Dyslipidemia nyob rau hauv cov ntshav qab zib yog qhov mob thaum tus neeg mob cov ntshav muaj cov ntsiab lus siab ntawm lipoproteins thiab lipids.
Ib qho dhau heev ntawm cov tshuaj no yog qhov txaus ntshai nyob rau hauv tias nws nce qhov ntau ntxiv ntawm kev ua haujlwm tsis zoo hauv kev ua haujlwm ntawm cov hlab plawv, feem ntau ua rau cov tsos ntawm atherosclerosis. Muaj qhov siab ntawm cov roj (cholesterol) ua rau pom qhov tseeb ntawm tus mob ua ke.
Hyperlipidemia feem ntau cuam tshuam nrog ntshav qab zib. Cov duab hauv chav kuaj mob zoo ib yam li cov cim ntawm tus mob pathologies thiab atherosclerosis. Koj tuaj yeem pom nws tom qab kuaj sim.
Dyslipidemia: nws yog dab tsi, kev loj hlob yam rau ntshav qab zib
Lipoproteins yog macromolecular, spherical complex uas yog nqa khoom ntawm cov protein ntau thiab lipids hauv ntshav ntshav. Hydrophobic triglycerides ua ke nrog cov roj cholesterol ester lwg me me ua cov tub ntxhais ntawm lipoproteins, uas nyob ib puag ncig los ntawm amphipathic proteins thiab phospholipids.
Lub hauv paus tseem ceeb ntawm lipoproteins nqa 100-5000 cholesterol esters thiab triglyceride lwg me me. Cov kua protein saum npoo ntawm lipoproteins yog alo-lipoproteins. Lawv tsis tsuas yog tso cov lipids los ntawm lub nucleus, tab sis kuj koom nrog kev thauj ntawm lipoproteins thiab kev cai ntawm ntshav lipid ntau.
Apolipoprotein B100 yog xav tau cov khoom lag luam ntawm hepatic lipoproteins ntawm qhov sib txawv (qis, nruab nrab, tuab). Apo B 48 yog lub luag haujlwm rau kev nkag chylomicrons los ntawm txoj hnyuv. Thiab ApoA-1 yog tus thawj coj cov khoom muaj protein ntau ntawm HDL.
Dyslipidemia nyob hauv ntshav qab zib hom 2 yog tshwm sim los ntawm ntau yam:
- Kev tsis pom zoo metabolism hauv.
- Rog.
- Cov kev phiv tshuaj tom qab noj ntau ntawm qee cov tshuaj (beta-blockers, diuretics, androgens, corticosteroids systemic, progestins, immunosuppressants, AIPs).
- Kab mob hyperlipidemia.
- Cov kab mob sib xyaw (feem ntau muaj ntshav qab zib - qhov no yog hypothyroidism).
Vim li cas ntshav qab zib cuam tshuam lipoprotein thiab chylomicron metabolism? Tom qab noj mov, triglycerides (kev noj haus cov rog) nrog rau cov roj (cholesterol) yog nqus tau los ntawm lub plab hnyuv me thiab tau nkag mus rau hauv nucleus ntawm txoj kev ua chylomicrons nkag mus rau hauv lymphatic system, thiab tom qab lawv suav nrog hauv kev ncig los ntawm superior vena cava.
Hauv lub txaj capillary, chylomicron thiab adipose cov leeg nqaij khi lipoprotein lipase enzymes. Raws li qhov tshwm sim, cov roj khov ua kom dawb tso tawm.
FFAs raug ntes los ntawm adipocytes, qhov chaw uas lawv rov tshwm sim ntxiv rau hauv cov khoom muaj pes tsawg leeg triglycerides. Yog tias cov nqaij ntshiv tau los ntawm FFA, tom qab ntawd nws siv lawv los ua lub zog, txuas mus rau cov metabolism hauv plab.
Cov khoob (chylomicron cov seem) yog ib qho khoom lag luam ntawm cov txheej txheem lipolytic uas tau poob txog li 75% ntawm triglycerides, uas tau nrawm rau hauv lub siab.
PL - hepatic lipase (triglyceride), hydrolyzing triglycerides ntawm chylomicron cov seem, tseem koom nrog kev tshem tawm cov seem. Ntawm hom 2 mob ntshav qab zib mellitus, ib qho kev ua tsis zoo ntawm cov metabolism hauv ntawm holomicron cov seem thiab chylomicrons feem ntau tshwm sim. Ntxiv mus, nrog rau daim ntawv no ua rau muaj mob hyperglycemia, LPL yam kev ua haujlwm raug txo.
