ʻO ka Dyslipidemia ma ke kōpeka ke ʻano kahi i ka wā o ke koko o ka mea maʻi e loaʻa kahi kiʻekiʻe o ka lipoproteins a me nā lipids.
Hoʻopilikia ka oi loa o kēia mau mea i loko o ka hoʻonui ʻana i ka hiki ke loaʻa nā ʻano hana ʻole i loko o ka hana o ka ʻōnaehana cardiovascular, e alakaʻi pinepine ana i ke ʻano o ka atherosclerosis. Hāʻawi ka paʻapū kiʻekiʻe o ka cholesterol i ka hiʻohiʻona o ka pancreatitis maʻa.
Pā pinepine ka Hyperlipidemia me ka maʻi diabetes. ʻO ke kiʻi o ka lāʻau lapaʻau o kēia kūlana e like nō me nā hōʻailona o nā ala holoholo a me nā atherosclerosis. Hiki iā ʻoe ke 'ike ma hope o kahi hoʻokolohua loea.
ʻO Dyslipidemia: he aha ia, nā kumu hoʻomohala no ka maʻi maʻi
ʻO nā lipoproteins he macromolecular, spherical complexes kahi e lawe ai i nā ʻano o nā protein a me nā lipids i ka plasma koko. ʻO ka triglycerides Hydrophobic me nā molekole ester e hoʻopololi ai i ka kiko o nā lipoproteins, kahi e hoʻopuni ʻia e nā protein amphipathic a me nā phospholipids.
ʻO ka mea nui o nā lipoproteins e lawe i ka 100-5000 kolamu esters a me nā molekika triglyceride. ʻO nā pale kūleʻa o nā lipoproteins he alo-lipoproteins. ʻAʻole lākou wale ka hoʻokuʻu i nā lipids mai ka nucleus, akā komo pū i ka lawe ʻana i nā lipoproteins a me ka hoʻoponopono ʻana i ka lawelawe ʻana o nā lipid plasma.
Pono ʻo Apolipoprotein B100 no ka hana ʻana i nā lipoproteins hepatic o nā meaʻokoʻa ʻē aʻe (haʻahaʻa, waena, waena, palapū). Na Apo B 48 ke kuleana no ke komo ʻana i nā chylomicrons mai ka ʻōpū. A ʻo ApoA-1 ke alakaʻi koʻikoʻi o ka protein HDL.
ʻO ka Dyslipidemia ma ke ʻano maʻi diabetes 2 no nā kumu he nui:
- ʻO ka hana kāpili i helu ʻia.
- ʻOiaʻiʻo.
- ʻO kahi hopena maikaʻi aʻe ma hope o ka lawe ʻana i ka nui o nā lāʻau lapaʻau (beta-blockers, diuretics, androgens, corticosteroids systemic, progestins, immunosuppressants, AIPs).
- Heneritary hyperlipidemia.
- Nā maʻi hoʻohālikelike (ʻoi aku ka maʻamau me ka maʻi maʻi - ʻo ka hypothyroidism kēia).
No ke aha i hoʻopilikia ai ka maʻi diabetes i ka lipoprotein a me ka metabolith chylomicron? Ma hope o ka ʻai ʻana, ua hoʻoneʻe ʻia ka triglycerides (nā kāʻai meaʻai) a me ka cholesterol i ka ʻōpū liʻiliʻi a hoʻokomo ʻia ʻia i loko o ke kinona o ka hua chylomicrons e komo ana i ka lymphatic system, a ma hope o ko lākou komo ʻana i ka mika ma o ke kūlana vena cava.
I ka moena capillary, nā chylomicron a me nā uaua adipose kikoo i hoʻopaʻa ai i nā lipoprotein lipase. Ke hopena, ua hoʻokuʻuʻia nā waikawa momona free.
Hopu ʻia nā FFA e nā adipocytes, kahi i ʻike hou ʻia i ka mana o triglycerides. Inā hopu ʻia ka mākala e FFA, a laila hoʻohana ia iā lākou ma ke ʻano he kumu ikehu, e hoʻopili ana i ka metabolac intracellular.
