MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01CA4914.8FC29CB0" Tento dokument je webová stránka tvořená jedním souborem, rovněž nazývaná soubor webového archivu. Zobrazí-li se tato zpráva, znamená to, že prohlížeč nebo editor nepodporuje soubory webových archivů. Stáhněte si prohlížeč, který podporuje webový archiv, například aplikaci Windows® Internet Explorer®. ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy

Obsah této prezentace pravděpodobně nebude prohlížeč schopen správně zobrazit.

Chcete-li i přesto pokračovat, klepněte sem.

 ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/master03.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
Klepnutím lze upravit styl = předlohy nadpisů.
Klepnutím lze upravit styly předlohy textu. =
Druhá úroveň
Třetí úroveň
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Pátá úroveň
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9.10.2009
‹#›
------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0060.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Vyšetřování lipidů v klinické biochemii
Martin Beránek= 3;
Přednáš= ka pro bakaláře FaFUK
------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0115.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
3Do4
Příklad jednoduchého lipidu
triacylglycerol (triglycerid) =3D TAG (= TG)
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4t7VhDKA1MEoYch5Aq039h45+q7FzZHwzhMQADs= ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Lipidy – dělení podle struktu= ry
= •<= /span>Lipidy jednoduché =3D estery VMK s alkoholy:      glycerol u tuk&= #367; a olejů  (acylglyceroly)        = ;            &n= bsp;            = ;          vyšší jednosytné nebo steroly u vosků
= •<= /span>Fosfolipidy<= /span> =3D estery = MK s alkoholy a k. fosforečnou  <= /span>(glycerolFL, sfingosinFL)
<= span style=3D'font-size:88%;color:yellow;mso-color-index:3'>•Glykolipidy<= /span> =3D <= /span>estery MK s alkoholy a sacharidy  =
<= span style=3D'font-size:88%;color:yellow;mso-color-index:3'>•Sulfolipidy, aminolipidy= 3;
<= span style=3D'font-size:88%;color:yellow;mso-color-index:3'>•Lipoproteiny (LP= )
= •<= /span>Prekursory a odvozené lipidy: MK, alkoholy (gly-cerol, cetylalkohol ve vozcích, cholestero= l) steroidy= , = aldehydy, ketolátky
<= span style=3D'font-size:88%;visibility:hidden'>•
------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Vlastnosti a funkce lipidů v organismu=
•Nerozpustnost ve vodě (rozpu= stnost éter, chloroform, benzen).
<= span style=3D'font-size:75%;color:#66FFCC'>•Transport krví= ; ve formě lipoproteinů (LP).
<= span style=3D'font-size:75%'>•Souč&aa= cute;st buněčných a mitochondriálních membrán =
= 226;    (FL, dvouvrstva amfipatických molekul s částí hydrofó= bní<= /span> a hydrofilní). 
•<= /span>Elektrická izolace umožňující rychlé šíření depolarizačn&ia= cute;ch vln podél myelinizovaných nervových vláken. <= /div>
<= span style=3D'font-size:75%'>•Vysoká energetická hodnota (TAG, zásoby v tukové tkáni)
•Tepelná a mech. izolace (TAG v podkožn&i= acute; tukové tkáni)
<= span style=3D'font-size:75%;color:#66FFCC'>•Esenciální MK, <= /b>vitamíny A,D,E,K <= /span>
<= span style=3D'font-size:75%'>•Druzí posl= ové (IFL), aktivátor trombocytů (alkylfosfolipid).
•Glykosfingolipidy funkce komunikace s buněčným povrchem.
<= span style=3D'font-size:75%;visibility:hidden'>•
<= span style=3D'font-size:88%;visibility:hidden'>•
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text/html; charset="us-ascii" Lipidy
Mast= né kyseliny (MK, 50)
<= span style=3D'font-size:86%;color:yellow;mso-color-index:3'>•Neesterifikovan&= eacute; (volné) VMK (FFA)
<= span style=3D'font-size:86%;color:yellow;mso-color-index:3'>•Esterifikovan&ea= cute; MK v tucích (pevné) a olejích (tekuté)
<= span style=3D'font-size:86%;visibility:hidden'>•
•zásobní funkce        = ;         tuhé       nasycené        C ≥ 12 =
•
•membr&aacu= te;nové funkce       teku= té   nenasycené      C = ≥ 18 =
<= span style=3D'font-size:86%;visibility:hidden'>•