Txawm li cas los xij, insulin tsis kam ua rau muaj kev tsim cov chylomicrons hauv txoj hnyuv. Nyob rau hauv cov ntaub ntawv ntawm cov ntshav qab zib hom 1, kev cuam tshuam nyob rau hauv lipid metabolism tshwm sim tsuas yog nrog decompensation ntawm tus kab mob. Qhov no yog ua kom pom los ntawm qhov kev txo qis hauv Ll kev ua si, uas nrog los ntawm qhov muaj zog ntawm cov triglycerides ntau ntxiv tom qab noj mov.
Hyperlipidemia kuj tseem tuaj yeem tshwm sim los ntawm kev txiav txim siab txog lub caj ces. VLDLP yog tsim tawm los ntawm lub siab, cov roj cholesterol thiab triglycerides esters yog nyob rau hauv cov tub ntxhais, thiab phospholipids thiab Apo 100 lwg me me nyob rau saum npoo.
Kev tsim cov VLDL hauv lub siab yog tsa los ntawm kev noj ntau ntawm FFA ntawm lawv cov ntaub so ntswg adipose. Tab sis txhim kho ua ke nyob rau hauv lub siab cov roj (cholesterol) thiab FFA hauv cov ntshav qab zib tsis yog-insulin kuj muaj peev xwm, uas yog vim li cas VLDL ntau ntxiv kuj nce.
Triglycerides hauv VLDL hauv ntshav yog hydrolyzed hauv LPL, tig mus rau hauv me me thiab ntom LSPP thiab VLDL. Nws yog qhov tsim nyog tias LPPs zoo ib yam li cov chylomicron cov seem, tab sis lawv txawv hauv qhov ntawd ntxiv rau kev siv hauv lub siab, lawv cov catabolized hauv cov ntshav rau LDL. Yog li, cov haujlwm ntawm LPL muab cov kev ua haujlwm metabolic ib txwm pib los ntawm VLDL, kis STD, thiab xaus nrog LDL.
ApoVUO tsuas yog muaj protein tsuas nyob rau thaj tsam ntawm LDL uas yog cov roj ntsha rau LDL receptors. Yog li ntawd, cov LDL cov ntsiab lus hauv cov ntshav nyob ntawm ob yam:
- muaj txaus ntawm LDL receptors;
- LDL cov khoom.
Ntawm hom 2 mob ntshav qab zib, VLDL triglycerides feem ntau ua kom xeb. Qhov kev nce ntxiv ntawm cov cholesterol los ntawm LDL hauv cov kab mob hyperglycemia yog piav qhia los ntawm nws cov ntsiab lus muaj zog hauv txhua tus lipoprotein hais.
Peroxidation lossis glycation ntawm LDL ua rau kev ua haujlwm tsis zoo ntawm kev tshem tawm ib txwm muaj lipoprotein hais, ua rau qhov tseeb tias lawv pib sau rau ntawm cov hlab ntsa. Ntxiv rau, insulin txhawb cov kev qhia ntawm LDL receptor gene, thiab, raws li, insulin tsis kam lossis tshuaj hormone tseem tuaj yeem cuam tshuam LDL metabolism.
HDL yog cov qauv txheej txheem nruj. Qhov pib sib xyaw hu ua prebeta-HDL. Cov no yog cov lees txais cov roj cholesterol dawb, yog li HDL yog thawj kauj ruam hauv kev thauj cov roj (cholesterol) mus rau daim siab thiab ntu nqaij, qhov uas lawv tawm hauv lub cev.
Cov roj (cholesterol) esters kuj tseem tuaj yeem yog ib feem ntawm VLDL cov lus hais thiab chylomicrons thaum muaj cholesterolyl ester thauj protein. Ntawm hom 2 mob ntshav qab zib mellitus, HDL-C tus lej feem ntau raug txo vim muaj kev thauj ntau ntawm cov cholesterol ester los ntawm HDL rau HDL.
Txawm li cas los xij, nrog hom mob ntshav qab zib hom 1, HDL-C tseem nyob los sis qis dua me ntsis.
Cov ntsiab cai dav dav ntawm kev kho mob
Kev kho mob ntshav qab zib dyslipidemia raws li peb txoj hauv kev ua ntej. Nov yog kev tswj cov ntshav qab zib, poob phaus thiab zaub mov noj.
Hauv hom mob ntshav qab zib hom thib ob, kev nqus ntawm carbohydrates yooj yim, cov roj cholesterol thiab roj ntau txaus yuav tsum muaj tsawg. Hauv cov zaub mov txhua hnub, nws yog ntshaw kom suav nrog cov khoom uas muaj monounsaturated fatty acids thiab kev noj haus fiber ntau, thiaj li txhim kho lipid profile.
