Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

September 2012 No 24, ISSN 2073-0713

Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site Ismail S. Kakey Univ.of Koya Dept. of Biology Rezhna Adil Rasheed Koya Technical Institute

Raza H. Husin Univ. of Sulaimani Dept. of Biology

Abstract In this hospital-based study, fasting blood sample of (10) normal subjects and (80) clinically diagnosed and histopathologically proven patients of stomach, brain, urinary bladder cancer and leukemia were investigated for comparison their effects on serum cholesterol, high density lipoprotein, low density lipoprotein, very low density lipoprotein and total serum protein beside their oxidative stress state. The results shows an elevation in the serum cholesterol, total serum proteins and lipid peroxidation in patients as compared to health control subjects, evaluation of the alterations in lipid profile in several types of tumors, revealed elevation in the levels of the triglycerides, LDL and VLDL in serum of cancer patients, while reduction in the level of the HDL were detected in patients serum. In this investigation , we aim to present a summary of recent emphasis on the role of biomarkers in the prognosis of cancers of different organ sites. Key Words: lipid profile, Cancer, Lipid peroxidation, Lipoproteins. Introduction In this study, the relation between some tumor cases and some biochemical parameters were examined to investigate the role clinical lipid profile in the early diagnosis of tumor cases. Lipids are major cell membrane components essential for various biological functions including cell growth and division of normal and malignant tissues. However, only few reports are available on plasma lipid ‫تةوةرى بايؤلؤجى‬ 5

Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

profile in cancers , an alteration in the circulatory cholesterol levels has been found to be associated in the etiology of breast cancer and colorectal cancer (Ravi, et al., 2009) There was no clear relationship between cancer diagnosis and patterns of changes for some lipoproteins as high density lipoproteins, triglycerides; there are several reports of elevated plasma lipid level such as total lipids, phospholipids, triglycerides, total cholesterol, low density lipoproteins and free fatty acids in breast cancer patients (Hasija and Bagga, 2005). However for many years, a large number of evidences have been accumulated indicating that a possible central role of endogenous cholesterol is played in the pathobiology of cancer. Alteration in the synthesis (Diamianaki et al., 2000; Hasija and Bagga, 2005), uptake (Cao et al., 2004; Fiorenza et al., 2000) and membrane content of cholesterol have been observed in a variety of experimental tumor models as well as in human neoplesia (Hasija and Bagga, 2005; Fiorenza et al., 2000). It is known that cholesterol metabolism in the body is regulated through a complex series of transport and biosynthetic mechanisms, which rely on the continuous exchange between tissues and blood. Therefore any substantial alteration of cholesterol metabolism of the cellular level entails changes in the plasmatic pool of the cholesterol (Garofolo et al., 2005). It was reported that cholesterol content in tumor tissue inversely associated with LDL cholesterol in sera in patients with gastrointestinal cancer (Dessi et al., 1994; Hasan and Al-Samaraae, 2009). Oxidative stress plays an important role in carcinogenesis, the process of lipid peroxidation is one of oxidative conversion of polyunsaturated fatty acids to products known as malondialdehyde (MDA), or lipid peroxides, which is the most studied, biologically relevant, free radical reaction (Dessi et al., 1994; Samir and el Koholy, 1999). Cholesterol presents in the plasma as VLDL and is produced in the liver and is subjected to lipase mediated digestion process that leads to intermediate density lipoprotein (IDL) production. This IDL will undergo an additional remodeling to produce LDL. HDL is synthesized in the liver and intestine, and also generated in part by lipolysis of chylomicorn and VLDL ( Hasan and Al-Samaraae, 2009) High density lipoproteins (HDL) has been shown to be higher in mammography dysphasia and family history of breast cancer (Fiorenza et al., 2000; Hasija and Bagga, 2005), however studies reported either elevated or depressed level of HDL in women with breast cancer (Hasija and Bagga, 2005). ‫تةوةرى بايؤلؤجى‬

