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Protocolo de estudio bioquímico de hipercolesterolemia familiar en un niño de 6 años
Biochemistry study protocol of familial hypercholesterolaemia in a 6 year-old child
Silvia Caparrós Cánovasa, Teresa Arrobas Velillaa,
Autor para correspondencia
teresaarrobasvelilla@hotmail.com

Autor para correspondencia.
, Berta Fernández Péreza, Jose Antonio Bermúdez de la Vegab, Carmen González Martina, Isabel Orive de Diegoa, Maria del Carmen Cruz Mengíbara, Fernando Fabiani Romeroa
a Unidad de Riesgo Vascular, UGC de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
b Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen Macarena, Sevilla, España
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en el caso de los heterocigotos y 1 de cada mill&#243;n&#44; en el caso de los homocigotos&#44; presenta HF&#46; En Espa&#241;a&#44; se calcula entre 80&#46;000 y 100&#46;000 las personas afectadas&#46; En el mundo se calcula unos 10 millones de personas&#44; de las cuales menos del 10&#37; est&#225;n diagnosticadas y menos del 25&#37; reciben tratamiento hipolipemiante<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La HF debe sospecharse en cualquier adulto que presente concentraciones plasm&#225;ticas muy elevadas de CT &#40;300-500<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; generalmente con concentraciones de triglic&#233;ridos inferiores a 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; En el caso de la HF homocigota &#40;HFH&#41;&#44; las concentraciones de colesterol son extremadamente altas&#44; generalmente superiores a 500<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; pudiendo alcanzar los 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Si no se diagnostica precozmente&#44; la HF puede dar lugar a manifestaciones cl&#237;nicas en la edad adulta &#40;dep&#243;sitos de colesterol en tejidos extrahep&#225;ticos formando engrosamientos o tumefacciones&#41; como son el arco corneal &#40;anillo p&#225;lido alrededor del iris que tiene valor diagn&#243;stico de HF cuando se da antes de los 45 a&#241;os&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> y&#47;o los xantomas tendinosos&#46; De estos &#250;ltimos&#44; los m&#225;s frecuentes se localizan en el tend&#243;n de Aquiles y en los tendones extensores de las manos&#46; Adem&#225;s&#44; para valorar el riesgo cardiovascular global&#44; es importante conocer&#44; especialmente en ni&#241;os&#44; los antecedentes familiares de hipercolesterolemia&#44; ictus y aterosclerosis en edades temprana en familiares de primer grado&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Actualmente&#44; en el caso de los ni&#241;os&#44; se recomienda utilizar como valores de referencia en lugar de los puntos de corte del <span class="elsevierStyleItalic">National Cholesterol Education Program</span> &#40;NCEP&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; los percentiles obtenidos seg&#250;n edad y g&#233;nero de los datos proporcionados por sociedades cient&#237;ficas como la Sociedad Espa&#241;ola de Bioqu&#237;mica Cl&#237;nica y Patolog&#237;a Molecular &#40;SEQC&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> derivados del estudio DRECE<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> &#40;Dieta y Riesgo de Enfermedades Cardiovasculares en Espa&#241;a&#41;&#44; y la <span class="elsevierStyleItalic">American Academy of Pediatrics</span> &#40;AAP&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; datos derivados del estudio de prevalencia de la &#171;<span class="elsevierStyleItalic">Lipid Research Clinic Pediatric</span>&#187;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Ambas recomiendan que se consideren como sospechosos de HF los pacientes cuyas concentraciones de CT y c-LDL son superiores al percentil 95 &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Presentaci&#243;n del caso</span><p id="par0025" class="elsevierStylePara elsevierViewall">Paciente var&#243;n de 6 a&#241;os que es remitido de la Unidad de Pediatr&#237;a al laboratorio de Riesgo Cardiovascular &#40;RCV&#41; de la Unidad de Gesti&#243;n Cl&#237;nica de Bioqu&#237;mica Cl&#237;nica del Hospital Virgen Macarena de Sevilla&#46; El paciente presenta concentraciones elevadas de colesterol total y c-LDL&#44; con sospecha de HF&#44; rama paterna no confirmada gen&#233;ticamente&#46; El padre no presenta signos cl&#237;nicos que manifiesten dep&#243;sitos de colesterol ni otros factores de riesgo asociados tales como diabetes&#44; hipertensi&#243;n o h&#225;bito tab&#225;quico&#46; Toma como tratamiento hipolipemiante estatinas que mantienen el c- LDL en 125<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Es de destacar su elevada concentraci&#243;n de lipoprote&#237;na &#40;a&#41;&#44; 