Yog tias tus mob ntshav qab zib ua kom hnyav nrog lub cev nyhav dhau lawm, tom qab ntawv cov tshuaj triglycerides hauv nws cov ntshav yuav nqis los ntawm 18%, thiab cov roj (cholesterol-cholesterol) ua kom tsawg dua yuav txo tau li 8%.
Nws yog tsim nyog sau cia tias nrog cov ntshav qab zib tsis muaj tshuaj tiv thaiv kab mob ntshav qab zib, noj cov tshuaj qab zib, nrog rau cov insulin ntxiv, tsuas yog kho qee theem ntawm cov metabolism hauv cov rog.
Yog li, Metformin tsuas tuaj yeem txo cov plasma triglycerides txog 10%, Pioglitazone - txog 20%, thiab Rosiglitazone tsis muaj cov teebmeem ntawm cov metabolism hauv lipid. Hais txog LDL-C, kev txo cov tshuaj muaj piam thaj cuam tshuam rau cov txheej txheem no raws li hauv qab no:
- Metformin txo los ntawm 5-10%;
- Pioglitazone nce ntxiv 5-15%;
- Rosiglitazone nce ntxiv los ntawm 15% lossis ntau dua.
Kev kho tshuaj Insulin pab ua rau txo qis hauv LDL-C. Thiab sulfonamides tsis muaj kev cuam tshuam tseem ceeb ntawm cov metabolism hauv lipid.
Ntawm ntshav qab zib hom 1, kev kho mob insulin ntau tuaj yeem txo ntshav LDL-C thiab triglycerides. Txawm li cas los xij, cov theem ntawm cov nyiaj them rau lipid metabolism tsis cuam tshuam rau HDL-C hauv hom mob ntshav qab zib thib ob.
Sulfanilamides uas txo cov piam thaj hauv ntshav tsis cuam tshuam rau qhov kev txiav txim siab ntawm HDL-C. Txawm li cas los xij, Metformin, vim qhov txo qis hauv triglycerides, nce HDL-C, tab sis tsis yog los ntawm ntau.
Pioglitazone thiab Rosiglitazone nce HDL-C hauv cov neeg mob ntshav qab zib hom 2. Yog li, txhawm rau ua rau cov rog rog metabolism hauv cov neeg mob ntshav qab zib tsis yog insulin, kev kho lipid-txo qis yog qhov tsim nyog. Thiab nyob rau hauv rooj plaub ntawm thawj hom mob ntshav qab zib, nws yog ib qhov tsim nyog los ua kom tiav nyiaj them rau cov khoom noj khoom haus metabolism.
Kev mob ntshav qab zib hauv ntshav qab zib yog kho nrog statins thiab lwm yam tshuaj, uas suav nrog Niacin, SCF, Fenofibrate, Ezetimibe. Cov tshuaj no txo cov roj cholesterol LDL.
Txhawm rau nce HDL-C, fibrates thiab nicotinic acid siv, uas tso cai rau kom txo tus nqi ntawm triglycerides. Gemfibrozil, Fenofibrate, thiab kuj Niacin yuav tsum tau faib los ntawm pab pawg thib ob. Yog tias theem ntawm LDL-C siab dhau lawm, ces cov koob tshuaj statins ntau yog tau muab tshuaj rau cov ntshav qab zib.
Kev sib xyaw ua ke hyperlipidemia yog tshem tawm hauv peb txoj kev:
- kom ntau zog ntawm statins;
- kev sib txuas ntawm satin nrog fibrates;
- kev sib txuas ntawm satins nrog niacin.
Cov laj thawj uas kev kho mob lipid-txo qis yuav tsum tau ua nrog ntau yam. Ua ntej, txoj hauv kev no tau txo qis LDL-C thiab LDL-C.
Thib ob, kev sib txuas ua ke txo txoj kev pheej hmoo ntawm cov kev tshwm sim tsis zoo thiab txo cov roj cholesterol-LDL cuam tshuam nrog kev noj cov tshuaj fibrates.
Qhov thib peb, txoj hauv kev no tso cai rau kev siv SCLC hauv cov neeg mob hypertriglyceridemia thiab kev ntsuas qhov ntau ntawm LDL-C.
Pawg ntawm cov tshuaj siv rau dyslipidemia
Muaj 3 pawg ntawm cov tshuaj uas cuam tshuam rau ntshav lipoproteins plasma. Cov no yog HMG-COA reductase inhibitors, cov kab mob sib npaug ntawm cov kua tsib kua qaub, fibrates.
