Department of Laboratory Medicine, AZ St-Jan, Ruddershove 10, 8000 Brugge, Belgium.
University of Ghent, Ghent, Belgium.
Clin Chem Lab Med. 2020 Mar 26;58(4):496-517. doi: 10.1515/cclm-2019-1253.
The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), LDL cholesterol (LDLC), and calculated non-HDLC (=total - HDLC) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDLC is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDLC shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a) [Lp(a)]-cholesterol is part of measured or calculated LDLC and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDLC declines poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDLC or apolipoprotein B (apoB), especially in patients with mild-to-moderate hypertriglyceridemia (2-10 mmol/L). Non-HDLC includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apoB measurement can detect elevated LDL particle (LDLP) numbers often unidentified on the basis of LDLC alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20-100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.
欧洲动脉粥样硬化学会(EAS)和欧洲临床化学和实验室医学联合会(EFLM)联合共识小组最近探讨了目前和未来在致动脉粥样硬化脂蛋白的实验室诊断方面所面临的挑战。总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)和计算得出的非高密度脂蛋白(=总胆固醇-高密度脂蛋白胆固醇)构成了评估动脉粥样硬化性心血管疾病(ASCVD)风险的主要脂质谱,可以在非禁食状态下进行测量。LDLC 是降脂治疗的主要目标。对于治疗后的随访,应使用相同的方法测量或计算 LDLC,以减少由于方法之间存在显著差异而导致的治疗决策错误。脂蛋白(a)[Lp(a)]胆固醇是测量或计算得出的 LDLC 的一部分,应至少在所有有 ASCVD 风险的患者中进行一次估计,尤其是在那些他汀类药物治疗后 LDLC 降低不理想的患者中。即使在最佳 LDL 降低治疗下,仍应通过非高密度脂蛋白胆固醇或载脂蛋白 B(apoB)评估 ASCVD 的残余风险,尤其是在轻中度高甘油三酯血症(2-10 mmol/L)患者中。非高密度脂蛋白胆固醇包括残余脂蛋白胆固醇的评估,应在所有标准脂质谱中报告。额外的 apoB 测量可以检测到 LDL 颗粒(LDLP)数量的升高,而仅凭 LDLC 往往无法识别这些颗粒。报告了 20-100 岁欧洲男性和女性的脂质、脂蛋白和载脂蛋白的参考区间。然而,实验室应根据治疗决策阈值标记异常脂质值。
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