ʻO nā alaala (chylomicron remnants) kahi huahana o ka kaʻina lipolytic i nalowale e pili ana i ka 75% o nā triglycerides, ka wikiwiki kaili i ka ate.
ʻO ka PL - hepatic lipase (triglyceride), hydrolyzing triglycerides o nā koena chylomicron, ke komo mau nei i ka wehe ʻana o nā koena. Ma ke ʻano 2 diabetes mellitus, kahi hewa ʻole i ka metabolism o nā koena holomicron a me nā chylomicrons e hele pinepine. Eia kekahi, me kēia ʻano o ka hyperglycemia maʻi, hoʻemi ʻia ka hana LPL.
Eia naʻe, hoʻonāukiuki ka pale ʻana i ka hoʻokumu ʻana o nā chylomicrons i loko o ka pūpū. I ka hihia o ke ʻano maʻi maʻi type 1, ʻo nā hoʻonāukiuki i loko o nā hana lipid ka mea e loaʻa wale i ka decompensation o ka maʻi. Hōʻike ʻia kēia e ka emi nui o ka hana o Ll, i ukali ʻia e ka ulu ikaika o ka nui o ka triglycerides ma hope o ka ʻai ʻana.
Hiki ke hele ʻia ʻo Hyperlipidemia ma muli o nā hemahema i ʻike ʻia. ʻO ka VLDLP e hoʻohālikelike ʻia i ka ate, kolesterol a me nā esterly triglycerides i ka waiwai, a me ka pūpū phospholipids a me Apo 100 mau mea ma ka ʻaoʻao.
Hoʻololi ʻia ka hana ʻana o VLDL i ka ate e ka hoʻokomo nui o FFA o kā lākou mau kelepa adipose. Akā ʻo ka hoʻonui ʻana i ka synthesis ma loko o ke kolamu o ka kolamu a me FFA i ka maʻi non-insulin-dependence kekahi mea hoʻi, ʻo ia ke kumu e hoʻonui ai ka hoʻonui ʻana o VLDL.
ʻO Triglycerides ma VLDL i ka plasma ka hydrolyzed i LPL, e hoʻohuli ana i LSPP liʻiliʻi a koʻikoʻi a me VLDL. ʻAʻole ia he mea like me ko LPP like me nā koena chylomicron, akā like lākou i kēlā me kēia, he mea i ka hoʻohana ʻana i loko o ka ate, ua catabolized lākou i ke koko me LDL. No laila, ʻo ka hana o LPL e hoʻolako i kahi hana metabola maʻamau e hoʻomaka ana mai VLDL, e hele ana i ka STD, a hoʻopau me LDL.
ʻO ApoVUO wale nō ka protein e kū ana ma ka wai o LDL i kahi ligand no nā LDL receptors. No laila, pili ka ʻōpili LDL i ke koko i nā mea ʻelua:
- ka loaʻa ʻana o ka mea LDL;
- Nā huahana LDL.
Ma ke ʻano maʻi type 2, ʻike pinepine ka Vlyl triglycerides. ʻO ka hoʻonui iki o ka kolamu ma o LDL i ka hyperglycemia maʻi i wehewehe ʻia e kona hoʻonui ʻia i loko o kēlā me kēia pālani lipoprotein.
ʻO ka peroxidation a glycation o LDL e alakaʻi i kahi hala ole o ka hoʻopau ʻana o nā maʻamau lipoprotein, ke alakaʻi nei i ka mea hoʻomaka lākou e hōʻiliʻili ma nā paia vascular. Hoʻohui ʻia, hoʻowalewale ʻia ka insuline i ka hōʻike o ka gene receptor LDL, a, no laila, hoʻonāukiuki ʻia ka pale a i ʻole ka pilikia o ka hormone a hiki ke hoʻopilikia maikaʻi i ka metabolism LDL.