<= span style=3D'font-size:86%'>•Synté= ;za hlavně v játrech, zásoby jako TAG v tukové tkáni
<= span style=3D'font-size:86%'>•Koncentrace VMK v plasm&#= 283; po jí= ;dle 0,5 mmol/l
<= span style=3D'font-size:86%'>•Při hladovění  0,8 mmol/l<= /span>
<= span style=3D'font-size:86%'>•U DM až= 2 mmol/l. 
<= span style=3D'font-size:86%'>•Vazba na a= lbumin
<= span style=3D'font-size:86%'>•Plasmatick= ý poločas 1,5 min.
<= span style=3D'font-size:86%;visibility:hidden'>•
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Cis a trans mastné nenasycené MK
Přirozená konformace
v membránách
Tresčí játra, kožní= tuk, rostlinné oleje (řepka)
Zrychlují odbourávání = LDL
Mléko, živočišné tuky (rostliny)
Katalytická hydrogenace MK v tucích rostlinného původu
Zvyšují hladinu LDL
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Tria= cylglyceroly (TAG)
•<= /span>Při příjmu potravou katabolismus = 10-12 H (odběr na lačno!!)
•Při syntéze (hlavně v játrech, střevě z acetyl-CoA ), lze prok&= aacute;zat =
• Uložení v tukové tkáni; zásob= ní zdroj MK (15 kg u   
•       neobézních, 570 000 kJ – 3M zásoba p"= 5;i hladovění)  =
•
•
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3Do4
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Content-Type: text/html; charset="us-ascii" Lipidy
Lymfa, krev
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mitochondrie
cytosol
E
Alb
FL
H-sensitivní Lipasa
  -- Insuli= n
Lipasa
Lipasa
OH-butyrát,
acetacetát
INSULIN
INSULIN
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TAG + 3 H2O        = ;            &n= bsp;            = ;             glycerol +  3 MK        = ;            
glycerol + ATP        = ;            &n= bsp;            = ;        glycerol-3-P + ADP
glycerol-3-P + O2        = ;            &n= bsp;            = ;            &n= bsp;     dihydroxyaceto= n-P +  H2O2        = ;            &n= bsp;            = ;            &n= bsp;   
H2O2 + 4-aminofenazon + 4-chlorofenol        = ;  
        = ;    4(p-benzochin= on-monoimino)-fenazon + 2 H2O + HCl
       TAG=   – enzymová fotometrická metoda (Roche)
LPL
GK, MgCl2
GPO
Sérum, heparin, EDTA krev (3 ul) nalačno; Jednostupňová reakce, 37 °C
2 bodová kalibrace (C.f.a.s., Roche); 0,05 – 11,4 mmol/l; CV pod 2,5%
Normální rozmezí 0,8 – 1,9 mm= ol/l; Návaznost na ID/MS
<= span style=3D'mso-special-format:"numbullet2\,1";position:absolute;left:-7.53%'= >1)Alkalická hydrolýza TAG pomocí KOH
<= span style=3D'mso-special-format:"numbullet2\,1";position:absolute;left:-5.11%'= >2)Enzymatická hydrolýza TAG pomocí lipas, proteas, esteras
<= span style=3D'color:#FF9900;mso-color-index:4;font-weight:bold'>3)Enzymatická hydrol&yac= ute;za TAG pomocí LPL (S_glr pod 0,1)
peroxidasa, λ =3D 505 nm
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Lipidové spektrum v plasmě člověka
1,5 mmol/l
3,7 mmol/l
5,2 mmol/l
1,6 mmol/l
0,5 mmol/l
95% obsahu lipidů v tkání= ch tvoří TAG
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Složené lipidy
•<= /span>Fosfolipidy  - hlavní lipidová součást membr&= aacute;n – tvoří rozhraní = (obsahují zbytky kyseliny fosforečn&ea= cute;). Krevní FL vznikají v játrech<= span style=3D'font-size:69%'>
•      kardiolipin (mitochondrie) <= /span>
•      fosfa= tidylcholin
•      fosfatid= yletanolamin (kefalin)<= /span>
•      fosfatid= ylserin
•      fosfatid= ylinositol     
•      plasmalogeny
•   = ;  sfingo= myelin  
•     Metabolismus fosfolipázami= A2, B, A1,= C., D. 
•   = ;  LCAT katalyzuje přenos zbytku MK
•   = ;  z C2 lecitinu na chol, čímž vzniká ester chol
•    
•<= /span>Glykolipidy - <= /span>funkce v nervové tkáni (galaktosy= l-ceramid, gangliosidy) a buněčné <= /span>membr&aa= cute;ně (glukosylceramid).
Lecitin
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St= eroly
•Zoosteroly a fytosteroly=
•<= /span>Cholesterol ve všech živočišných buňkách jako hlavní součást pov= rchu membr&aacut= e;n a lipoproteinů
•Cholesterol je prekursorem ŽK , nadledvin= ových a pohlavních hormonů.
•Esterifikován s MK (linolová, linolenová) – transportní a zásobní forma v hepatocytech, tukové tkáni a kůži.