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

Previously significant decrease were found in plasma levels of total cholesterol, LDL and apoprotein B of breast cancer cases, this suggest the association between breast cancer and plasma lipid and lipoprotein levels (Boyd et al., 1995). Breast cancer proved to be an exception associated with increased serum total cholesterol, LDL and triglycerides, with no difference in other lipoproteins (Alexopoulos et al., 1987). Previous studies have reported marked lipoproteins and lipids abnormalities in patients with leukemia and lymphoma, specifically low levels of HDL-C and elevated levels of triglycerides (Kritchevsky et al., 1991; Boyd et al., 1995), later in another study (Sarrel, 1998) revealed that serum lipid levels and in particular serum HDL-C levels are module by androgen. The low level of serum HDL-C is related to increased levels of several cancer promoting hormones like androgens, estrogens, insulin and IGF-1(Furberg et al., 2004). However, we cannot find any study about the relationship between lipids profile and HDL. In another study on patients with advanced breast cancer and gynecological malignant tumors, decreased α1-lipoprotein levels, phospholipids, and cholesterol were reported and it was seems to be independent of age, sex, state of nutrition, treatment, and organ site of the cancer and the study revealed that decreased level of serum α1 -lipoproteins is not only reflects the neoplastic state in general, it perhaps may be especially useful in the early detection of cancers (Nydegger and Butler, 1972). In a recent study revealed, a dyslipidemia (elevation of total cholesterol , triglycerides and LDL, reduction in HDl levels) related with breast cancer (Qui, et al., 2010). Serum protein profiles have been investigated frequently to discover early biomarkers for cancer. It was validated that serum proteins used as an effective and good biomarkers for the detection of the early stages of ovarian cancer (Nosov, et al., 2009). The aim of the present study was to investigate the changes in serum total cholesterol, triglycerides, and total serum protein, lipoprotein and lipid peroxidation levels in patients with stomach, brain tumors, and urinary bladder cancers and leukemia. Methods and materials During this study, total serum cholesterol, triglycerides, total serum proteins and lipoproteins (HDL, LDL, and VLDL) and lipid peroxidation were studied in the sera of control groups (healthy persons) and of patients with stomach, brain, urinary bladder cancers and leukemia. Serum was obtained from (10) normal persons and (80) patient of , brain, stomach, leukemia and urinary bladder cancers. All cases were newly diagnosed at hospital Tumor and Nuclear Center Medicine Hospital in Mosul city, they ‫تةوةرى بايؤلؤجى‬ 7

Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

were of normal weight, non smokers , not receiving any treatments and aged from about (20-45) years old. Fasting blood were collected, serum was separated and kept at – 80O C until analyzed. The serum cholesterol level was estimated using standard kit (Syrbio, France), which depend on enzymatic conversion of cholesterol to quinoneimine pigment. The absorbance was measured at a wave length of 500 nm using UV/VIS spectrophotometer (Philips, Pye Unicam SP800). Serum triaceylglycerol level was estimated using standard kit (Syrbio, France). The absorbance was determined at wave length of 520 nm using UV/VIS spectrophotometer (Philips, Pye Unicam SP800). Serum total protein measured colorometerically using commercial kit supplied by BIOLABO, 02160, Maizy, France. LDL- cholesterol, HDL-cholesterol and VLDL- cholesterol were measured according to Sewerynek (2000). The concentration of MDA was measured using modified thiobarbituric acid TBA reaction method (Guid & Shah,1989). According to this method, MDA level was measured in the serum depending on the reaction of producing lipid peroxides specially MDA with TBA (Mizil et al.,2002),The absorbance determined at a wave length of 532 nm using UV/VIS spectrophotometer (Philips, Pye Unicam SP800). Data thus obtained was analyzed by using student F- test and T-test by statistical packages for social science software (SPSS). Statistical analysis where the value of P>0.05 considered as non significant (NS), P<0.05 as significant and p<0.01 as highly significant. Results The results shows an elevation in the serum total cholesterol in patients with brain cancer, lung cancer and leukemia was observed and this elevation was found to be highly significant in the case of lung cancer and leukemia when compared to healthy control groups (P<0.01) and significant in the case of brain and stomach cancer patients (P<0.05),table (1).

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

Table 1: Serum Cholesterol, Triglycerides , Proteins and MDA levels in some Tumor patients. Parameters (Mean ±SE) Groups

N

Cholesterol (mg/dl)

Triglycerides (mg/dl)

Total proteins (mg/dl)

MDA Micromole /L.