99<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;l&#237;mite superior del intervalo de referencia 30<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; El abuelo del paciente sufri&#243; un ictus a los 60 a&#241;os&#44; por lo que se incrementa la probabilidad de riesgo cardiovascular en la rama paterna&#46; Tanto la madre como la hermana tienen concentraciones lip&#237;dicas dentro de los intervalos de referencia y sin factores de riesgo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El paciente presenta un peso comprendido en el percentil 50 y una talla en el percentil 90 para su edad y sexo&#46; La familia afirma que el ni&#241;o sigue una alimentaci&#243;n correcta y que no toma tratamiento farmacol&#243;gico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se practicaron las determinaciones anal&#237;ticas siguientes&#58; bioqu&#237;mica general&#44; que incluye glucosa&#44; HbA1c e insulina &#40;para valorar estado de resistencia a la insulina&#41;&#44; transaminasas &#40;valoraci&#243;n de funci&#243;n hep&#225;tica&#41;&#44; TSH &#40;descartar hiperlipidemia secundaria&#41; y un perfil de RCV&#44; en el cual se determinan las lipoprote&#237;nas mediante un m&#233;todo de ultracentrifugaci&#243;n en gradiente de densidad&#44; cocientes aterog&#233;nicos y factores de riesgo emergentes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las concentraciones de glucosa&#44; HbA1c&#44; insulina&#44; transaminasas&#44; TSH&#44; calcio y f&#243;sforo se encontraron dentro de los intervalos de referencia&#46; Se confirma la elevada concentraci&#243;n del CT &#40;313<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; y del c-LDL &#40;232<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; con c-HDL &#40;52<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; c-VLDL &#40;23<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; y TG &#40;117<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; dentro de sus intervalos de referencia&#46; En cuanto a los &#237;ndices aterog&#233;nicos&#44; el cociente CT&#47;c-HDL o &#237;ndice de Castelli es el &#250;nico que se encuentra elevado &#40;valores superiores a 4 proporcionan mayor riesgo aterog&#233;nico&#41;&#46; Los valores de las determinaciones anal&#237;ticas del perfil de RCV se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Los factores de riesgo emergentes &#40;us-PCR&#44; fibrin&#243;geno&#44; homocisteina y Lp&#40;a&#41; se encuentran dentro de los intervalos de referencia&#44; as&#237; como la concentraci&#243;n de apolipoprote&#237;na A1&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los datos obtenidos alertan de una concentraci&#243;n de CT y c-LDL an&#243;mala para la edad y sexo del paciente &#40;CT<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>313<span class="elsevierStyleHsp" style=""></span>mg&#47;dL y c-LDL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>232<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; que superan el percentil 95 avalados por los criterios de las 2 sociedades cient&#237;ficas anteriormente mencionadas<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; Sin embargo&#44; en Espa&#241;a los criterios derivados del estudio DRECE <a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> muestran unos puntos de corte m&#237;nimamente incrementados en concentraci&#243;n de CT y c-LDL entre ni&#241;os de sexo masculino de 5 a 9 a&#241;os&#44; como es nuestro caso&#44; con respecto a los de la <span class="elsevierStyleItalic">American Academy of Pediatrics</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> &#40;CT&#58; 222<span class="elsevierStyleHsp" style=""></span>mg&#47;dL versus 186<span class="elsevierStyleHsp" style=""></span>mg&#47;dL y c-LDL 145<span class="elsevierStyleHsp" style=""></span>mg&#47;dL versus 129<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; respectivamente&#41;&#46; Esto quiere decir que los ni&#241;os espa&#241;oles en este intervalo de edad&#44; seg&#250;n los resultados del DRECE&#44; presentan valores de colesterol m&#225;s elevados para edad y g&#233;nero que los ni&#241;os estudiados por la <span class="elsevierStyleItalic">American Academy of Pediatrics</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Otro dato a destacar es el incremento en la concentraci&#243;n de apolipoprote&#237;na B&#44; 131<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; &#40;el valor en la poblaci&#243;n global de 5-59 a&#241;os es de 113<span class="elsevierStyleHsp" style=""></span>mg&#47;dL<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41;&#46; La combinaci&#243;n de valores elevados de c-LDL y apo B -100 confirman la sospecha de HFH&#46; El ni&#241;o&#44; en cambio&#44; no presenta concentraci&#243;n elevada de Lp&#40;a&#41; como