Dyslipidemia na ọrịa shuga bụ ọnọdụ mgbe ọbara onye ọrịa nwere ọdịnaya dị elu nke lipoproteins na lipids.
Mmebi nke ihe ndị a dị ize ndụ n'ihi na ọ na-eme ka ohere dị iche iche na-arụ ọrụ nke sistem obi, na-eduga n'ọdịdị nke atherosclerosis. Nnukwu ọnya cholesterol na-eso akpata ọdịdị nke nnukwu ọrịa pancreatitis.
Hyperlipidemia na - ejikọkarị ọrịa shuga. Ihe onyonyo onyonyo nke onodu a di ka ihe iriba ama nke akwara obi na atherosclerosis. Nwere ike ịchọpụta ya mgbe nyocha ụlọ nyocha gachara.
Dyslipidemia: kedu ihe ọ bụ, ihe mmepe maka ọrịa shuga
Lipoproteins bụ macromolecular, ogige dị gburugburu nke na-ebu protein na lipids dị iche iche na plasma ọbara. Hydrophobic triglycerides tinyere cholesterol ester molecules na-etolite isi nke lipoproteins, nke protein na amphipathic gbara na phospholipids gbara ya gburugburu.
Isi nke lipoproteins na-ebu 100-5000 cholesterol esters na ụmụ irighiri triglyceride. Ihe nchebe nke elu ala nke lipoproteins bụ alo-lipoproteins. Ọ bụghị nanị na-atọhapụ lipids site na akwara, kamakwa ha na-ebugharị na mbugharị nke lipoproteins yana nhazi nke mkpokọta akwara plasma.
Apolipoprotein B100 dị mkpa maka ịmịpụta mkpụrụ ọgwụ hepatic lipoproteins dị iche iche (nke dị ala, etiti na okomoko). Apo B 48 na-ahụ maka ntinye chylomicrons site na eriri afọ. Na ApoA-1 bụ protein na-eduga na nhazi nke HDL.
Dyslipidemia na ụdị shuga nke 2 kpatara ọtụtụ ihe:
- Metabolism na-agbagọ.
- Obese.
- Mmeghachi omume na-adịghị mma mgbe ị takingụsịrị nnukwu ọgwụ ụfọdụ (beta-igbochi, diuretics, androgens, system corticosteroids, progestins, immunosuppressants, AIPs).
- Ọrịa hyperlipidemia.
- Ọrịa concoitant (ọtụtụ mgbe ọ na-arịa ọrịa shuga - nke a bụ hypothyroidism).
Kedu ihe kpatara ọrịa shuga ji kwụsị Lipoprotein na chylomicron metabolism? Mgbe e risịrị nri, triglycerides (abụba nke nri) yana kọlestrọl ka obere eriri afọ na-abanye ya ma webata ya n’ime akwara nke na-akpụ akpụ chylomicrons na-abanye n’usoro lymphatic, na mgbe agwachara ha na mgbasa site na elu vena cava.
N'ime akwa a na-adọrọ adọrọ, akwara chylomicron na adipose anụ ahụ na - ejikọ enzymes lipoprotein. N'ihi ya, a na-ahapụ abụba abụba n'efu.
A na-ejide FFAs site na adipocytes, ebe ha na-apụta ọzọ na nchịkọta nke triglycerides. Ọ bụrụ na FFA jidere olu ahụ, mgbe ahụ ọ na-eji ha dị ka isi iyi ike, na-ejikọ ya na metabolism intracellular.
Ihe ndozi (ihe ndị ọzọ chylomicron) bụ ngwaahịa nke sistemu egbugbere ọnụ nke tụfuru ihe dịka 75% nke triglycerides, nke bụ ngwa ngwa metaraolized na imeju.
PL - hepatic lipase (triglyceride), hydrolyzing triglycerides nke chylomicron remnants, ka na-etinye aka na mkpochapu mkpocha. Na ụdị ọrịa shuga abụọ nke ọrịa mellitus, nsogbu na-arụ ọrụ nke holomicron remnants na chylomicrons na-apụtakarị. Ọzọkwa, na ụdị ụdị hyperglycemia na-adịghị ala ala, a na-ebelata ọrụ LPL.