<= span style=3D'font-size:75%'>•50% choles= terolu ze žluče a asi 95 % ŽK reabsorpce <= /div>
<= span style=3D'font-size:75%'>•Denn&iacut= e; bilance cholesterolu je asi  = 300 mg ze stravy
•Ergosterol  - v kvasnicích, prekursor VD
•<= /span>Fytosteroly (sitoster= ol, campesterol, stigmasterol...), C8 deriv&aacu= te;ty.
3Do2
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CHE + H2O        = ;            &n= bsp;            = ;            &n= bsp;       CHOL + MK        = ;            
CHOL + O2        = ;            &n= bsp;            = ;        cholest-4-en-3-on + H2O2
2 H2O2 + 4-aminofenazon + fenol        = ;  
        = ;    4(p-benzochinon-m= onoimino)-fenazon + 4 H2O
3Do2
 Celkov&yacu= te; cholesterol – enzymová fotometrická metoda (Roche)=
cholesterol esterasa
cholesterol oxidasa
peroxidasa, λ =3D 505 nm
3
Sérum, heparin, EDTA krev (3-4 ul)
Jednostupňová reakce, 37 °C
2 bodová kalibrace (C.f.a.s., Roche)
0,08 – 20, 7 mmol/l
CV pod 3%
Ref. rozmezí: 3,9 – 5,2 m= mol/l
Návaznost na ID/MS
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text/html; charset="us-ascii" Lipidy
Co jsou fytosteroly?
•<= /span>tč. 40 rostlinných sterolů C28 a = C29
•<= /span>Obsahují metyl/ethyl na C24
•Funkce podobná cholesterolu –neesterifikovány v buněčných membránách
•Olej kukuřičný, slunečnicový, sójový, řepkový, rýžové otruby, kukuřičné klíčky, sojové boby, = Tribulus terrestris (Indie)
•
• 
•<= /span>
•<= /span>
3Dsitosterol
β-sitosterol
3Dstigmasterol
stigmasterol
3Dkampesterol
kampesterol
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•V potravě 0,25g/den, absorpce 5-15%, 500x nižší hladiny než cholesterol, krátký biologický poločas
•Podstatou mechanismu účinku fytosterolů je zamezení <= /span>vstřebání cholesterolu (odchází do stolice) jeho vytlačením z micel 
• Při denním příjmu rostlinných sterolů v množstv&iac= ute; 1–3 g/den se snižuje CHOL o 8 % a  LDL-cholesterol o 10–15%
•Vyš&#= 353;í příjem není efektivní, naopak snižuje hladi= ny karotenoidů a dalších lipofilních látek  v krvi
•1 rok konsumace margarinu dodávajícího 3 g fytosterolů za den se hladina b-karotenu v krvi snižuje= o 33 %.
•
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Fytosteroly v medicíně
------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0007.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Lipo= proteiny
3Do6
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------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0019.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
CHM
=
B-48
A
C
E
 HDL
E
C
A
VLDL
B-100
E
C
 IDL
E
 LDL
B-100
B-100
Pr&#= 367;měr         = ;   500 nm        = ;            &n= bsp;  60 nm        = ;         30 nm        = ;        25 nm        = ;      9-15 nm
Hust= ota         = ;  pod 0,95        = ;        0,95 – 1,006      1,006 = 211; 1,019       1,019 – 1063  &nbs= p; 1,063 – 1,21  &nbs= p; nad 1,28
Proteiny        = ;  1– 2%        = ;            &n= bsp;  7 – 10%   &nb= sp;          11%        = ;             21%        = ;        33 - 57%         99%     &= nbsp;
Lipidy             = ;   99%        = ;            &n= bsp;       90%        = ;        89%     &= nbsp;           &nbs= p;   79%        = ;        43 – 67%        1%
  TAG (TG)       88%        = ;            &n= bsp;       56%        = ;        29%        = ;             13%        = ;        13 - 16%
  FL        = ;             8%        = ;            &n= bsp;        20%        = ;        26%        = ;             28%        = ;        43 - 46%<= /b>        = ;            &n= bsp;               
  CHOL              4%        = ;            &n= bsp;         23%        = ;       43%        = ;            &n= bsp; 58%        = ;       35 - 41%&= #13;
  FFA        = ;           0        = ;            &n= bsp;             1%        = ;         1%        = ;            &n= bsp;  1%     &n= bsp;             0 - 6%        = ;  100%
Alb-FFA
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C= HOL
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 LDL
VLDL
HDL
MK rp
TAG
LPlipasa
 
