Lipid Management Strategies nyob rau hauv cov neeg mob uas muaj mob raum mob
Aug 04, 2023
Lub Koom Haum Ntiaj Teb Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv tau qhia tias ntau dua 90 feem pua ntawm cov neeg mob uas muaj kab mob raum ntev (CKD) tau nce cov roj (cholesterol) tag nrho, 85 feem pua ntawm cov roj lipoprotein tsawg (LDL-C), thiab 50 feem pua siab lipoprotein. cholesterol (HDL-C) txo qis. LDL-C yog qhov kev pheej hmoo tseem ceeb tshaj plaws rau cov kab mob atherosclerotic cardiovascular, thiab atherosclerotic cardiovascular kab mob yog ib qho teeb meem ntawm CKD. Tsuas yog 5 feem pua ntawm cov neeg mob CKD nce mus rau theem kawg ntawm lub raum kab mob, thiab thaum kawg tuag. Txawm li cas los xij, nws yog siab li 30 feem pua ntawm cov kab mob plawv. Yog li ntawd, LDL-C yog qhov txaus ntshai heev thiab yuav tsum tau ua tiag tiag.
Nyem rau cistanche tubulosa phiv rau cov kab mob raum
Cov kab mob lipid metabolism muaj ntau nyob rau hauv cov neeg mob CKD, tab sis cov txheej txheem lipid metabolism txawv nyob rau hauv cov neeg mob uas muaj ntau yam etiologies lossis ntau theem ntawm CKD (xws li nephritis, raum tsis ua haujlwm, lim ntshav, thiab ntshav qab zib nephropathy). Cov kab mob lipid metabolism hauv cov neeg mob CKD xws li mob nephritis thiab nephrotic syndrome yog vim muaj cov protein ntau, uas ua rau lub siab ua kom cov lipoproteins, ua rau hyperlipidemia. Cov neeg mob uas muaj tus mob nephrotic yuav xau lipoproteins uas tiv thaiv tib neeg lub cev, xws li lipoproteins ntau ntom ntom. Kev hloov pauv hauv cov receptors ntawm lipoproteins hauv cov neeg mob zoo li no yuav ua rau lipid metabolism tsis zoo. Mob ntshav qab zib nephropathy yog qhov tseem ceeb ntawm vascular puas tsuaj, uas yog qhov nkag siab zoo rau lipid metabolism, thiab lipid metabolism tsis meej tuaj yeem tshwm sim nws tus kheej, thiab lipid metabolism tsis meej yuav ua rau cov hlab ntsha puas tsuaj. Yog li ntawd, lipid metabolism tsis meej nyob rau hauv cov ntshav qab zib nephropathy yuav tsim ib lub voj voog vicious.
Tam sim no, thaj chaw ntawm nephrology tau cais cov ntshav qab zib nephropathy los ntawm cov tsis muaj ntshav qab zib nephropathy. Txawm li cas los xij, nyob rau theem ntawm lub raum tsis txaus, qhov txawv txav lipid metabolism yog lwm txoj hauv kev pathophysiological. Cov neeg mob uas muaj lub raum tsis ua haujlwm kawg feem ntau cuam tshuam nrog hyperinsulinemia, uas tuaj yeem ua rau cov metabolism hauv lipid tsis zoo. Cov co toxins ntau ntxiv hauv cov neeg mob uremia kuj tseem tuaj yeem cuam tshuam lipoproteins thiab ua rau lipid metabolism tsis zoo, thiab kev hloov pauv ntawm lipoprotein receptors kuj tseem muaj txiaj ntsig zoo ib yam. Thaum lub sijhawm lim ntshav, cov tshuaj heparin tau siv thaum lub sijhawm lim ntshav, tshwj xeeb tshaj yog cov piam thaj siab dialysate siv los ntawm peritoneal dialysis cov neeg mob, tuaj yeem ua rau muaj kev cuam tshuam lipid metabolism. Yuav kom suav tau, etiology thiab pathophysiological mechanism ntawm lipid metabolism tsis zoo hauv ntau hom CKD cov neeg mob sib txawv heev, yog li lawv yuav tsum tau kho txawv.