Agbanyeghị, nguzogide insulin na-akpali imepụta chylomicrons n'ime eriri afọ. N'ihe banyere ụdị ọrịa shuga 1, ihe ndị na-eme ka ike gwụ mmadụ na-egbochi onwe ya na-emetụta nanị ọrịa kọwaa. E gosipụtara nke a site na mbelata nke ukwuu na ọrụ Ll, bụ nke mmụba dị ukwuu na ọnụọgụ triglycerides na-ebikọ.
Hyperlipidemia nwekwara ike ime n'ihi nkwarụ sitere na mkpụrụ ndụ ihe nketa. VLDLP mepụtara site na imeju, cholesterol na triglycerides esters dị na isi, ma mkpụrụ ndụ phospholipids na Apo 100 nọ n’elu.
Mmepụta VLDL na imeju na-akwalite nnukwu oriri nke FFA nke anụ ahụ adipose. Ma njikọta nkwalite na imeju nke cholesterol na FFA na ọrịa shuga na-enweghị insulin bụkwa ihe kwere omume, ọ bụ ya mere mmepụta VLDL na-aba ụba.
A na-agbanye mmiri na Triglycerides na VLDL na plasma na LPL, na-agbanwe n'ime obere LSPP na VLDL. Ọ bụ ihe kwesịrị ịrịba ama na LPP dị ka chylomicron remnants, mana ha dị iche na nke ahụ na mgbakwunye na itinye aka na imeju, ha na-ejigide ya n'ọbara na LDL. Yabụ, ọrụ LPL na-enye arụ ọrụ metabolic nkịtị site na VLDL, na-agafe STD, na-ejedebe na LDL.
ApoVUO bụ naanị protein dị n’elu LDL nke bụ ligandụ maka ndị na-anabata LDL. Yabụ, ọdịnaya LDL dị n’ọbara dabere n’ihe abụọ:
- nnweta nke ndị na-anabata LDL;
- Ngwa ahia LDL.
N'ime ụdị ọrịa shuga 2, a na-ebute ọrịa VLDL triglycerides. A na-akọwawanye ụba nke cholesterol site na LDL na hyperglycemia na-adịghị ala ala site na mmụba ya na-abawanye na mkpụrụ nke lipoprotein ọ bụla.
Peroxidation ma ọ bụ glycation nke LDL na-eduga na mmebi nke mkpochapu ahụ ụmụ irighiri mmiri, na-eduga n'eziokwu ahụ na ha malitere ịnakọta na mgbidi vaskụla. Na mgbakwunye, insulin na-akpali ngosipụta nke mkpụrụ ndụ nnabata LDL, ma, n'ihi ya, nkwụghachi insulin ma ọ bụ ụkọ homonụ nwekwara ike metụta metabolism LDL na-adịghị mma.
HDL bụ ihe owuwu dị mgbagwoju anya. A na-akpọ irighiri ihe mbido prebeta-HDL. Ndị a bụ ndị nakweere cholesterol cellular na-akwụghị ụgwọ, yabụ HDL bụ nzọụkwụ mbụ na ebufe cholesterol na imeju na akwara akụkụ, ebe ha na-apụ n'ahụ.
Cholesterol esters nwekwara ike ịbụ akụkụ nke VLDL ururu na chylomicrons na ọnụnọ protein protein iga cholesteryl. Na ụdị ọrịa shuga abụọ nke ọrịa mellitus, a na-egbukarị HDL-C n'ihi ọkọlọtọ cholesterol ester site na HDL gaa HDL.
Agbanyeghị, na-arịa ụdị ọrịa shuga 1, HDL-C na-anọgide na-adịkarị ma ọ bụ na-echekarị oke.
General ụkpụrụ nke ọgwụgwọ
Usoro ọgwụgwọ maka ọrịa dyslipidemia sitere na ụkpụrụ atọ na-eduga. Nke a bụ nchịkwa shuga ọbara, ịbelata oke yana nri.
N'ime ụdị shuga nke abụọ, ịnweta carbohydrates dị mfe, cholesterol na abụba juru afọ kwesịrị oke. N'ime menu nke ụbọchị, ọ bụ ihe na-achọsi ike ịgụnye ngwaahịa nwere monounsaturated faty acids na fiber na-eri nri, si otú a kwalite profaịlụ lipid.