=
acetyl-CoA
TAG
-&#= 13;
+ ACAT
mevalonát
HMG-CoA
HMG-CoA R
-
hladovění
vysoký chol v b.
    v j&aa= cute;trech (LDL)
glukagon glukokortik= oidy
+
nízký chol v b. Insulin
T4 &= #13;
isopren
skvalen
lanosterol
MK
=
hepatocyty
neurony
enterocyty
...
=
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• Transportní proteiny
•<= /span> Receptorové ligandy
    apo B-100 = a apoE pro LDL receptory
    apoE pro <= /span>receptor remnantů a IDL
    apoA-I pro= HDL rp
    apoB-48 pro tvorbu chylomikronů ve střevě
    apoC – blok vaz= by CHM a VLDL na apoE rp        = ;     
        = ;        v játrech
  
•<= /span>  Kofaktory enzymů (= apo A-I aktivuje LCAT, apoC
    LCAT a LPL)
•
=
Význam apolipoproteinů
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Patofyziologie lipidů
•<= /span>Zvýšené hladiny lipidů (LDL) - &uacut= e;klad v tkáních, zánětlivé procesy<= /span>, kalcifika= ce, atd.
•kor= natění tepen (koronárních tepen) =3D ATS
•zu&= #382;ování průsvitu - ↓živin, O2, ↑ katabolity
•isc= hemická ch. (ICHS): angina pectoris a IM
•isc= hemie CNS =3D mozková m= rtvice
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=
Rizikové faktory pro aterosklero= su (ATS)
       Celkový cholesterol
       LDL cholesterol
       TAG (méně rizikový)
       LP = (a)
       Apo B-100
       HDL= cholesterol (pod 1 mmol/l)
       Apo A-I
R= iziko ICHS je zvýšeno při prodlou= žené postprandiální lipemii a zvýšeném podílu malých denzních = LDL3.
Další faktory ICHS: zp&= #367;sob stravování, nadváha, hypertenze, nedostatek fyzické aktivity, příbuzný s DLP, kouření, věk nad 45 let u mužů a nad= 55 let u žen, sekundární akutní či chronické onemocnění (DM).
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Riziko ICHS v závislost= i na koncentraci celkového cholesterolu
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quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Mortalita v závislosti = na koncentraci celkového cholesterolu
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Normáln&iac= ute; (žádoucí) hodnoty krevních lipidů
=
      (konsensus odborných společností)
Vy= šetření TCHOL a TAG
P&= #345;i TCHOL < 5,0 mmol/l kontrola za 5 let
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Fredricksonova klasifikace DLP (WHO klasifikace, 1967)
•     Typ V
•Zvýšení pre-beta<= span style=3D'font-size:44%'>
• (VLDL a CM)        = ;       
•  sérum zkalené
R= 26;po 12H prstenec CM
•       ↑↑↑<= span style=3D'mso-spacerun:yes'>   TG
-
+
         CM
    