Statins feem ntau siv los txo qis qhov kev sib xyaw ntawm LDL-C, yog li lawv tau muab tshuaj rau hyperlipidemia. Pravastatin, Simvastatin, Lovastatin yog cov tshuaj tiv thaiv fungi lossis cov kev coj ua ntawm metabolites. Thiab Rosuvastatin, Atorvastatin, Fluvastatin yog cov tshuaj siv hluavtaws.
Simvastatin thiab Lovastatin raug suav hais tias yog "cov neeg ua haujlwm pabcuam", vim tias lawv muaj cov nyhuv khomob tsuas yog tom qab hloov kho hydrolysis nyob hauv lub siab. Thiab lwm yam statins yog raug tawm hauv daim ntawv nquag.
Lub hauv paus ntsiab lus ntawm kev ua haujlwm ntawm HMG-COA reductase Cov Tshuaj Tiv Thaiv yog tias lawv txwv ib qho tseem ceeb roj synthesis enzyme. Ntxiv rau, cov neeg sawv cev no txo qis tsim Apo B100, uas ua kom LDL receptors thiab teeb tsa lipoproteins. Qhov no ua rau qhov tseeb tias qhov concentration ntawm triglycerides ntawm VLDL, LDL cov cholesterol, poob qis hauv cov ntshav.
Pharmacokinetics ntawm statins:
- kev nqus ntawm 30 txog 90%;
- metabolized los ntawm daim siab los ntawm 50 rau 79%;
- ntau dua tawm los ntawm ob lub raum.
Nrog kev sib cuam tshuam ntawm statins nrog FFA, lawv qhov nqus poob qis. Tsis tas li, cov txiaj ntsig zoo sib xws tau sau tseg nrog kev sib txuam ntawm cov tshuaj uas potentiate myopathic nyhuv ntawm Lovastatin.
Tsis tas li ntawd, qhov ntsuas ntawm Lovastatin, atorvastatin thiab Simvastatin yuav nce ntxiv tom qab haus cov kua txiv kab ntxwv qaub. Nrog kev qhia ntawm Warfarin thiab Rosuvastatin, kev nce prothrombin tshwm sim.
Hauv ib koob tshuaj txhua hnub ntawm 10-40 mg, HMG-COA reductase inhibitors txo qis LDL cov roj cholesterol mus rau 50% thiab nce HDL-C los ntawm 5-10%.
Statins tau qhia rau cov neeg mob ntshav qab zib muaj qhov nce siab TG thiab nrog LDL cov roj (cholesterol) siab. Lawv kuj tiv thaiv qhov tsim ntawm gallstones, uas yog qhov tshwj xeeb tshaj yog rau cov ntshav qab zib mob neuropathy.
Myositis yog ib qho kev phiv tshuaj uas tshwm sim tom qab siv tshuaj statins, tab sis nws tsis tshua muaj tshwm sim. Cov kev tsis zoo xws li:
- cem quav
- arthralgia;
- mob plab
- dyspepsia thiab ntshav qab zib mob plab zom mov;
- mob ib ce.
Bile acid sequestrants yog cov resins uas khi cov kua tsib kua qaub hauv cov hnyuv. Cov tshuaj no qis LDL-C rau 30% los ntawm kev hloov cov ntsiab lus HDL. Muaj peev xwm, SCFAs tuaj yeem nce triglycerides.
Hauv kev kho mob ntawm dyslipidemia nrog ntshav qab zib mellitus, cov txiaj ntsig ntawm bile acid sequestrants zoo ib yam li kev ua ntawm statins, tab sis tsuas yog nrog kev siv ua ke ntawm cov tshuaj no. SCFA tau nqus rau hauv qhov ntau me me nkag mus rau txoj hnyuv. Cov txiaj ntsig kho tau txiav txim siab los ntawm theem ntawm kev txo qis cov roj cholesterol, uas ua tau nws tus kheej hauv 2-3 lub lis piam.
SCFAs cuam tshuam qhov kev nqus ntawm ntau yam tshuaj, suav nrog qhov ncauj tiv thaiv lub cev, tshuaj tiv thaiv kab mob thiab anticonvulsants. Yog li, lwm pob nyiaj yuav tsum tau nqa tom qab 4 teev dhau mus tom qab xeem SCFA
Bile acid sequestrants raug siv los tshem tawm hypercholesterolemia. Tab sis txij li hom tshuaj no tuaj yeem ua rau mob siab ntxiv rau triglyceride concentration, nws yog qhov tseem ceeb uas tswj cov ntsuas no thaum kho. Yog li, SCFA yuav tsum tsis txhob coj cov neeg mob hyper-triglyceridemia.