Ọ bụrụ na onye ọrịa mamịrị na-agbasi mbọ ike maka oke ibu, mgbe ahụ ịta nke triglycerides n'ime ọbara ya ga-agbada site na 18%, ọgwụ mgbochi cholesterol na-agbada belata ga-ebelata 8%.
Ọ dị mma ịmara na ọrịa shuga na-abụghị insulin, ị ,ụ ọgwụ ndị na-ebelata shuga, gụnyere insulin ọzọ, nanị na-eme ka ikelata metabolism dị ala dịghachi otú o kwesịrị.
Yabụ, Metformin nwere ike belata plasma triglycerides ruo 10%, Pioglitazone - ihe ruru 20%, Rosiglitazone enweghị mmetụta na metabolism lipid. Banyere LDL-C, ọgwụ iji belata shuga na-emetụta usoro a dị ka ndị a:
- Metformin belata 5-10%;
- Pioglitazone na-abawanye site na 5-15%;
- Rosiglitazone na-abawanye site na 15% ma ọ bụ karịa.
Usoro ọgwụgwọ insulin na-enye aka na mbelata na LDL-C. Na sulfonamides enweghị mmetụta pụtara ìhè na metabolism lipid.
N'ime ụdị shuga 1, ịgwọ ọrịa insulin nwere ike belata plasma LDL-C na triglycerides. Agbanyeghị, ọkwa ịkwụ ụgwọ maka metabolism lipid anaghị emetụta HDL-C n'ụdị shuga nke abụọ.
Sulfanilamides na shuga dị ala adịghị emetụta ịta nke HDL-C. Agbanyeghị, Metformin, n'ihi mbelata nke triglycerides, na-abawanye HDL-C, mana ọbụghị nke ukwuu.
Pioglitazone na Rosiglitazone na-abawanye HDL-C n’ime ndị ọrịa nwere ụdị shuga 2. Yabụ, iji kwado metabolism abụba na ndị ọrịa shuga na-abụghị insulin, ọgwụgwọ Lipid dị mkpa. Na ụdị ọrịa shuga mbụ, ọ dị mkpa iji nweta nkwụghachi ụgwọ maka metabolism metabolism.
A na-agwọ hypolipidemia na ọrịa shuga na statins na ọgwụ ndị ọzọ, nke gụnyere Niacin, SCF, Fenofibrate, Ezetimibe. Ọgwụ ndị dị otú a na-ebelata cholesterol LDL.
Iji mee ka HDL-C dịkwuo elu, a na-eji fibrates na nicotinic acid, nke na-enye aka belata ọnụego nke triglycerides. Ekwesịrị ekenye Gemfibrozil, Fenofibrate, yana Niacin na ndị otu abụọ. Ọ bụrụ na ọkwa nke LDL-C dị oke, mgbe ahụ, a na-enye ndị ọria mamịrị usoro onyunyo ogo.
A na - ekpochapụ hyperlipidemia a na - ejikọ ọnụ n'ụzọ atọ:
- ụba usoro onunu ogwu;
- ngwakọta nke satin na fibrates;
- nchikota satins na niacin.
Ihe mere eji ekwusi usoro ọgwụgwọ dị ala dị ala dị iche iche. Nke mbu, uzo a si aghalata LDL-C na LDL-C.
Nke abuo, ọgwụgwọ ngwakọta na-ebelata ohere nke mmeghachi omume na-adịghị mma ma belata cholesterol-LDL metụtara ị fiụ fibrates.
Nke ato, uzo a na - enye ohere iji SCLC na ndi ọrịa nwere hypertriglyceridemia na njiri mara nke LDL-C.
Otu ogwu eji eme aru dyslipidemia
E nwere ụdị ọgwụ atọ dị iche iche na-emetụta plasma lipoproteins. Ndị a bụ HMG-COA reductase inhibitors, usoro nke bile acid, fibrates.
A na-ejikarị Statins iji belata mkpokọta nke LDL-C, yabụ, etinyere ha maka hyperlipidemia. Pravastatin, Simvastatin, Lovastatin bụ metabolites nke fungi ma ọ bụ usoro nke metabolites. Ma Rosuvastatin, Atorvastatin, Fluvastatin bụ ọgwụ sịntetik.