ʻO HDL kahi hana paʻakikī. ʻO nā mea hoʻomaka nā mea i kapa ʻia ʻo prebeta-HDL. ʻO kēia nā mea i koho i ka cholesterol cellel free, no laila ʻo HDL ka hana mua i ka lawe ʻana i ke kolamu i ka palaleka a me nā ʻili peripheral, kahi e puka ai ke kino.
Hiki i nā ester kolestia ke lilo i ʻāpana o nā kikoʻī VLDL a me nā chylomicrons ma mua o ka protein protein kolesteryl ester. Ma ke ʻano 2 diabetes mellitus, hoʻohaʻahaʻa pinepine ʻia ka hōʻike o ka HDL-C ma muli o ka hoʻonui ʻia ʻana o ka halihali o ka cholesterol ester mai HDL a i HDL.
Eia nō naʻe, me ka maʻi pākahi papa 1, noho mau ʻo HDL-C a i ʻole he overestimated.
ʻO nā kumuhana ākea o ka mālamaʻana
Hoʻokumu ʻia ka Therapy no ka maʻi diabetes dyslipidemia ma ʻekolu mau alakaʻi kumu. ʻO kēia ka mea e mālama ai i ke kōkela o ke koko, ka momona kaumaha a me kaʻai.
Ma ke ʻano ʻelua o ka maʻi maʻi, pono e kaupalena ʻia ka hoʻopili ʻana o ka mau lepa māmā, ke kolamu a me nā momona momona. I ka papa helu o kēlā me kēia lā, makemake ʻia e hoʻopili i nā huahana e loaʻa ana i nā momona momona monounsaturated a me ka momona kai, no laila e hoʻomaikaʻi ai i ka ʻōlelo lipid.
Inā hoʻomau ikaika ka maʻi maʻi me ka nui o ka paona, a laila e emi ka neʻe o ka triglycerides i kona koko e ka 18%, a me ka hoʻoemi ʻana i ke koko-cholesterol-hoʻohaʻahaʻa i ka nui o 8%.
He mea kūpono ia me ka dial-non-insulin-acid, ke lawe i ka lāʻau hoʻohaʻahaʻa i ka meli, me ke ʻano o ka insulin hou, e hoʻihoʻi wale i nā pae maʻamau o ka momona o ka momona.
No laila, hiki i ka Metformin ke hōʻemi wale i nā triglycerides plasma i 10%, Pioglitazone - a hiki i 20%, a ʻaʻohe hopena o Rosiglitazone e pili ana i ka lipid metabolism. E pili ana i LDL-C, nā lāʻau hōʻemi i ke kōkōlama e pili i kēia kaʻina penei:
- Hoʻemi ʻia ka Metformin e ka 5-10%;
- Hoʻonui ʻia ʻo Pioglitazone e ka 5-15%;
- Hoʻonui ʻia ʻo Rosiglitazone e 15% a i ʻole.
Hāʻawi ka Insulin therapy i ka hoʻohaʻahaʻa iki i LDL-C. A ʻaʻohe hopena nui o sulfonamides e pili ana i ka hana lipid metabolism.
Ma ke ʻano maʻi diabetes type 1, hiki i ka inika ke kaumaha i ka lāʻau e hiki ke hoʻemi i ka plasma LDL-C a me ka triglycerides. Eia naʻe, ʻaʻole o ka pae o ka hoʻihoʻi no ka lipid metabolism e pili i ka HDL-C i ka lua o ka maʻi maʻi.
Sulfanilamides e hoʻokaʻawale i ke kōhi koko koko ʻaʻole i pili ka manaʻo o HDL-C. Eia nō naʻe, ʻo Metformin, ma muli o ka emi ʻana o ka triglycerides, hoʻonui i HDL-C, akā ʻaʻole i ka nui.
ʻO Pioglitazone lāua ʻo Rosiglitazone e hoʻonui i ka HDL-C i nā mea maʻi me ka maʻi maʻamau 2. No laila, e hoʻomaʻamaʻa i nā momona metabolism i nā maʻi diabetes-non-insulin-dependence, pono i ka maʻi lipid-hoʻohaʻahaʻa. A ma kahi o ke ʻano o ke ʻano maʻi mua, pono e hoʻokō i ka uku no ka ʻaina metabolism.