su padre&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Una vez establecida la sospecha diagn&#243;stica&#44; se procede a la confirmaci&#243;n de la HFH por la determinaci&#243;n de la mutaci&#243;n del receptor de LDL &#40;Lipochip<span class="elsevierStyleSup">&#174;</span>&#41; mediante an&#225;lisis gen&#233;tico&#46; Esta t&#233;cnica es capaz de identificar m&#225;s de 250 mutaciones del receptor LDL&#44; 3 mutaciones de apo B-100 y 6 mutaciones de pcsk9 y tambi&#233;n es capaz de identidicar los cambios en el n&#250;mero de copias &#40;10&#37; de las mutaciones causantes de la HF&#41; m&#225;s frecuentes en la poblaci&#243;n espa&#241;ola del gen del receptor de LDL&#46; La t&#233;cnica se basa en la capacidad que tienen las mol&#233;culas de ADN de unirse espec&#237;ficamente a su secuencia complementaria<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se cita al paciente en el laboratorio de RCV explic&#225;ndole previamente que no puede comer&#44; beber&#44; ni masticar goma de mascar en los 30 min previos a la toma de la muestra de saliva&#46; A continuaci&#243;n se cumplimenta un cuestionario de puntuaci&#243;n facilitado por el laboratorio &#40;programa internacional de la OMS MEDPED&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> basado en criterios diagn&#243;sticos de HFH y se le asigna un c&#243;digo al paciente y muestra para preservar su intimidad&#46; Los criterios diagn&#243;sticos comprenden&#58; historia personal y familiar&#44; examen f&#237;sico &#40;xantoma tendinoso y arco corneal&#41; y valores de c-LDL en ayunas con concentraciones de TG inferior a 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Se valora el total de puntos&#44; cercior&#225;ndose el diagn&#243;stico de HF superior a 8 puntos y probable de 6 a 7 puntos&#46; La puntuaci&#243;n obtenida por el paciente fue de 4 puntos&#44; ya que tanto la exploraci&#243;n f&#237;sica como los antecedentes personales fueron normales&#44; detect&#225;ndose &#250;nicamente concentraciones elevadas de c-LDL&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Previo consentimiento de los padres del paciente &#40;ya que este era menor de edad&#41;&#44; la muestra se recolecta en un recipiente especializado proporcionado por el laboratorio que contiene un conservante &#40;2<span class="elsevierStyleHsp" style=""></span>mL de l&#237;quido Oragene&#41;&#46; Si existe dificultad a la hora de salivaci&#243;n&#44; se le explica al paciente t&#233;cnicas para facilitar la salivaci&#243;n &#40;masajeo de mejillas o enjuague bucal con agua&#41;&#46; Posteriormente se conserva la muestra a temperatura ambiente &#40;entre 15-30<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; hasta que se env&#237;a al laboratorio de referencia &#40;Prog&#233;nika&#44; Bilbao&#44; Espa&#241;a&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se confirma la HFH por Lipochip<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; una mutaci&#243;n de clase alelo nulo con una deleci&#243;n del ex&#243;n 9 al ex&#243;n 12&#46; Este tipo de mutaciones de alelo nulo suelen estar asociadas a fenotipos m&#225;s graves que cursan con aterosclerosis m&#225;s avanzada<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46; Asimismo&#44; se han determinado asociaciones con un mayor riesgo de enfermedad cardiovascular&#44; concentraciones de colesterol m&#225;s elevadas y necesidad de un tratamiento m&#225;s intensivo para conseguir los mismos objetivos terap&#233;uticos a nivel de c-LDL&#46; Se trata de una mutaci&#243;n de clase A directamente asociada con la HF<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46; Al continuar el estudio familiar&#44; se demuestra la misma mutaci&#243;n en el padre&#46;</p></span></span>"
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          "titulo" => "Abstract"
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        3 => array:2 [
          "identificador" => "xpalclavsec103903"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Presentaci&#243;n del caso"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Resultados"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discusi&#243;n"
        ]
        8 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-10-28"
    "fechaAceptado" => "2012-01-31"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec103902"
          "palabras" => array:7 [
            0 => "Hipercolesterolemia familiar"
            1 => "An&#225;lisis gen&#233;tico"
            2 => "Riesgo cardiovascular"
            3 => "Colesterol ligado a lipoprote&#237;nas de baja densidad"
            4 => "Colesterol"
            5 => "Ni&#241;o"
            6 => "Aterosclerosis"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec103903"
          "palabras" => array:7 [