A na-ahụ Simvastatin na Lovastatin dịka "ndị na-elekọta mmadụ", n'ihi na ha nwere ọgwụgwọ ọgwụgwọ naanị mgbe ha gbasasịrị hydrolysis na imeju. A na-ahụ ihe oyiyi ndị ọzọ n'ụdị arụmọrụ.
Ofkpụrụ nke ọrụ nke HMG-COA reductase Inhibitors bụ na ha na - ebelata enzyme cholesterol synthesis. Na mgbakwunye, ndị ọrụ a na-agbadata mmepụta Apo B100, nke na-eme ka ndị na-anabata LDL ma na-etinye lipoproteins. Nke a na - eduga n'eziokwu ahụ na mkpokọta triglycerides nke VLDL, LDL cholesterol, na - agbada n'ọbara na mberede.
Pharmacokinetics nke akpụ akpụ:
- absorption si 30 ruo 90%;
- metabolized site na imeju sitere na 50 ruo 79%;
- ndị ọzọ akụrụ.
Site na mmekorita nke statins na FFA, mmata ha na-ebelata. Ọzọkwa, a na-ahụta mmetụta yiri nke ahụ na ngwakọta ọgwụ na-eme ka mmetụta myopathic nke Lovastatin dị.
Na mgbakwunye, ihe ngosi nke Lovastatin, atorvastatin na Simvastatin ga-abawanye mgbe ha drinkingụsịrị mmiri mkpụrụ osisi grape. Site na ntinye akwụkwọ nke Warfarin na Rosuvastatin, mmụba nke ihe prothrombin na-apụta.
N'ihe dị kwa ụbọchị nke 10-40 mg, HMG-COA reductase inhibitors belata LDL cholesterol ịba 50% ma mụbaa HDL-C site na 5-10%.
Egosiputara oria ndi n’eto oria ndi n’aru oria otutu TG na cholesterol di elu. Ha na - egbochi imeze nke gallstones, nke kachasị mkpa maka neuropathy mamịrị.
Myositis bụ mmeghachi omume kachasị emetụta mgbe ị nwesịrị statins, mana ọ naghị enwekebe. Mmeghachi omume ọjọọ dịka:
- afọ ntachi
- arthralgia;
- mgbu afọ
- dyspepsia na ọrịa shuga;
- olu mgbu.
Ndị na-eso ụzọ Bile acid bụ resins nke na-ejikọ eriri bile na eriri afọ. Ọgwụ ndị dị otú ahụ na-agbadata LDL-C ruo 30% site na ịgbanwee ọdịnaya HDL. Nwere ike, SCFAs nwere ike ịbawanye triglycerides.
Na ọgwụgwọ dyslipidemia na ọrịa shuga mellitus, arụmọrụ nke bile acid na-esote ya bụ ihe a na-eme na emume nke statins, mana naanị na ijikọ ọgwụ ndị a. A na-etinye SCFA na obere obere na eriri afọ. A na-ekpebi ọgwụgwọ ọgwụgwọ site na ọkwa nke iwelite cholesterol dị ala, nke na-egosipụta onwe ya na izu 2-3.
SCFAs na-emetụta nnabata nke ọtụtụ ọgwụ, gụnyere ọgwụ mgbochi, antiarrhythmic na anticonvulsants. Ya mere, ego ndị ọzọ kwesiri iwere naanị mgbe awa 4 gafere ka ewere SCFA.
A na - eji ọgwụ ndị na - eme ihe Bile acid iji kpochapụ hypercholesterolemia. Mana ebe ụdị ọgwụ a nwere ike ịkpalite ịrị elu nke triglyceride, ọ dị mkpa ijikwa akara ngosi a n'oge ọgwụgwọ. Ya mere, ekwesighi iburu SCFA na ndị ọrịa nwere hyper-triglyceridemia.
Ọtụtụ mgbe, mgbe ị nwesịrị SCFA, nsogbu afọ na ọnyụnyụ ọbara na-apụta .. can nweghị ike ijikọ ọnụ ha na sulfonamides na ọgwụ ndị ọzọ, na-ahụ oge ezumike awa isii. A na-egbochi SKHK na ọnụnọ nke nkume na ọnya ọnya, eriri afọ yana mgbochi biliary zuru ezu yana ịba ụba nke triglycerides.
