Cambios en el perfil lipídico en hepatopatías crónicas.

Abstract

Se ha analizado el perfil de llpoprotelnas y apollpoprotelnas en un grupo de pacientes con hepatopatia cr6nica, tratando de valorar posibles diferencias en cuanto al grado de deterioro funcional del mismo y a la presencia de colestasis. Mtrooos: Se han estucliado 21 sujetos con clrrosis hepatica y 12 con clrrosis biliar primaria. Se divldieron en dos subgrupos cada uno, atendiendo a la exlstencia de descompensaci6n cilnica y el estadio de Scheuer, respectivamente. La separacl6n de lipoprotelnas se efectu6 medlante ultracentrifugaci6n del plasma, estudiandose los lipldos y de su composlci6n en apolipoprotelnas. La lipoproteina X se ldentlflc6 rnediante electroforesls en gel de agarosa. Rtsumoos: En los grupos de menor afectacl6n solo se reglstraron camblos mlnlmos: disminucl6n del colesterol esteriflcado y de Apo E en '(LDL en los clrr6tlcos y un aumento de colesterol-HDL en la cirrosis billar. En los cirr6tlcos descompensados estaban dismlnuidos VLDL, HDL, trigliceridos y colesterol esteriflcado. Las fracclones de Apo C en VLDL eran normales y los niveles de Apo E indetectables. En los pacientes con clrrosls blliar avanzada, . estaban elevados los trigllceridos, el colesterol llbre y las LDL, y dismlnuldos el colesterol esteriflcado y las HDL; las VLDL estaban enriquecldas en Apo C-110. La lipoprotelna X se detect6 en todos estos sujetos y en la mltad de los drr6ticos descompensados. , CoNCLUSIONts: La hepatopatia cr6nlca avanzada se asoda con un descenso de los nlveles de las llpoproteinas de origen hepatico y la ausencla de Apo E en VLDL, probablemente debldo a un falio en su sintesls. El perfll de los pacientes con drrosls blliar primaria avanzada deflnlrla la colestasis cr6nica y se caracterlza por la presencia de llpoprotelna X. la elevad6n del colesterol ilbre y el descenso del colesterol-HDL; las VLDL, que estan aumentadas, son ricas en Apo C-11. Los datos muestran la dlstinta repercusi6n de estas patologias en la composici6n de apoprotelnas de las VLDL

The pattern of ilpoprotelns and apollpoproteins has been studied in a group of patients with chronic liver disease. The differences In this pattern were analysed in relation with the stage of llver disease and the presence of cholestasls. METHoos: Twenty one patients with hepatic cirrhosis and 12 with primary billar cirrhosis were studied. Two subgroups were established according to the disease severity and to the Scheuer ciasslflcatlon, respectively. Plasma llpoprotelns were separated by ultracentrifugation, and the llpld and apolipoprotein composition were determined. Upoproteln X was Identified by means of agarose gel electrophoresis. RtsuLrs: In the subgroups with less severe liver disease, only mlnlmal changes were found, such as the decreases in esterifled cholesterol and Apo E contents In VLDL In the cirrhotic patients, and the increase of HDL-cholesterol In the patients with primary biliary cirrhosis In the first stages. In patients with severe hepatic cirrhosis, total esterifled cholesterol, triglycerides, VLDL and HDL were diminished. Apo E In VLDL was undetectable whereas the different Apo C lsoforms were In the normal proportion. Patients with severe biliary cirrhosis showed high levels of total cholesterol and triglycerides, ·e1evated LDL-cholesterol, and decreased. HDL-cholesterol and total esterifled cholesterol. Apo C-11O In VLDL was proportionally Increased • related to both Apo E and Apo C-111. Upoproteln X was detected In ail these patients •lid In haH of the patients with severe hepatic cirrhosis. C0Ncws10Ns: Severe chronic liver disease Is associated with • decrease of the concentration of hepatic lipoprotelns and the absence of Apo E In VLDL, probably as • result of a defect In their synthesis. The lipld profile found In patients with blllary cirrhosis delineates the pattern of chronic cholestasls, which Is charecterized by the presence of llpoproteln X. a significant increase of free-cholesterol and a decrease of HDL-cholesterol; VLDL, which are Increased, are rich In Apo C-11- Data show the distinct apolipoproteln composition of VLDL In the different hepatic diseases.