lipid metabolism tsis zoo ua rau cov hlab ntsha puas tsuaj, uas tau raug pov thawj hauv ntau cov kev tshawb fawb hauv cov hlab plawv, thiab cov lipid metabolism tsis zoo tuaj yeem ua rau lub raum puas tsuaj. Tom qab ib tug loj npaum li cas ntawm lipoprotein deposits nyob rau hauv lub raum, nws yuav tsub kom lub zos cov ntaub so ntswg hyperplasia thiab ua rau ib tug inflammatory txheej txheem. Tsis tas li ntawd, lipoproteins, tshwj xeeb tshaj yog cov lipoprotein oxidation tsis zoo, tseem yuav ua rau cov kab mob endothelial, ua rau mob hauv lub raum cov hlab ntsha, ua rau cov nqaij fibrosis, arteriosclerosis, thiab thaum kawg glomerulus sclerosis. Tom qab hyperlipidemia ua rau cov hlab ntsha thiab cov hlwb endothelial puas tsuaj, cov tshuaj tiv thaiv mob ntev tshwm sim hauv cov ntaub so ntswg thiab ua kom cov kab mob hauv lub raum ua kom sai. Clinically, hyperlipidemia yuav tsum tau ua haujlwm tswj kom qeeb txoj kev loj hlob ntawm cov kab mob raum.
Yav dhau los, ntau tus kws kho mob nephrologists ntseeg tias qhov txawv txav lipid metabolism hauv cov neeg mob CKD tuaj yeem yog vim kev puas tsuaj los ntawm cov proteinuria mus ntev. Tom qab cov proteinuria raug tshem tawm, tus neeg mob cov lipoprotein theem yuav rov zoo li qub. Yog li ntawd, peb tsis muab qhov tseem ceeb heev rau kev kho lipid-txo qis hauv cov neeg mob CKD. Ntau thiab ntau cov kev tshawb fawb tau pom tias muaj kev sib raug zoo heev ntawm cov lipid metabolism tsis zoo thiab cov kab mob hauv lub raum, tshwj xeeb tshaj yog cov kab mob glomerulosclerosis, thiab kev txo cov lipid nruj yog xav tau rau cov neeg mob raum, tshwj xeeb tshaj yog cov neeg mob hyperlipidemia.
Yog li, kev kho mob, cov tshuaj uas tsim nyog lipid-txo cov tshuaj yuav tsum raug xaiv raws li tus neeg mob lub lipid metabolism ntau li ntau tau. Rau cov neeg mob hyperlipidemia hnyav lossis hnyav lipid metabolism abnormality, muaj zog lipid-txo cov tshuaj siv tau; Rau cov neeg mob uas muaj lipid metabolism hauv me me, Kev siv tshuaj statins tau pom zoo rau cov neeg mob uas muaj qhov txawv txav, tshwj xeeb tshaj yog cov uas xav tau kev siv mus ntev. Tag nrho hauv tag nrho, nws yog ib qho tsim nyog yuav tsum ua kom tus neeg mob cov ntshav lipid li qub nyob rau lub sijhawm ntev.
Hauv kev kho mob, cov neeg mob CKD feem ntau siv ntau yam tshuaj, tab sis cov tshuaj feem ntau yog metabolized los ntawm lub siab thiab lub raum. Rau cov neeg mob CKD uas xav tau kev kho mob mus sij hawm ntev, txhawm rau txo qis rau lub raum kev puas tsuaj ntxiv los ntawm kev siv tshuaj, nws yog ib qho tsim nyog yuav tsum tau hais txog cov tshuaj me me, kev ua siab ntev ntev, thiab kev nyab xeeb ua ntej. Statins yog lub hauv paus ntawm kev kho mob dyslipidemia.
Lub Koom Haum Ntiaj Teb Kev Txhim Kho Raum Kab Mob Kho Mob tau hloov kho cov txheej txheem tswj lipid rau cov neeg mob CKD (2016), xa mus rau tam sim no American Heart Association/American College of Cardiology (AHA/ACC) cov neeg laus cov roj cholesterol cov lus qhia, tso tseg LDL-C lub hom phiaj tus nqi thiab hais txog lub luag haujlwm ntawm statins hauv CKD. Central txoj hauj lwm hauv kev kho mob ntawm dyslipidemia. Raws li cov ntaub ntawv tshawb fawb tau tshaj tawm tshiab nyob rau xyoo tas los no, Lub Koom Haum Ntiaj Teb Kev Txhim Kho Kev Tshawb Fawb Txog Kab Mob Raum tau hloov kho 2013 cov lus qhia, thiab cov ntsiab lus tsim nyog yuav tsum tau ua raws li hauv qab no:
1. Xa mus rau tam sim no AHA / ACC cov txheej txheem tswj cov neeg laus cov roj cholesterol, LDL-C lub hom phiaj tus nqi raug tso tseg, thiab qhov tseem ceeb ntawm statins hauv kev kho mob CKD dyslipidemia tau hais meej.