Ihe ndi ozo Fibric acid dika Hem fibrosyl na Fenofibrate bu ndi Pon alfa agonists. Ọgwụ yiri ya maka ọrịa shuga na-enwe mmetụta siri ike na metabolism lipid, na -ebelata ohere nke ịmalite inwe nsogbu obi. Yabụ, fibrates dị ala cholesterol-LDL ruo 20%, triglycerides - ruru 50%, ọkwa nke cholesterol-HDL na-abawanye site na 10-20%.
Ọ bụ ihe kwesịrị ịrịba ama na fenofibrate bụ usoro dị mma na ọgwụgwọ nke nnukwu oriri nke LDL-C na ndị ọrịa mamịrị na-ewere statins na-enweghị mmetụta achọrọ.
Fibrates na-emetụta lipid metabolism na ọrịa shuga, na-abawanye njikọ:
- lipoprotein lipase;
- ABC-A1;
- Apo A-P na apo A-1 (protein HDL kachasị).
Fibrates na-ebelata ngosipụta nke protein na-adọrọ adọrọ cholesterol ma belata apo C-III. Ọzọkwa, ọgwụ ọjọọ na-abawanye apo A-V, imepụta nke na-ebelata mkpokọta lipoproteins, yana nnukwu TG.
Na mgbakwunye, fibrate esters na-egbochi lipogenesis na imeju. Ha na onye na-anabata hepatic X na-emekọ ihe, na-egbochi lipogenesis nke PCR. Ngwakọta nke fibric acid nwekwara mmetụta antiatherogenic.
Agbanyeghị, ihe ndị na - eme ka ọrịa dyslipidemia bụ statins, a na - enye ndị ọrịa ọgwụ ọgwụ shuga na - akpata ọrịa shuga, naanị ndị ọrịa ahụ enweghị ike ịnabata ọgwụ ndị a. Maka njikọta ọgwụ fibrates, ana-atụ aro ịenoụ fenofibrate.
Ọ dị mma ịmara na enwere ike ịkọwa ọgwụ ndị dị otú ahụ iji belata LDL na ntinye dị ala nke TG. Mana na nke a, a na-ejikarị ọgwụ ọjọọ eme ihe site na otu ndị ọzọ, dịka SCFA, nicotinic acid na statins.
Ogologo oge ọgwụgwọ fibrate bụ ọnwa 3-6. Ebe ọgwụ ndị a na-abawanye ike nke cholelithis, ndị ọrịa mamịrị na-arịa ọrịa neuropathy ekwesịghị iji ha.
Ndị ọrịa mamịrị na nephropathy na ndị ọrịa merela agadi kwesịrị iji fibrates mee ihe nke ọma, ebe ọ bụ na akụrụ na-ewepụ ha karịa. N’oge a na-enye nwa ara na n’oge afọ ime, amachibidoro ịgwọ ndị mmadụ n’ihe ndị a.
Ihe kachasị dị njọ na-akpata ị takingụ ọkụ bụ:
- mẹ ivu;
- ọgbụgbọ
- mẹkpoo ivu;
- mgbu afọ
- akpukpo anụ;
- vomiting
- afọ ọsịsa
- Dizziness
- afọ ntachi na stof.
Na mgbakwunye na statins, SCFAs na fibrates, maka hyperlipidemia na-etolite na ndị ọrịa mamịrị mgbe afọ 50 gasịrị, a pụrụ inye ọgwụ nicotinic acid. Nke a bụ naanị ihe dị ala nke na-agbadata mkpolata lipoprotein, mana ọ nwere ọtụtụ mmetụta.
Ọzọkwa, dọkịta nwere ike ịnye omega-3 abụba asịd iji belata hypertriglyceridemia. Ọzọkwa, OZHK belata ohere nke nsogbu obi ma nwee mmetụta antiatyrogenic. Vidio dị n’isiokwu a ga-agwa gị otu ị ga-esi gwọọ nsogbu ọgbụgba metabolism.
