Forti Neusa, Diament Jayme
Instituto do Coração, HCFM, USP, CEP 05427-000, São Paulo, SP, Brazil.
Rev Assoc Med Bras (1992). 2007 May-Jun;53(3):276-82. doi: 10.1590/s0104-42302007000300029.
Apolipoprotein (apo) B is present in atherogenic lipoproteins (remnant Qm and VLDL, LDL and Lp (a)) and apo A is present in non-atherogenic lipoprotein (HDL). Measurement of the apos is automated, standardized, with a small variation of coefficient and does not require fasting blood samples. The authors reviewed clinical, epidemiological and therapeutic trials on hyperlipidemia with apo B and A-I evaluation. These works showed the importance of apo B and A-I as cardiovascular risk factors. Experts recommended apo B / apo A-I ratio as an alternative to TC / HDL-c ratio for risk estimate. Future positioning from the Guidelines is expected to include apos in individual risk prediction and as a therapeutic target. The authors suggest that, in clinical practice, measurement of apo B is necessary for coronary heart disease patients with desirable LDLc levels or when this assessment is not possible and the measurement of apo A-I if HDL-c values are very low.
载脂蛋白(apo)B存在于致动脉粥样硬化脂蛋白(残余颗粒和极低密度脂蛋白、低密度脂蛋白和脂蛋白(a))中,而apo A存在于抗动脉粥样硬化脂蛋白(高密度脂蛋白)中。载脂蛋白的测量是自动化的、标准化的,变异系数小,且不需要空腹血样。作者回顾了关于高脂血症伴apo B和A-I评估的临床、流行病学和治疗试验。这些研究表明apo B和A-I作为心血管危险因素的重要性。专家推荐将apo B/apo A-I比值作为估计风险的替代总胆固醇/高密度脂蛋白胆固醇比值。预计未来指南的定位将把载脂蛋白纳入个体风险预测并作为治疗靶点。作者建议,在临床实践中,对于低密度脂蛋白胆固醇水平正常的冠心病患者或无法进行该评估时,有必要测量apo B;而当高密度脂蛋白胆固醇值非常低时,则需测量apo A-I。