Hypolipidemia ma ke kōʻai ʻana e mālama ʻia me nā statins a me nā lāʻau ʻē aʻe, a laila ʻo ia ʻo Niacin, SCF, Fenofibrate, Ezetimibe. ʻO ia mau lāʻau hōʻemi i ka kolamu LDL.
No ka hoʻonui i ka HDL-C, ua hoʻohana ʻia nā fibrates a me ka hoʻohuihui nicotinic, e hiki ai ke hoʻohaʻahaʻa i ka nui o nā triglycerides. Pono e hoʻokaʻawale ʻia ʻo Gemfibrozil, Fenofibrate, a ʻo Niacin hoʻi mai ka hui lua. Inā kiʻekiʻe loa ke kiʻekiʻe o ka LDL-C, a laila kuhikuhi ke kumu kiʻekiʻe o nā statins i ka maʻi maʻi.
Hoʻopili ʻia nā hyperlipidemia i ʻekolu mau ala:
- piʻi nui o nā statins;
- ka hui pū ʻana o satin me nā fibrates;
- ka hui pū ʻana o satins me niacin.
ʻO nā kumu kumu e pono ai e mālama ʻia kahi hoʻomaʻamaʻa lipid-hoʻohaʻahaʻa nui. ʻO ka mea mua, ʻo kēia ala hana e hoʻohaʻahaʻa i ka LDL-C a me LDL-C.
ʻO ka lua, hoʻokaʻawale ka lāʻau hoʻohui i ka hōʻemi o nā hopena ʻokoʻa a hoʻēmi i ka cholesterol-LDL e pili ana i ka lawe ʻana i nā fibrates.
ʻO ke kolu, ua hiki i kēia ala ke hoʻohana i ka hoʻohana ʻana o SCLC i ka poʻe maʻi me ka hypertriglyceridemia a me kahi hōʻailona overestimated o LDL-C.
Nā hui o nā lāʻau lapaʻau i hoʻohana ʻia no ka dyslipidemia
Aia, he 3 mau lāʻau o nā lāʻau e pili ana i ka lipoproteins plasma. ʻO kēia kēia o ka HMG-COA reductase inhibitors, sequestrants o nā hua bile, nā paʻakai.
Hoʻohana pinepine ʻia nā Statins e hoʻohaʻahaʻa i ka ʻike o LDL-C, no laila ua kuhikuhi ʻia no ka hyperlipidemia. ʻO Pravastatin, Simvastatin, Lovastatin he mau metabolites o nā fungi a i ʻole mea derivatives o nā metabolites. A ʻo Rosuvastatin, Atorvastatin, Fluvastatin he mau lāʻau lapaʻau synthetic.
Hoʻomaopopo ʻia ʻo Simvastatin a me Lovastatin e "pro-agents", no ka mea he hopena therapeutic wale nō ma hope o ka hydrolysis i loko o ka puʻuwai. A hoʻopili ʻia nā statins ʻē aʻe i kahi hana ikaika.
ʻO ke kuʻina o ka hana o ka HMG-COA reductase Inhibitors ʻo ia ka mea e kāohi i kahi enzyme synthesis synthe nui. Eia kekahi, hoʻohaʻahaʻa kēia mau mea i ka hana o Apo B100, ka mea e hoʻopili ai i nā mea hoʻokae LDL a hoʻokomo i nā lipoproteins. Ke alakaʻi nei kēia i ka hōʻoia o ka liloʻana o nā triglycerides o VLDL, ka LDL cholesterol, e hoʻololi koke i loko o ke koko.
ʻO nā pharmacokinetics o nā statins:
- huke ʻana mai 30 a 90%;
- hoʻonohonoho ʻia e ka ate mai ka 50 a i ka 79%;
- nā mea hou aʻe i kaʻili.
Me ka hoʻohui o statins me FFA, ua pau kā lākou koho. Eia kekahi, hopena like me kahi hui pū me ka hoʻohui ʻana i nā lāʻau lapaʻau ka mea i hoʻomakeʻa i ka hopena myopathic o Lovastatin.