Control

10

188.0  9.44

99.0 ±4.47

6.06 ± 0.27

1.09 ± 0.46

Stomach tumor

20

224.6  5.64*

238.5 ± 18.02*

5.17 ± 0.19*

2.80 ± 0.16*

Brain tumor

20

231.9 17.2*

223.4±18.16*

5.06 ± 0.34*

3.21 ± 0.16*

20

273.3 12.95**

238.2±15.37*

5.32 ± 0.24*

4.50 ± 0.16*

20

249.0  14.51**

238.7±17.58*

5.17 ± 0.37*

3.83 ± 0.16*

Urinary bladder Leukemia

**P<0.01:Highly significant

*P<0.05:Significant

It was observed that there was a increase in sera triglycerides in patients with stomach cancer, brain cancers, lung and leukemia(P>0.05), when compared to serum triglycerides of healthy control persons, as in table (1). Table,1 shows the concentration of total sera protein concentration in health control persons and patients with stomach, brain, lung, cancer and leukemia. It was appeared that there is decreasing of total serum proteins in stomach, brain, lung and leukemia cancer patients (P>0.05) when compared to healthy control persons. The results showed significant ( P<0.05 )increases in MDA level in patients of all cancer groups as compared to normal individuals (Table 1). With respect to the total sera lipoprotein levels of patients with stomach, brain, lung cancers and leukemia, the results show significant decrease(P<0.05) in the levels of serums HDL in stomach , brain, lung cancer patients and also in leukemia patients , table (2). Table 2: Serum Lipid Profile (HDL, LDL, VLDL) levels in some Tumor patients. Parameters (Mean ±SE) Groups

N

HDL (mg/dl)

LDL (mg/dl)

VLDL (mg/dl)

Control

10

46.6±9.45

117.1± 10.97

17.32± 4.54

Stomach tumor

20

36.7±8.35*

135 ±18.66

25.33 ± 5.58*

Brain tumor

20

34.3±6.88*

169.7±18.44*

39.3± 9.72*

Urinary bladder

20

38.4± 6.26*

177.8±15.32*

37.1 ± 10.89*

Leukemia

20

37.2± 7.09*

139.2 ± 14.85*

36.5± 7.34*

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‫تةوةرى بايؤلؤجى‬

Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

It was noticed that stomach cancer patients show non significant increase in the levels of LDL as compared with healthy persons , while in the patients of the brain cancer, urinary bladder cancer and leukemia showed significant increased significant in the level of LDL (table 2). It was observed that VLDL concentration was significantly increased in stomach cancer patients, brain, lung cancer patients and also in leukemia patients (P>0.05)as in table (2). Discussion The changes in the lipid levels may have a diagnostic or prognostic role in the early diagnosis or prognostication of premalignant and malignant lesions. Malignant proliferations in most tissues have been reported to be associated with changes in plasma lipid (Dessi et al., 1994) and lipoprotein levels (Hasija and Bagga, 2005). The changes also impair the catabolism of very low density lipoproteins (VLDL), leading to an increase in high density lipoprotein-C cholesterol (HDL-C) and HDL-C shown to be higher in mammography dysphasia and family history of breast cancer (Dessi et al., 1994; Fiorenza et al., 2000). However studies reported either elevated or depressed level of HDL-C in women with breast cancer (Hasija and Bagga, 2005). Low HDL-C, level is a part of the metabolic syndrome associated with increased postmenopausal breast cancer risk. ( Anne, et al., 2003 ). The elevation seen in lipid peroxidation level in the all caners patients. Oxidative stress induces a cellular redox imbalance that has been found to be present in various cancer cells as compared with normal cells, the redox imbalance thus may be related to oncogenic stimulation (Valko et al.,2006). The disturbance of the pro-oxidant/antioxidant balance, resulting from increased free radical production, antioxidant enzyme inactivation, and excessive antioxidant consumption, is the causative factor in oxidative damage (Aymelek et al., 2006). There are potentially different types of DNA lesions resulting from ROS and reactive nitrogen species, which could be mutagenic and involved in the etiology of cancer (Beevi et al., 2007). Kakey and Owayes (2009), found an increase in lipid peroxidation level and a decrease in glutathione level in tumor cases in both sexes at age groups (25-45) and (46-70) year. MDA itself, owing to its high cytotoxicity and inhibitory action on protective enzymes, is suggested to act as a tumor promoter and a cocarcinogenic agent (Seven et al., 1999). On the other hand, it was reported that lipid hydroperoxides decompose to yield reactive aldhydes, such as MDA and 4-hydroxynoneal (Samir and el Koholy, 1999). MDA is a well characterized mutagen that reacts with deoxyguanosine to form endogenous ‫تةوةرى بايؤلؤجى‬