        LDL
      (β-LP)
  =
      VLDL = ;
(pre- = 46;-LP)
       HDL=
     (α-LP)   
        = ;     Typ I  
        Zvýšené CM <= /div>
   = ;  mléčná vrstva CM
      spodní  f&aacut= e;ze čirá   
       ↑↑  TAG   = 593; TC
  Typ IIa
Zvýšená beta
      (LDL) = ;
  sérum čiré        = ;           
       ↑↑ TC
    Typ IIb
   Zvýšená beta+
      + pre-beta
    (LDL+VLDL)
sérum lehce zkalené
↑↑  TC   &#= 8593; TAG
     Typ III
Atypická pre-beta
         (IDL)
   = ;  sérum čiré        = ;            &n= bsp; 
    ↑ TC ↑ TAG
     Typ IV
Zvýšená prebeta   
      (VLDL) &#= 13;
    sérum mírně   
      chylózní
  ↑↑ TAG  ↑ TC
= = <= ![endif]> = =
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ABMAgAAAAIAAAAInRIynyRoPo5yO2miuhnnb7n2hOJIldlJguqaV27IuN6N1fDb6wgMFADs= ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0184.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Fredricksonova klasifikace DLP
důvody jejího nepoužívání
Vych&= aacute;zí ze stanovení koncentrace celkového cholesterolu, triglyceridů a elektroforézy lipoproteinů, a na zhodnocení přítomnosti chylomiker ve vzorku séra= po 12 hodinách stání při 4°C (pracnost)=
nerozl= išuje mezi primární a sekundární DLP (nerozlišuje příčinu). Výjimkou diagnostika hyperlipoproteinemie typu III (dysbetalipoproteinemie) typické přítomností „široké frakce β“ v elektroforéze
Hypoli= pidemika (statiny a fibráty) ovlivňují LP a tím mění jejich elektroforetickou aktivitu, která je jiná před léčbou a v průběhu léčby (nejedn&a= acute; se o celoživotní klasifikaci)
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Terapeutická klasifikace DLP (doporučení Evropskou společnosti= pro aterosklerózu, 1992)
1. izolovaná hypercholesterolemie
2. izolovaná hypertriglyceridemie
3. kombinovaná hyperlipoproteinemie =
<= /div>
Výběr vhodného hypolipidemika
Nebere v úvahu koncentrace HDL cholesterolu
Nezohledňuje příčinu DL= P
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↑ LDL Chol=         
↓ HDL Chol        
Familiární hypercholesterolemie
     (1:500; defektní LDL-Rp gen) 
     Familiární defekt apo-B100
        = ;   (defektn&iac= ute; apoB-100)
Klasifikace dyslipidemie podle etiologie (300 000 DL= P v ČR)
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Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
        = ;            &n= bsp; 
= 3;
1.endokrinní onemocnění (hypothyreosa, vyšší glukokortikoi= dy, KA, nedostatek STH) či změny během těhotenství = ;
2.
2.dekompenzovan&yacu= te; DM 
3.
3.onemocněn&iac= ute; ledvin (hypoalbuminemie, podání glukokortikoidů = po transplantaci ledviny, léková nefrotoxicita - cyklosporin, .= ..)
4.
4.obezita a poruchy příjmu potravy
5.
5.onemocnění jater (syntéza, sekrece a metabolismus CHOL, ŽK)
6.
6.infekční onemocnění
7.
7.glykogenosa I typu, MM, porfyrie
Sekundární DLP
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Preanalytick&eacut= e; požadavky pro vyšetření lipidů v séru <= /span>
Dodržování stálého životního stylu a výživy 2 týdny před = odběrem
Abstinence alkoholu 2 dny (zvyšuje TAG)
12-24 hodinové lačnění= (bez cukrů a tuků)
Před odběrem 10 min v klidu vsedě (40 = min stání ↓ lipidy o 15%)
Po 5 min stažení žíly se lipi= dy ↑ o 10-15%
Infekce?, DM?, těhotenství  či porod před 6M?
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Vy&= #353;etřování lipidových markerů
•    I. Základní
•TC, TAG, HDL-C, LDL-C výpočtem př= i TC nad 5 mmol/l a v= 53;ech osob v riziku ICHS
•
•    II. Specializované
•apo B100, apo AI, lipoprotein(a), ultracentrifugac= e LP, LD3
•
•    III. Ostatní (obsolentní) metody
•celkov&eac= ute; lipidy, FL, estery MK, ELFO LP, chylosita séra
•= 3;
•    IV. Metody molekulární biologie
•defekt LDL= rp a apoB100, apoC, E, LPL, CETP, LCAT
•
•
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Apolipoproteiny= AI a B100
Koncentrace apo B100 korelují= s LDL Chol
Koncentrace apo AI korelují s= HDL Chol
Zvýšené apoB100 a snížené apo AI rizikové faktory ICHS =
        = ; 
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        = ;            &n= bsp;       Index  TC / HDL-C  má být < 5.
       Výpočet non-HDL cholesterolu (tedy aterogenních = LP)
        = ;            &n= bsp;            = ;          (při  TAG nad 4,5 mmol/l)
        = ;            &n= bsp;        TC – HDL-C =3D non-HDL= -C   
        = ;        má být < 3,8 u osob v primární prevenci ICHS
Výpočet koncentrace LDL cholesterolu= Friedewaldovou rovnicí<= span style=3D'color:maroon;display:none'>
        = ;            &n= bsp; LDL-C =3D TC - (HDL-C + TAG/2,2)
         při TAG > 4,5 mmol/l nesprávně nízká hodnota LDL-C
      je-li chy= losita je nutno vzít v úvahu CM (IDL u HLP typ III) 
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•ICH metody – Ag-Ab – komplex stanoven turbidimetricky <= /span>
<= span style=3D'font-family:Arial;font-size:75%'>•Různé proteinové izoformy (u LP (a) )
•<= /span>Různé používané protilátky s jinou vazebností –mezilaboratorní nesrovnatelnost výsledků
•<= /span>Normální hodnoty nastaveny různ= 83; dle výrobce a pro= duktu 
<= span style=3D'font-family:Arial;font-size:75%'>•Apoliporotein AI
<= span style=3D'font-family:Arial;font-size:75%'>•Apolipoprotein B-100
<= span style=3D'font-family:Arial;font-size:75%;color:yellow;mso-color-index:3'><= span style=3D'mso-special-format:bullet;position:absolute;left:-4.34%'>•<= /span>Lipoprotein (a)
<= span style=3D'font-family:Arial;font-size:75%;color:#FF99FF'>•Apolipoproteiny tříd E a C
•     nejsou standardizovány
Imunochemické stanovení koncentrace apolipoproteinů
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Lipoprotein (a)= (Lp a)
Struktura a funkce jako LDL
Hustota jako HDL
Mobilita v elektrickém poli ve frakci VLDL=
Není rozpoznávána LDL receptorem
Na povrchu kromě apoB100 i apo (a) strukturn= ě homologní
s plasminogenem
= Kompetice funkčně s plasmi= nogenem o plasmin (↓ fibrinolýza)
Riziko uzávěru arterie trombem =3D riziko předčasné ICHS
Vysoké Lp(a): geneticky, u FH a chronického selhání ledvin
12 izoforem a 19 genotypů
norma pod 0.3 mg/l
------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0139.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
Separace LP částic ultracentrifugací
  s využitím jejich rozdílné hustoty
(roztoky NaCl o různé koncentraci)
 