Eia kekahi, e hoʻonui nā hōʻailona o Lovastatin, atorvastatin a me Simvastatin ma hope o ka inu waiʻawa. Me ka hoʻomakaʻana o Warfarin a me Rosuvastatin, he piʻi nui i ka hana prothrombin.
Ma nā papa lāʻau o kēlā me kēia lā he 10-40 mg, HMG-COA reductase inhibitors emi ʻana i ka LDL cholesterol kiʻekiʻe a 50% a hoʻonui i ka HDL-C e 5-10%.
Hōʻike ʻia nā statins no nā maʻi maʻi me ka hoʻonui ʻia ʻana o ka TG a me ka cholesterol LDL kiʻekiʻe. Kāohi lākou i ka hoʻokumu ʻana o nā gallstones, kahi mea nui loa ia no ka neuropathy maʻi.
ʻO Myositis ka hopena maʻamau loa ma hope o ka lawe ʻana i nā statins, akā uluʻa kahi ulu. Nā manaʻo ʻino e like me:
- constipation
- aopala;
- ʻeha ka ʻōpū
- dyspepsia a me nā maʻi diabetes;
- nā ʻeha ʻōpala.
ʻO nā resestrants acid ʻoi he mau resins e hoʻopaʻa i nā waikawa bile i loko o nā meaʻawaʻawa. ʻO nā lāʻau lapaʻau e hoʻohaʻahaʻa i ka LDL-C i ka 30% ma o ka hoʻololi ʻana i ka ʻike o ka HDL. Loaʻa, hiki i nā SCFA ke hoʻonui i ka triglycerides.
Ma ka mālamaʻana i ka dyslipidemia me ka maʻi mellitus o ka maʻi, ʻo ka hoʻokō ʻana o nā hua mua o ka loiloi bile e like me ka hana o nā statins, akā aia wale nō me ka hoʻohana pū ʻana i kēia mau lāʻau. Hoʻokomo ʻia ʻo SCFA i nā hua liʻiliʻi i loko o nā mea palupalu. Hoʻoholo ʻia ka hopena therapeutic e ka pae o ka hoʻohaʻahaʻa i ka kolamu, ka mea i hōʻike iā ia iho i 2-3 mau pule.
Hoʻokomo ʻia ʻo SCFA i ka lawe ʻana o nā ʻano lāʻau he nui, me ka hui pū ʻia o nā waha, antiarrhythmic a me anticonvulsants. No laila, lawe ʻia nā kālā ʻē aʻe ma hope o 4 mau hola i hala ma hope o ka lawe ʻana iā SCFA.
Hoʻohana ʻia nā ʻōmole Bile acid e hoʻopau i ka hypercholesterolemia. Akā no ka mea hiki i kēia ʻano lāʻau lapaʻau ke hoʻonāukiuki i ka piʻi ʻana o ka kukuna triglyceride, pono nui e hoʻomalu i kēia hōʻailona i ka wā o ka mālama ʻana. No laila ʻaʻole pono ʻo SCFA i loko o nā mea maʻi me ka hyper-triglyceridemia.
ʻO ka pinepine, ma hope o ka lawe ʻana iā SCFA, constipation a me dyspeptic disorders e hiki mai iā ʻoe ke hui pū i ko lākou intake me sulfonamides a me nā lāʻau ʻē aʻe, e nānā ana i kahi hoʻomaha aono mau hola. ʻO SKHK i contraindicated ma ke alo o nā pōhaku i ka ʻūhā, ka gastrointestinal a me ka hoʻopale biliary piha a me ka hoʻonui ʻana o nā triglycerides.
ʻO nā derivatives acid Fibric e like me Hem fibrosyl a me Fenofibrate ʻo PPAR alpha agonists. ʻO nā lāʻau like like no ka maʻi maʻi e hopena i ka lipid metabolism, e hōʻemi ana i ka hiki ke hoʻomohala ʻana i nā hoʻopiʻi cardiovascular. No laila, hoʻopiʻi i ka haʻahaʻa haʻahaʻa-LDL i 20%, triglycerides - a hiki i 50%, a me ka pae o ka cholesterol-HDL e hoʻonui i ka 10-20%.