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

adduct found in the DNA of human liver (Dessi et al., 1994) and the findings of (Delimaris et al., 2007) exhibit a correlation between oxidized LDL and malignancy, supporting the contribution of oxidative stress to carcinogenesis and the possible involvement of oxidized LDL in the process of malignancy. In Indian patients with cancers of esophagus, colon, stomach, pancreas and gallbladder respectively, large number of evidences have been revealed and indicated that a possible central role of endogenous cholesterol is played in the pathobiology of cancer (Damianaki et al., 2000). For gastric cancer patients, preoperative low serum HDL-C concentration or high TC/HDL-C ratio might be a potential biomarker of advanced pathologically confirmed tumor stages (Guo et al., 2008). The current study results showed elevated level of total cholesterol, triglyceride, LDL and VLDL level, and lowering in the level of HDL nearly in all cancer patients groups of stomach cancer, brain cancer, urinary bladder cancer and leukemia, which is agree with the results observed in different organ cancer patients, reported by (Muralikrishnan and Shyamaladevi, 1996; , Hasinja and Bagga, 2005; Han , et al., 2005; Hasan and Al-Samaraae, 2009). Also Jack, et al, (2011), found lowering in the level of the HDL in gastric cancer patients, and previously increased level of LDL- cholesterol found to be a risk factor of colorectal cancer (Suzuki, et al., 2004). The sustained process of cellular growth represents an increase in cholesterol synthesis accompanied by an accumulation of cholesterol in growing tissues and a marked reduction of high density lipoprotein cholesterol (HDL) in the plasma compartment. Oxidative stress can make some types of lipids more destructive to tissues (Dessi et al., 1994). Al- Kakey and Owayes, 2009 in a study on some tumor cases showed that tumor cases caused increase in serum triglyceride, very low density lipoproteins levels but not low density lipoproteins and high density lipoproteins levels in both sexes at age group (25-45) &(46-70) years. The alterations in lipid profile levels showed a significant correlation with breast cancer risk, Plasma TC and HDL were significantly lower, and VLDL and TG were significantly higher in breast cancer patients as compared with controls. ( Shah, et al., 2008 ) Ovary cancer patient, showed that ovarian carcinoma is associated with a significant reduction of total cholesterol and its esters and HDL fraction when compared to healthy controls (Qadir and Malik, 2008). However another study showed that most patients with leukemia, brain and gastric cancer with the exception of breast cancer significantly had lower total

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

cholesterol, LDL-cholesterol, HDL-cholesterol concentration than age and sex matched non cancer subjects (Fiorenza et al., 2000). It was also revealed that the inverse association between cancer and serum cholesterol may reflect a physiological response to the early stages of cancer (Naik et al., 2006), Low serum cholesterol may also have been caused by undetected cancer (Eichholzer et al., 2000), in a study on patient with upper and lower digestive tract cancer, results showed Vitamin-A deficiency that resulted from low levels of serum LDL which inturn leads to cascade of events resulting in tumor genesis (Mittal and Mittal, 2004) however in another study it was indicated that the lipid and lipoprotein disorders reported in cancer patients are reversible by effective treatment of the tumor, suggesting that these disorders are a secondary phenomenon of malignancy (Alexopoulos et al., 1992). High density lipoprotein (HDL) stimulated the growth of many types of cells, including those of breast cancer, so high level of HDL are associated with an increse risk of breast cancer development and it was believed that HDL have apoptotic effects on various cell types that enable it to promote cell growth (Cao et al., 2004) and it was revealed that alterations in lipid profile levels showed a significant correlation with breast cancer risk, disease status and treatment outcome (Shah et al., 2008). Serum HDL levels were lower in the patients than in controls , Serum LDL and VLDL levels measured in the patient group were not significantly different from those of the control group ( Akcay et al., 2003) When the protein levels in our study measured in all types of stomach cancer, brain cancer, lung cancer and leukemia, results showed decrease levels of the total serum protein these patients. Since cancers are known to possess highly unique metabolic profiles, identification of specific biomarkers in serum using a metabolomic approach could be noninvasive and useful for early cancer detection and prognosis (Song et al., 2012). In a study shown a non- significant decrease in total proteins in bladder cases compared to normal persons (Metwally et al., 2011). Some studies suggested that abnormal protein synthesis occurs in cancer cells and the altered amino acid levels could be the phenotypic markers in serum (Sreekumar et al., 2009) because several essential and non-essential amino acids have been found to be related to abnormal protein synthesis in the process of carcinogenesis in colorectal cancer (Ong et al., 2010) and recently, it was reported that the prevalence of sarcosine increases with escalating severity of prostate cancer as it progresses towards metastatic disease and amino acid metabolism increases along nitrogen breakdown pathways (Song et al., 2012). In another study (Pisani and Andreoni, 1959) ‫تةوةرى بايؤلؤجى‬

