Bost M, Foulon T, Groslambert P, Lien C, Servage M N
Département de Médecine et Réanimation Pédiatrique, CHU de Grenoble.
Ann Pediatr (Paris). 1993 Sep;40(7):444-52.
Four-year-old schoolchildren with a positive family history for atherogenic dyslipidemia and/or clinical atheroma before 55 years of age were screened for hypercholesterolemia. Investigations included determination of serum levels of total cholesterol, triglycerides, HDL cholesterol, apolipoprotein A1, apolipoprotein B, and Lp(a); an agarose lipidogram; acrylamide gradient electrophoresis; and determination of LDL composition by ultracentrifugation. Normal values were defined as values under the 90th centile, i.e., 1.97 g/l for total cholesterol, 0.89 g/l for triglycerides, 1.36 g/l for LDL-cholesterol, and 1.26 g/l for apolipoprotein B. Among 3,565 children routinely evaluated at 4 years of age, 525 (16.2%) had a positive family history; of these, 72 underwent lipid investigations. Eight children (11%) had hypercholesterolemia type IIA, eight had a variety of lipid disorders, and 14 (20.6%) had increased Lp(a) levels as an isolated anomaly or concomitantly with an atherogenic dyslipidemia. Because Lp(a) is a cardiovascular risk factor independent from total cholesterol levels, we believe this parameter should be determined in high risk children.
对有动脉粥样硬化性血脂异常家族史和/或55岁之前有临床动脉粥样硬化的4岁学童进行高胆固醇血症筛查。检查包括测定血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B和脂蛋白(a)的水平；琼脂糖血脂图；丙烯酰胺梯度电泳；以及通过超速离心法测定低密度脂蛋白组成。正常值定义为低于第90百分位数的值，即总胆固醇为1.97 g/l、甘油三酯为0.89 g/l、低密度脂蛋白胆固醇为1.36 g/l、载脂蛋白B为1.26 g/l。在3565名4岁时接受常规评估的儿童中，525名(16.2%)有阳性家族史；其中72名接受了血脂检查。8名儿童(11%)患有IIA型高胆固醇血症，8名有各种血脂异常，14名(20.6%)脂蛋白(a)水平升高，为孤立异常或与动脉粥样硬化性血脂异常同时存在。由于脂蛋白(a)是独立于总胆固醇水平的心血管危险因素，我们认为该参数应在高危儿童中测定。