            0 => "Familial hypercholesterolemia"
            1 => "Genetic analysis"
            2 => "Cardiovascular risk"
            3 => "Low density lipoprotein cholesterol"
            4 => "Cholesterol"
            5 => "Child"
            6 => "Atherosclerosis"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La hipercolesterolemia familiar &#40;HF&#41; es una de las enfermedades hereditarias m&#225;s frecuentes&#44; afectando a unas 10 millones de personas en todo el mundo&#46; Se caracteriza por niveles elevados de c-LDL y por una elevada prevalencia de enfermedad cardiovascular prematura&#46; La HF se origina por mutaciones en el gen que codifica el receptor de c-LDL&#46; Presentamos el caso de un ni&#241;o de 6 a&#241;os que es remitido al laboratorio de Riesgo Cardiovascular &#40;RCV&#41; por sospecha de hipercolesterolemia familiar&#46; Se le realiza una bioqu&#237;mica general y un perfil de RCV&#44; donde se observa un colesterol total y un c-LDL elevado&#44; con el resto de los par&#225;metros dentro de los rangos de normalidad&#46; Se procede a la confirmaci&#243;n de la HF heterocigota mediante la determinaci&#243;n de la mutaci&#243;n del receptor de c-LDL &#40;Lipochip<span class="elsevierStyleSup">&#174;</span>&#41; mediante an&#225;lisis gen&#233;tico&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Familial hypercholesterolaemia &#40;FH&#41; is one of the most common hereditary diseases&#44; affecting about 10 million people around the world&#46; It is characterised by high levels of c-LDL&#44; and a high prevalence of premature cardiovascular disease&#46; It is caused by mutations in the gene that encodes the c-LDL receptor&#46; We present the case of a 6 year-old child who was referred to the Cardiovascular Risk &#40;CRV&#41; Laboratory due to suspicion of familial hypercholesterolaemia&#46; General biochemistry analysis and a CRV profile were performed&#44; showing a high total cholesterol and c-LDL&#46; As the rest of parameters were within the normal ranges&#44; secondary causes of hypercholesterolaemia&#44; such as hypothyroidism and diabetes&#44; were ruled out&#46; The presence of the FH heterozygote was confirmed by determining the mutation of the c-LDL receptor mutation by gene analysis &#40;Lipochip <span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Fuente&#58; Plasma lipid distributions in selected North American populations&#58; the Lipid Research Clinics Program Prevalence Study&#46; The Lipid Research Clinics Program Epidemiology Committee&#46; Circulation&#46; 1979&#59;60&#40;2&#41;&#58;427-39<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>13-19 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="8" align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Colesterol de LDL &#40;mg&#47;dL&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>5-12 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>13-19 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>20-29 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>30-39 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>40-49 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>5-12 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">145&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab204468.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Percentiles de colesterol total y colesterol de LDL &#40;mg&#47;dL&#41; en la poblaci&#243;n espa&#241;ola&#46; Estudio DRECE</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
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            0 => array:2 [
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                0 => """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Triglic&#233;ridos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Apolipoprote&#237;na A-I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Apolipoprote&#237;na B-100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#205;ndice CT&#47;c-HDL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;02 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice c-VLDL&#47;TG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;20 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice c-LDL&#47;Apo B-100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;77 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrin&#243;geno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">311 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">PCR-ultrasensible&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;15 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lp&#40;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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ISSN: 18884008
Idioma original: Español
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