RESUMEN
Objetivo: Dar a conocer una presentación atípica de dislipidemia mixta severa en población pediátrica y su abordaje diagnóstico y terapéutico. Caso Clínico: Escolar femenina de 7 años de edad, quien es referida por presentar suero lactescente, evidenciado al realizarle pruebas de laboratorio. Examen físico: talla, peso e índice de masa corporal en percentil 50, hepatomegalia palpable no dolorosa. Paraclínicos de ingreso: glucemia 114 mg/dl, colesterol: 166 mg/dl y triglicéridos: 1200 mg/ dl. Electroforesis: se evidencia VLDL y quilomicrones. Se hace diagnóstico de hiperlipoproteinemia tipo V, se inicia tratamiento con modificación de estilo de vida y ácidos omega 3, 1500 mg/día. Persisten niveles elevados de triglicéridos y aumenta el colesterol, por lo que se omite el omega 3 y se indica tratamiento con ezetimiba 10 mg y ciprofibrato 50 mg diarios. El estudio genético evidenció una variante intrónica G/C en el intrón 7 para el gen de PPARα, correlacionándose con un riesgo elevado de hipertrigliceridemia y mutación del exón 4 del gen del receptor de LDL, por lo que se modifica el diagnóstico a dislipidemia mixta con elevación de VLDL, quilomicrones y LDL. La evolución actual ha sido satisfactoria. Conclusión: Las hiperlipidemias primarias son un grupo de patologías con frecuencia variables de acuerdo a los diferentes fenotipos presentes. El diagnóstico diferencial es importante para descartar una causa secundaria. La electroforesis y el estudio genético orientan al diagnóstico, y el tratamiento debe ser individualizado dependiendo de la clínica del paciente, los niveles de lípidos plasmáticos y los factores de riesgos asociados.
Objective: To present an atypical presentation of severe mixed dyslipidemia in the pediatric population and its diagnostic and therapeutic approach. Case Report: Female 7-year-old is referred because of presenting lactescent serum, evidenced by laboratory tests. Physical exam: height, weight and body mass index in the 50th percentile, painless palpable hepatomegaly. Initial paraclinical: glucose 114 mg/dl, cholesterol 166 mg/dl and triglycerides 1200 mg/dl. Electrophoresis: evidence of VLDL and chylomicrons. Hyperlipoproteinemia type V diagnosis is made; treatment is initiated with lifestyle modification and omega 3 fatty acids, 1500 mg/day. However, given the persistence of high levels of triglycerides and cholesterol, the omega 3 fatty acids is omitted and treatment with ezetimibe 10 mg and ciprofibrate 50 mg daily, is indicated. Genetic studies revealed an intronic variant G/C in intron 7 for gene PPARα, correlated with a high risk of hypertriglyceridemia, and a mutation of exon 4 of gene LDL receptor; for this reason, the diagnosis is modified to mixed dyslipidemia, with elevated VLDL, LDL and chylomicron. The current evolution has been satisfactory. Conclusions: Primary hyperlipidemia is a group of diseases with variable frequency according to the different phenotypes present. The differential diagnosis is important to exclude a secondary cause. Electrophoresis and genetic study guide the diagnosis. Treatment should be individualized depending on the clinical findings of the patient, plasma lipid levels, and associated risk factors.
RESUMEN
Objective:To evaluate the efficacy and safety of rosuvastatin and atorvastatin in the treatment of the patients with primary hyperlipidemia in China.Methods:The related literatures in CNKI,VIP,Wanfang medicine network,PubMed/MEDLINE,CBM and Chinese dissertations full text database were retrievaled by computer from the establishment time of database to December 31,2015. Two researchers according to the inclusion and exclusion criteria independently selected the studies and extracted the data and assessed the quality of the literatures.The Revman 5.0 software was used to perform Meta analysis of all effect indicators in various groups.Results:A total of 7 randomized controlled trial (RCT)were included,and there was no significant abnormality in bias evaluation. 8 weeks after treatment, the total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C)and high density lipoprotein cholesterol (HDL-C)levels of the patients in 5 mg rosuvastain group and 10 mg atorvastatin group had no significant differences between before and after treatment (P >0.05);the HDL-C levels of the patients in 10 mg rosuvastatin group and 10 mg atorvastatin group had significant differences between before and after treatment (P 0.05);the TG,TC,LDL-C and HDL-C levels of the patients in 5 mg and 10 mg rosuvastatin groups had no significant differences between before and after treatment (P > 0.05).12 weeks after treatment,there were no significant differences in the TC and LDL-C levels between 10 mg rosuvastatin group and 10 mg atorvastatin group (P >0.05),but there were significant differences in the TG and HDL-C levels (P 0.05).Conclusion:5 mg rosuvastatin and 10 mg atorvastatin in the treatment of the patients with primary hypercholesterolemia have similar lipid-lowering effect;with the the increase of the treatment time and the dose,10 mg rosuvastatin can obviously reduce the TG level and increase the HDL-C level of the patients,and the incidence of adverse reactions of two kinds of doses of rosuvastatin has no obvious difference.
RESUMEN
PURPOSE: To evaluate the clinical efficacy of etofibrate in primary hyperlipidemia in patients from clinical centers representative of all main Brazilian cities. METHODS: One thousand, nine hundred and fourty three hyperlipidemic patients were submitted to diet and drug treatment with etofibrate (500 mg/day) for eight weeks. The data b WAS analyzed as to changes in the lipoprotein profile, as well as the side effects. RESULTS: There was an important reduction in total cholesterol (19.88), triglycerides (29.59), LDL-c (14.89) and VLDL-c (14.54) concentration. There was a significant increase in HDL-c (18.14). Adverse effects were observed in 8.5 of the patients, without major clinical relevance, however, in 1.44 the treatment had to be interrupted. CONCLUSION: Administration of etofibrate promoted positive changes in all parameters of the lipid and lipoprotein profile, thus reducing the risk of atherosclerotic disease, without significant side effects in the great majority of sample studied.