Feem ntau, tom qab noj SCFA, cem quav thiab dyspeptic cuam tshuam tshwm sim. Koj tsis tuaj yeem sib xyaw lawv cov kev noj nrog sulfonamides thiab lwm yam tshuaj, soj ntsuam ib so rau-teev. SKHK yog contraindicated nyob rau hauv muaj cov pob zeb nyob rau hauv lub zais zis, lub plab zom mov thiab txoj kev ua kom tiav biliary thiab muaj kev nce siab ntawm triglycerides.
Fibric acid derivatives xws li Hem fibrosyl thiab Fenofibrate yog PPAR alpha agonists. Cov tshuaj zoo ib yam li cov ntshav qab zib muaj qhov ntxim rau lipid metabolism, txo qhov ntxim nyiam ntawm kev mob plawv. Yog li, fibrates qis roj-LDL nce mus rau 20%, triglycerides - txog 50%, thiab theem ntawm cov roj-HDL nce li 10-20%.
Nws yog qhov tsim nyog tias fenofibrate yog qhov kev xaiv zoo hauv kev kho mob ntawm qhov muaj zog ntau ntawm LDL-C hauv cov neeg mob ntshav qab zib noj statins uas tsis muaj qhov xav tau.
Fibrates cuam tshuam rau lipid metabolism hauv cov ntshav qab zib, nce cov synthesis:
- lipoprotein lipase;
- ABC-A1;
- Apo A-P thiab apo A-1 (cov protein loj HDL).
Fibrates kuj tseem txo cov kev qhia txog cov teeb meem roj ntshav siab tseem ceeb txo cov protein thiab txo apo C-III. Tsis tas li ntawd, cov tshuaj nce apo A-V, kev tsim cov khoom uas txo qis lub siab ntawm lipoproteins, nrog tus nqi ntawm TG ntau dua.
Tsis tas li ntawd, fibrate esters inhibit lipogenesis nyob rau hauv daim siab. Lawv cuam tshuam nrog hepatic X receptor, inhibiting PCR-mediated lipogenesis. Derivatives ntawm fibric acid kuj muaj cov nyhuv antiatherogenic.
Txawm li cas los xij, cov neeg sawv cev coj ua rau dyslipidemia yog cov statins, thiab cov fibrates raug kho rau cov tshuaj ntshav qab zib insulin, tsuas yog rau cov neeg mob uas tsis tuaj yeem zam cov tshuaj no. Rau kev kho ua ke ntawm fibrates, kev siv ntawm fenofibrate yog pom zoo.
Nws yog tsim nyog sau cia tias cov tshuaj no tuaj yeem raug kho kom txo LDL nrog qhov tsis txaus ntawm TG. Tab sis qhov no, cov tshuaj los ntawm lwm pab pawg feem ntau siv, xws li SCFA, nicotinic acid thiab statins.
Qhov nruab nrab ntawm kev kho mob fiber ntau yog 3-6 lub hlis. Txij li cov tshuaj no ua rau muaj kev pheej hmoo siab ntawm cholelithis, lawv yuav tsum tsis txhob siv los ntawm cov ntshav qab zib nrog lub hlwb tsis nco qab neonpathy.
Cov neeg mob ntshav qab zib nrog nephropathy thiab cov neeg laus laus yuav tsum siv cov fibrates zoo heev, vim tias lawv tau muab ntau lub raum tshem tawm. Thaum cev xeeb tub thiab thaum cev xeeb tub, kev kho mob nrog cov neeg sawv cev no yog txwv tsis pub.
Feem ntau cov kev phiv tshuaj los noj cov tshuaj fibrates yog:
- ua tsis taus pa;
- xeev siab
- erectile kawg;
- mob plab
- daim tawv nqaij ua pob;
- ntuav
- zawv plab
- Kiv taub hau
- cem quav thiab os.
Ntxiv rau cov statins, SCFAs thiab fibrates, rau hyperlipidemia uas tsim muaj cov neeg mob ntshav qab zib tom qab 50 xyoo, nicotinic acid tuaj yeem raug kho. Qhov no tsuas yog cov lipid txo qis tus neeg sawv cev uas txo qis kev mloog zoo ntawm lipoprotein, tab sis nws muaj ntau cov kev phiv.
Tsis tas li, tus kws kho mob tuaj yeem sau tshuaj omega-3 fatty acids uas yog txo qis hypertriglyceridemia. Ntxiv mus, OZHK txo cov kev pheej hmoo ntawm teeb meem plawv thiab muaj cov nyhuv antiatyrogenic. Daim vis dis aus hauv tsab xov xwm no yuav qhia koj kom paub kho cov lipid metabolism li cas.