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

showed that statistically significant changes were found in the albumin and globulins, the first decreased and the second increased during and at the end of the cancer treatment by cobalt teletherapy. The Proteomic analysis of serum protein profiles has allowed researchers to identify new serum markers of pancreatic cancer, but the identified proteins included common serum proteins and components of the acute phase response, which are not probably released from tumors serum MBL2 and MLCK2 measurement which might be helpful in discriminating pancreatic adenocarcinoma from chronic pancreatitis and healthy controls. The newly identified proteins accompanied with the other serum biomarkers (CEA and CA19-9) might be useful for the early diagnosis of the pancreatic cancer (Rong et al., 2010). Most cancer cells produce energy by glycolysis rather than oxidative phosphorylation via the tricarboxylic acid (TCA) cycle termed as Warburg effect (Hirayama et al., 2009). As reported, an increase in aminoacids like valine has been detected in cancer tissues of stomach due to increased glycolysis (Wu et al., 2010). Increased levels of serum valine may be related to valine catabolism in cancer cells (Song et al., 2012). References Akcay MN, Yilmaz I, Polat MF, Akcay G. (2003).Serum paraoxonase levels in pancreatic cancer. Hepatogastroenterology. 2003 Dec; 50 Suppl 2. Alexopoulos, C. G., Blatsios, B. and Avgerinos, A., (1987). Serum lipids and lipoprotein disorders in cancer patients. Cancer research. 60 (12), pp: 3065-3070., Alexopoulos, C. G., Pournaras, S., Vaslamatzis, M, Avgerinos, A. and Raptis, S., (1992). Changes in serum lipids and lipoproteins in cancer patients during chemotherapy. Cancer chemotherapy and pharmacology, 30 (5), PP: 412-416. AL-kakey, Ismail S.and Al-Hassan, Owayes M. (2009). Changes in Lipid Peroxidation and Glutathione Levels and some Biochemical Parameters in Tumor Patients and Effect of the Sex , Age and Smoking. The 2nd Kurdistan conference on biological science, J.Dohuk Uinv.12(1):296-300. Anne-Sofie Furberg, Marit Bragelien Veierød, Tom Wilsgaard,Leslie Bernstein and Inger Thune(2003). Serum High-Density Lipoprotein Cholesterol, Metabolic Profile, and Breast Cancer Risk.. Natl Cancer Inst J. Volume 96 Issue 15: Pp. 1152-1160. Aymelek, G., Erten, D. and Aslan, S. (2006). Lipid peroxidation and antioxidant status in blood and tissue of malignant breast tumor and benign breast disease. Beevi SS, Rasheed MH, geetha A: Evidence of oxidative and nitrosative stress in patients with cervical squamous cell carcinoma. Clin Chim Acta 2007, 375:119-132. Boyd, N. F., Connelly, P., Lynch, H., Knaus, M., Michal, S., Fili, M., Martin, L.J., Lockwood, G. and Tritchler, D., (1995). Plasma lipids, lipoproteins, and familial breast cancer. Cancer Epidemiology Biomarkers &Prevention. 14 (2), pp: 117-122. Cao, W. M., Murao, K., Imachi, H., Yu, X., Abe, H., Yamauchi, A., Niimi, M., Miyauchi, A., Wong, N. C. and Ishida, T., (2004). A mutant high-density lipoprotein receptor inhibits proliferation of human breast cancer cells. Cancer research. 64, pp: 1515-1521.

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

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Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site

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‫‪Lipid Profile and oxidative stress in some Tumors in Relation to its Organ Site‬‬

‫‪Wu, H., Xue, R., Tang, Z., Deng, C., Liu, T. and Zeng, H., (2010). Metabolomic investigation of‬‬ ‫‪gastric cancer tissue using gas chromatography/mass spectrometry. Anal Bioanal Chem, 396,‬‬ ‫‪PP: 1385-1395.‬‬

