 mg\/dL;\u00a0\u00een aceste situa\u021bii se recomand\u0103 dozarea apolipoproteinelor A1 \u0219i B sau determinarea direct\u0103 a LDL-colesterolului pentru determinarea riscului de apari\u021bie a bolilor cardiovasculare<sup>1;4;6<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><b><i><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Valori de referin\u021b\u0103<\/span><\/span><\/i><\/b><\/p>\n<p style=\"text-align: justify;\"><b><i><span style=\"color: #000000; font-size: medium;\">\u00a0<\/span><\/i><\/b><b><i><span style=\"color: #000000;\"><span style=\"font-size: medium;\">Adult: <\/span><\/span><\/i><\/b><\/p>\n<table class=\"wp-block-table w-100\" style=\"width: 428px; height: 117px;\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u041e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u043e<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">\u00a0\u00a0\u00a0 &lt;100 mg\/dl<\/span><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u041e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u044b\u0439 \u043d\u0430 \u0433\u0440\u0430\u043d\u0438\u0446\u0435<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">100-129 mg\/dl<\/span><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u0412\u044b\u0448\u0435 \u043d\u043e\u0440\u043c\u044b<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">130-159 mg\/dl<\/span><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u0412\u044b\u0441\u043e\u043a\u0438\u0439<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">160-189 mg\/dl<\/span><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u041e\u0447\u0435\u043d\u044c \u0432\u044b\u0441\u043e\u043a\u0438\u0439<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">\u00a0\u00a0\u00a0 \u2265190 mg\/dl<sup>1<\/sup><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><b><i><span style=\"color: #000000; font-size: medium;\">\u00a0<\/span><\/i><\/b><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\"><span style=\"font-size: medium;\"><b><i>Copii \u0219i<\/i><\/b> <b><i>adolescen\u021bi<\/i><\/b> ( 12-18 ani): <\/span><\/span><\/p>\n<table class=\"wp-block-table w-100\" style=\"width: 429px; height: 79px;\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u041e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u043e<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">\u00a0\u00a0\u00a0 &lt;110 mg\/dl<\/span><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u0412\u044b\u0448\u0435 \u043d\u043e\u0440\u043c\u044b<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">110-129 mg\/dl<\/span><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"240\"><i><span style=\"font-size: medium;\">\u0412\u044b\u0441\u043e\u043a\u0438\u0439<\/span><\/i><\/td>\n<td valign=\"top\" width=\"181\"><span style=\"font-size: medium;\">\u00a0\u00a0 \u2265 130 mg\/dl<sup>3<\/sup><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Men\u021biune: la pacien\u021bii cu risc foarte crescut (sindrom coronarian acut recent; multipli factori de risc major &#8211; \u00een special diabet zaharat, factori de risc controla\u021bi deficitar &#8211; \u00een special continuarea fumatului) exist\u0103 op\u021biunea terapeutic\u0103 de a reduce LDL colesterol sub 70 mg\/dL.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Factor de conversie: mg\/dL x 0.026= mmol\/L<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 mmol\/L x 38.66= mg\/dL<sup>1;4;6<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><b><i><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Interpretarea rezultatelor<\/span><\/span><\/i><\/b><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\"><span style=\"text-decoration: underline;\">Cre\u0219teri:<\/span> hipercolesterolemie familial\u0103 (tip II-a), hiperlipoproteinemiile II-b \u0219i III, dieta bogat\u0103\u00a0\u00een colesterol \u0219i gr\u0103simi saturate, hipotiroidism, sindrom nefrotic, diabet zaharat, mielom multiplu \u0219i alte disgamaglobulinemii, colestaz\u0103, insuficien\u021b\u0103 renal\u0103 cronic\u0103, porfirie, anorexie nervoas\u0103<sup>2;3<\/sup>. <\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\"><span style=\"text-decoration: underline;\">Sc\u0103deri:<\/span> hipo-\/abetalipoproteinemie, boala Tangier, hipertiroidie, anemii cronice, afec\u021biuni hepatocelulare severe, sindrom Reye, stres acut, boli inflamatorii articulare, afec\u021biuni pulmonare cronice<sup>2;3<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Trebuie men\u021bionate c\u00e2teva aspecte legate de cele dou\u0103 metode de determinare a LDL-colesterolului.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Conform ghidului NCEP, LDL-colesterol reprezint\u0103 factorul cheie \u00een estimarea riscului cardiovascular \u0219i din acest motiv determinarea corect\u0103 a nivelului s\u0103u\u00a0\u00een serul pacien\u021bilor este foarte important\u0103. Calcularea LDL-colesterolului pe baza formulei lui Friedwald este comun\u0103\u00a0\u00een practica medical\u0103 \u0219i\u00a0\u00een multe cazuri ofer\u0103 o acurate\u021be apropiat\u0103 de cea a beta-cuantific\u0103rii. Utilizarea acestei formule este \u00eens\u0103 limitat\u0103\u00a0\u00een cazul pacien\u021bilor cu valori ale trigliceridelor serice &gt;400 mg\/dL sau cu hiperlipoproteinemie de tip III precum \u0219i dac\u0103 proba nu a fost recoltat\u0103\u00a0\u00een condi\u021bii \u00e0 jeun. Chiar \u0219i\u00a0\u00een prezen\u021ba unor valori ale trigliceridelor cuprinse \u00eentre 250 \u0219i 400 mg\/dL formula poate furniza erori de estimare a