He mea kūpono ia he fenofibrate maikaʻi maikaʻi ma ka mālama ʻia ʻana o ka ʻike nui o LDL-C i nā maʻi maʻi maʻi e lawe nei i nā statins ʻaʻole i loaʻa ka hopena makemake.
Hoʻokomo ka fibrates i ka lipid metabolism i loko o ka lolo, e hoʻonui nei i ka synthesis:
- lipoprotein lipase;
- ABC-A1;
- ʻO Apo A-P a me ke apo A-1 (ke kumu o nā ʻōmua HDL koʻikoʻi).
Hōʻemi hoʻi nā Fibrates i ka hōʻike o ka protein protein absorption koʻikoʻi a hoʻoemi i ka apo C-III. Hoʻonui pū ka lāʻau lapaʻau nui A-V, ka hana o nā mea haʻahaʻa i ka lipoproteins, me ka nui o TG.
Eia kekahi, lawe nā fibrate esters i ka lipogenesis ma loko o ke ake. Kūleʻa lākou me ka receptor X hepatic, ʻaeʻa i ka lipogenesis PCR-mediated. Loaʻa i nā hua o nā waikawa fibric kahi hopena antiatherogenic.
Eia nō naʻe, nā loea alakaʻi nui no ka dyslipidemia he kiko, a ua hāʻawi ʻia nā fibrates no ka maʻi nīnūnē e pili ana i ka insulin, wale nō i kēlā poʻe maʻi i hiki ʻole i ka hōʻola i kēia mau lāʻau. No ka hoʻohui huiʻana o nā fibrates, ua ʻōlelo ʻia ka hoʻohana ʻana o ka fenofibrate.
He mea pono ia e hoʻomaopopo i kēlā mau lāʻau i hiki ke hoʻokaʻawale i ka LDL me ka hoʻohaʻahaʻa haʻahaʻa o TG. Akā i kēia hihia, hoʻohana pinepine ʻia nā lāʻau mai nā hui ʻē aʻe, e like me SCFA, ka waʻo nikotinic a me nā statins.
ʻO ka manawa maʻamau o ka fibrate therapy ʻo 3-6 mau mahina. Ma muli o kēia mau lāʻau e hoʻonui i ka hapa o ka cholelithis, ʻaʻole pono lākou e hoʻohana ʻia e nā maʻi maʻi me ka autonomic neuropathy.
Pono nā maʻi maʻi me ka nephropathy a me nā maʻi maʻi e fibrates loa, no ka mea, ʻoi aku ka nui o nā keiki. I ka wā lactation a i ka wā hāpai, pāpā ʻia nā mea hoʻonā.
ʻO ka hopena maʻamau e hōʻike ai i nā fibrates:
- pāhawewe;
- ninini
- erectile dysfunction;
- ʻeha ka ʻōpū
- nā pulu ʻili;
- utuka
- nā ninia
- ʻʻAla
- constipation a me nā mea.
Hoʻopili i nā statins, SCFAs a fibrates, no ka hyperlipidemia e ulu ana i ka maʻi ma mua o nā makahiki he 50, hiki ke kuhikuhi ʻia ka waikawa nikotinic. ʻO kēia wale nō ka mea hoʻoheheʻe liʻiliʻi lipid e hoʻohaʻahaʻa i ka neʻe o ka lipoprotein, akā he nui nā hopena hopena.
Eia kekahi, ke kauka nei kekahi kauka i nā waʻa momona o omega-3 e hōʻemi i ka hypertriglyceridemia. Eia kekahi, hōʻemi ʻo OZHK i nā pilikia o ka naʻau a loaʻa ka hopena antiatyrogenic. ʻO ka wikiō i kēia moʻolelo e haʻi iā ʻoe pehea e mālama ai i nā maʻi lipid metabolism.