‫اخلالصة‬ ‫مشلح الدزاسة (‪ )01‬مناذج مً دو اشخاص اصخاء سسيسيا ومناذج منً دو ‪ 01‬مصنااا اناروزاو الطنسياى ة يف املعند او‬ ‫الدماغ اواملذاىة البول ة اولوك ن ا مً الريً مت ثشخ ص حارثهه سسيسيا وكرلك االفخص اليط جي‪.‬‬ ‫صننح الدزاسة لبخر ثأدري موقع ارصااة يف مطجوياخ الكول طجريول و الربوث ياخ الدهي ة عال نة الكذاةنة والواي نة‬ ‫الكذاةة والواي ة الكذاةة جدا يف مصل الدو و كرالك يف مطجوى الربوثني املصلي اىل جاىة دزاسة ثأدري موقع ارصااة يف حالة‬ ‫الكست الجأكطدي مواشىة مبطجوياثها يف مصل دو ارصخاء‪.‬‬ ‫اظهسخ املقازىة يف الجغرياخ احلاصلة اطبة ارصااة يف مطجوياخ الكل طسيداخ الذثاد ة والربوث ياخ الدهي ة ازثفاعا يف‬ ‫مطجوياخ الكل طسيداخ الذثاد ة والربوثني الدهين الوايى الكذاةة والربوثني الدهين الوايى الكذاةنة جندا يف مصنل املصنااني‬ ‫ااروزاو الطسياى ة يف حني قد ادخ ارصااة اىل خفض معيوي يف مطجوى الربوثني الدهين العالي الكذاةة‪ .‬اسجهدةح الدزاسنة‬ ‫احلال ة الجوصل اىل اجياد مؤشساخ موحد يف ثشخ ص ارصااة ااروزاو الطسياى ة يف خمجلف ارعضاء اجلطن ة‪.‬‬ ‫ثوختة‬ ‫لة ليَكؤلينةوةيةكذا بة ثشت بةشنت بة ثشكنني لةة اقييةةةكق ن ةشؤاةةق ةكق و شة يَ لةة ‪ )01‬كةشةن اقشةقي‬ ‫َذا و ايَرثةجنةى ش يَ ) بةة لةة‬ ‫كؤ رتِؤلَ) و ‪ ) 01‬ةشؤان ا واب و ب بة ةشؤايةكق ن ايَرثةجنةى طةدةو ميَشكو ميسةل‬ ‫قخن ا د وة طريا بؤ ثشكنني و بة او دكرد ن ِيَذةى طشتن كؤليصرتؤلو ِيَذةى طشةتن )‪HDL, LDL‬و‪(VLDL and‬‬ ‫و ِيَذةى طشتن ثرؤاني لة ش يَنذا جةة لة جيقوازى اؤكصق ذ ن ضةو يةكق ن ش يَنيق ‪.‬‬ ‫َن شة يَ و يَةذةى طشةتن‬ ‫َينةوةكة بة زب و ةوةيةكن بة ضقوى دة شصت لة يَذةى طشتن كؤليصرتؤل‬ ‫اةجنقمةكق ن ليَكؤل‬ ‫َذا و ايَرثةجنةى شة يَ ) بةة‬ ‫ثرؤاني و ضةو ية اؤكصق ذ اوةكق ن ش يَ لة طشت جؤ ةكق ن ايَرثةجنةى طةدةو ميَشكو ميسةل‬ ‫َذا‪.‬‬ ‫بة او د لةطةلَ كؤ رتؤل‬ ‫َصة ةق ذ ن هةم و اةو طؤ ا كق يق ةى كة لة طشت جؤ ةكق ن ضةو ى ش يَنن هة ذيَك ةشؤاةةكق ن ا واةب و بةة‬ ‫هةل‬ ‫ايَرثةجنة بة بة او دكرد لةطةلَ كةشق ن شقخ كؤ رتؤلَ) دة ى دةشقت كة بة زب و ةوةيةكن بة ضقو هةية لةة ضةةو ى جةؤ ى‬ ‫َم اقشتن ضةو ى جؤ ى ‪ )HDL‬لةة هقمةق‬ ‫‪ )Total cholesterol, LDL, VLDL‬ى شريؤمن ةشؤاةكق وبةال‬ ‫َن طر ةن بقيؤمق كةة ةكق بةؤ ثيَشةبينن كرد ةن‬ ‫ةشؤاذا سمة‪ .‬مةبةشت لة ليَكؤلينةوةية دلنيقب و ة لة بةكق هيَنق و ؤل‬ ‫ب و ن ةشؤان ايَرثةجنة لة اة ذامة جيقوازةكق ن جةشتةى مرؤظذا‪.‬‬

‫‪16‬‬

‫تةوةرى بايؤلؤجى‬

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