LDL-colesterolului (rezultate sc\u0103zute\u00a0\u00een mod artificial) ceea ce poate conduce la o clasificare incorect\u0103 a riscului pacien\u021bilor\u00a0\u00een raport cu ghidul NCEP<sup>6;7;8<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Un studiu publicat recent, care a inclus probe provenite de la un lot mare de subiec\u021bi adul\u021bi \u0219i care a avut ca scop comparerea valorilor de LDL-colesterol estimate conform formulei lui Friedewald cu cele determinate direct \u0219i implica\u021biile asupra strategiei terapeutice, a ar\u0103tat c\u0103 formula lui Friedewald tinde s\u0103 subestimeze nivelurile de LDL-colesterol \u00een situa\u021biile\u00a0\u00een care nivelul trigliceridelor este crescut \u2265150 mg\/dL \u0219i mai ales\u00a0\u00een prezen\u021ba unor valori LDL mai sc\u0103zute. \u00cen practica clinic\u0103, acest lucru afecteaz\u0103\u00a0\u00een mod special pacien\u021bii cu risc crescut la care se dore\u0219te men\u021binerea unor valori de LDL-colesterol sub 70 mg\/dL. Furnizarea unor rezultate de LDL-colesterol sc\u0103zute\u00a0\u00een mod artificial la ace\u0219ti pacien\u021bi ar putea conduce la subtratarea acestora<sup>9<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">O alt\u0103 men\u021biune este legat\u0103 de faptul c\u0103 determinarea LDL-colesterolului prin metoda direct\u0103 poate fi efectuat\u0103 \u0219i \u00een situa\u021biile\u00a0\u00een care probele nu au fost recoltate \u00e0 jeun (pe nem\u00e2ncate). Trebuie \u021binut \u00eens\u0103 cont de faptul c\u0103 rezultatele ob\u021binute sunt u\u0219or mai sc\u0103zute dec\u00e2t\u00a0\u00een cazul recolt\u0103rii\u00a0 \u00e0 jeun<sup>6;7;8<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><b><i><span style=\"font-size: medium;\"><span style=\"color: #000000;\">Limite \u0219i interferen\u021be<\/span><\/span><\/i><\/b><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\"><span style=\"text-decoration: underline;\">Cre\u0219teri:<\/span><b><i> <\/i><\/b>postprandial, sarcin\u0103, administrarea de steroizi anabolizan\u021bi, beta-blocante, antihipertensive, progestative, carbamazepina.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\"><span style=\"text-decoration: underline;\">Sc\u0103deri: <\/span>administrarea de estrogeni per os<sup>2<\/sup>.<\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: medium;\"><span style=\"color: #000000;\">\u00cen cazuri foarte rare prezen\u021ba gamopatiei, \u00een special IgM (macroglobulinemia Waldenstr\u00f6m) poate determina rezultate eronate la determinarea LDL-colesterolului prin metoda direct\u0103<sup>8<\/sup>. <\/span><\/span><\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">1. Cleeman JI. Executive Summary of the Third Report of the National Cholesterol Education Program <\/span><span style=\"font-size: small;\">(NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. In JAMA 285: 2486- 97. 2001. Ref Type: Journal (Full).<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">2. Frances Fischbach. Chemistry Studies. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp;Wilkins, USA, 8 ed., 2009, 452-455.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">3. Jacques Wallach. Boli metabolice \u0219i ereditare. \u00cen Interpretarea testelor de diagnostic. Editura Stiin\u021belor Medicale, Romania, 7 ed., 2001, 689-690.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">4. Scott M.Grundy et all. Implications of Recent Clinical Trials for NCEP Adult Treatment Panel III Guidelines. In Circulation, July 2004: 110-227-239.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">5. Valeriu Atanasiu. Maria Mohora. Compu\u0219i lipidici. \u00cen Biochimie Medicala, Ed. Niculescu, 2004, 223.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">6. Laborator Synevo. Referin\u021bele specifice tehnologiei de lucru utilizate 2014. Ref Type: Catalog.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">7. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Low-density Lipoprotein Cholesterol (Direct) www.labcorp.com . 2014. Ref Type: Internet Communication.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">8. Mayo Clinic. Mayo Medical Laboratories. Test Catalog. LDL Cholesterol (Beta-Quantification), Serum. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">9. Martin SS, Blaha MJ, Elshazly MB, Brinton EA, Toth PP, McEvoy JW, Joshi PH, Kulkarni KR, Mize PD, Kwiterovich PO, DeFilippis AP, Blumenthal RS, Jones SR. Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. L Am Coll Cardiol 2013 Aug 20;62(8):732-9<\/span>.<\/div>","protected":false},"excerpt":{"rendered":"<p>\u0425\u043e\u043b\u0435\u0441\u0442\u0435\u0440\u043e\u043b (\u0425\u0421, \u0445\u043e\u043b\u0435\u0441\u0442\u0435\u0440\u0438\u043d) \u2013 \u0436\u0438\u0440\u043e\u043f\u043e\u0434\u043e\u0431\u043d\u043e\u0435 \u0432\u0435\u0449\u0435\u0441\u0442\u0432\u043e, \u0436\u0438\u0437\u043d\u0435\u043d\u043d\u043e \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e\u0435 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0443. \u041f\u0440\u0430\u0432\u0438\u043b\u044c\u043d\u043e\u0435 \u043d\u0430\u0443\u0447\u043d\u043e\u0435 \u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u044d\u0442\u043e\u0433\u043e \u0432\u0435\u0449\u0435\u0441\u0442\u0432\u0430 \u2013 &#8220;\u0445\u043e\u043b\u0435\u0441\u0442\u0435\u0440\u043e\u043b&#8221; (\u043e\u043a\u043e\u043d\u0447\u0430\u043d\u0438\u0435 -\u043e\u043b \u0443\u043a\u0430\u0437\u044b\u0432\u0430\u0435\u0442 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