2. Tsuas yog rau cov neeg mob ntshav lim ntshav mus ntev, nws raug pom zoo tias txhua tus neeg mob CKD uas muaj hnub nyoog siab dua lossis sib npaug li 50 xyoo tau txais kev kho mob statin; Nws raug pom zoo rau cov neeg mob uas muaj kab mob hnyav [CKD theem 3-5, glomerular filtration rate (eGFR)<60 ml/(min·1.73 ㎡)] Combined treatment with statin and ezetimibe.
3. Rau cov neeg mob CKD hnub nyoog 18-49 uas tsis tau txais kev kho mob mus ntev, kev kho statin yuav tsum tsuas yog siv rau plaub yam nram no: (1) kuaj mob plawv. (2) Ua ke nrog ntshav qab zib. (3) Muaj keeb kwm ntawm ischemic stroke. (4) Framingham's 10-xyoo ntawm kev mob plawv muaj feem ntau dua lossis sib npaug li 10 feem pua.
4. Vim tias lub raum tsis ua haujlwm tsis zoo, ntau yam tsis sib xws, lossis siv ntau yam tshuaj, cov neeg mob CKD muaj kev pheej hmoo siab ntawm kev phiv thaum siv cov tshuaj txo qis lipid. Yog li, nws raug pom zoo rau cov neeg mob nrog eGFR<60 ml/(min·1.73㎡) Moderate-intensity statin therapy should be used, such as atorvastatin 20 mg, rosuvastatin 10 mg, simvastatin 40 mg, pravastatin 40 mg, fluvastatin 80 mg or pitavastatin 2 mg.
5. Cov neeg mob CKD yuav tsum zam kev sib xyaw ntawm fibrates thiab statins.
6. Ezetimibe ib leeg tsis pom zoo rau kev kho lipid-txo.
7. Cov neeg mob uas muaj CKD theem 1-2 thiab eGFR<60 ml/(min·1.73㎡) can refer to the blood lipid treatment strategy of the general population.
8. Ua ntej pib kho statin, qib transaminase yuav tsum raug kuaj rau txhua tus neeg mob CKD. Yog tias tsis muaj pov thawj kho mob ntawm daim siab puas thiab myopathy, kev kuaj niaj hnub ntawm creatine kinase tsis tsim nyog.
9. Cov neeg mob ntawm kev kho mob ntshav qab zib mus ntev yuav tsum tsis txhob pib tshuaj statin lossis statin ua ke nrog kev kho ezetimibe, tab sis cov neeg uas tau txais cov tshuaj tau hais los saum toj no ua ntej kev lim ntshav tuaj yeem txuas ntxiv noj cov tshuaj tom qab pib lim ntshav.
10. Txhua tus neeg laus uas tau hloov lub raum yuav tsum tau txais kev kho mob statin.
AHA / ACC qhov kev pom zoo zaum kawg: kev noj zaub mov tsawg-carb, noj zaub mov muaj roj tuaj yeem txo triacylglycerol.
Hypertriglyceridemia yog txuam nrog kev rog plab, insulin tsis kam, qis lipoprotein siab, siab triglycerides, thiab kub siab. Qhov kev pom ib txwm muaj yog tias hypertriglyceridemia yog tshwm sim los ntawm kev noj zaub mov muaj roj ntau, haus cawv ntau dhau, qee yam tshuaj, thiab lwm yam. Qhov kev pom zoo zaum kawg ntawm AHA/ACC rhuav tshem lub tswv yim ntawm kev txo qis triacylglycerol nrog kev noj zaub mov tsis muaj rog thiab ua rau ntau tus neeg paub tias. Tsuas yog los ntawm kev noj zaub mov tsawg dua xws li cov zaub mov tseem ceeb tuaj yeem ua tiav qhov kev txo qis ntawm triacylglycerol.