CHM
VLDL
LDL
HDL
-
+
   S  CHM     LDL (β-LP)   VLDL (pre-β-LP)   HDL (α-LP)   
Separace LP elektroforeticky na agarosovém gelu (proteiny)
Separační techniky v analýze LP
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R0lGODlh1QECAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADV AQIAgAAAAP///wI3jI+py+0Po5y02ouz3rz7D4biAQCBiZ5qyq5uC79yTM92jd96zu9+D/wJg8Sh sYg8KpPMpRNWAAA7 ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/slide0147.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Lipidy
     Typizace LP částice pomocí imunoelektroforesy (Ab proti
    apoLP).
   
    Separace a identifikace MK GC-FID (MS).
   
    Separace lipidů podle tříd pomocí TLC
   
    FL – rutinn= 3; se nevyšetřují, nemají specifický diagnostický 
    význam (TLC)&#= 13;
   
        
=
Další techniky používané při analýze LP
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FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else return gCurSld } function GetNumSlds() { if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); function ImgBtn( oId,bId,w,action ) { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } function TxtBtn( oId,oeId,action,chkState ) { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() { b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() { b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState var sNext=3D"Další",sPrev=3D"Předchozí",sEnd=3D"Kon= ec prezentace",sFont=3D"Arial",sArrow=3D"Šipka",sFreeform=3D"Voln&yacu= te; tvar",sRect=3D"Obdélník",sOval=3D"Ovál" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; s.fontFamily=3DsFont s.fontSize=3D"9pt" s.paddingLeft=3D2 } function CreateSeparator( node ) { var sObj=3DCreateItem( node ) SetCMBorder(sObj,"menu","menu") var s=3DsObj.style s.borderTopColor=3D"threedshadow" s.borderBottomColor=3D"threedhighlight" s.height=3D1 s.fontSize=3D"0px" } function CreateItem( node ) { var elem=3DPPTSld.document.createElement("DIV") node.insertBefore( elem ) return elem } function SetCMBorder( o,ltClr,rbClr ) { var s=3Do.style s.backgroundColor=3D"menu" s.borderStyle=3D"solid" s.borderWidth=3D1 s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr } ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/fullscreen.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; 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charset="us-ascii" Lipidy ------=_NextPart_01CA4914.8FC29CB0 Content-Location: file:///C:/1EC9B0F9/lipidy_soubory/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
 Po= známky
Prezentac= e
Osnova
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
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