Inta badan khabiirada wadnaha iyo cilmi-baarayaasha ayaa muddo dheer u qoondeeyay "" hypothesis hypothesis ". Qiyaasta "cholesterol", ayaa si fudud loo sheegay, waa in heerka dhiigga ee kor u kaca ee LDL kolestaroolku uu yahay sabab toos ah ee atherosclerosis . Sidaa daraadeed, qaadashada tallaabo lagu yareeyo heerka LDL ee kolesteroolka waa tallaabo muhiim ah oo lagu yareeynayo khatarta aan ugu jirno qaadista cudurka wadno-xanuunka ee atherosclerotic.
Tobaneeyo sano, khabiiradu waxay nagu dhiirigaliyeen in ay wax ka bedelaan cuntooyinkeena hababka loogu talagalay in lagu yareeyo heerarka hilibkayaga, shirkadaha dawooyinka ayaa isticmaalay balaayiin doolar si ay u kobcaan daroogada si loo yareeyo kolestaroolka. Qiyaasta "hypertesis" ayaa ka mid ah dhakhtarrada iyo xarumaha caafimaadka-iyo warshadaha, laakiin sidoo kale dadwaynaha waa weyn.
Sidaa daraadeed, waxaa laga yaaba in ay dhacdo in ay maqasho in khabiiro badan oo lipid iyo kalkaaliyayaashu ay haatan su'aal ka keenayaan in maaddada 'cholesterol hypothesis' runta ka dib. In kasta oo doodda ka dhexaysa xirfadlayaasha ka sarreeya sharraxa "cholesterol" ayaa inta badan ka dambeeyay muuqaalkii oo aaney ku jirin goobaha dadweynaha, taas oo aan hoos u dhicin xoogga iyo xishoodka doodda. Sidaas awgeed, inkastoo ay dadweynaha ku dhawaaqeen qaar ka mid ah khabiirada caanka ah, mala-goynta kolestaroolka ayaa si cad u ah "ma degsanayn sayniska."
Xalalka Hiliblaha
Qiyaasta "cholesterol" waxay ku salaysan tahay labo fiirin oo muhiim ah.
Marka hore, baarayaasha waxay muujiyeen waqti dheer ka hor intaan la shaacin in kolesteroolku uu yahay qayb weyn oo ka mid ah jimicsiyada atherosclerotic. Daraasaddan labaad, daraasadaha epidemiological-gaar ahaan, Framingham Heart Study-waxay muujisay in dadka qaba heerarka dhiigga ee sareeya ee kolestaroolka ay leeyihiin khatar aad u weyn oo ah xanuunka wadnaha ee xiga.
Kadib, 1990-meeyadii, tijaabooyin tijaabo ah oo la kala soocay ayaa muujiyay in kooxaha la xulay ee leh heerarka kolesteroolka sareeya ay heleen natiijooyin caafimaad oo kordhay markii heerarka LDL ee loo yaqaan 'kolesterol' la yareeyey daroogada dawooyinka . Khabiiro badan, tijaabooyinkan ayaa waxay caddeeyeen shucaacda kolestaroolka mar iyo dhammaanba.
Su'aalaha Cusub ee ku Saabsan Xaaladda Jadeecada
Si kastaba ha noqotee, sanadka gudahiisa, waxa loo yaqaan 'hypothesis hypothesis' oo su'aallo culus ah. Inkastoo dhowr tijaabo oo tijaabo ah oo daawooyinka loo yaqaan statin ay sii wadaan inay taageeraan taageero xooggan xagga hypothesis, baaritaanno kale oo badan oo kolesteroolka ah, oo isticmaalaya daroogo aan ka ahayn kuwa loo yaqaan 'statins' si loo yareeyo heerarka kolesteroolka, ayaa ku fashilmay inay muujiyaan lacagta bukaan-socodka.
Dhibaatadu waxay tahay, haddii maaddada 'cholesterol hypothesis' dhab ahaantii run tahay, markaa ma aha wax muhiim ah oo daroogada loo isticmaalo si loo yareeyo kolestaroolka; hab kasta oo hoos loogu dhigo kolestaroolka waa in uu hagaajiyo natiijooyinka caafimaad.
Laakiin taasi maahan waxa la arkay. Cilmi-baarisyo ay ka mid yihiin heerarka "kolesterol" ee LDL ayaa aad iyo aad hoos ugu dhacay niacin , ezetimibe , dheecaanka xabagta xiidmaha , fibrates , CETP celiyeyaasha , daaweynta hoormoonka beddelidda haweenka ka dib, iyo cuntooyinka dufanka yar, guud ahaan ma aysan awoodin inay muujiyaan natiijooyinka wadnaha iyo xididdada .
Xaqiiqdii, qaar ka mid ah tijaabooyinkaas, natiijooyinka ka soo baxa wadnaha oo aad u xun ayaa lagu arkay daaweyn, inkastoo ay kordheen heerarka kolesteroolka.
Maaddaama guud ahaan tijaabada guud ee jirka ee tijaabooyinka hoose ee hooseeya, waa wax caddaalad ah in la yareeyo heerarka kolestaroolka leh ee statins ay u muuqato in ay horumariso natiijooyinka wadnaha, laakiin hoos u dhigista waxqabadyada kale maahan. Natiijadani waxay si xoogan u soo jeedinaysaa in faa'iidooyinka hoos u dhaca maaddada "cholesterol" loo arko daaweynta daweynta statin ay gaar u tahay shinni ahaanta, iyo ma noqon karaan kuwo si buuxda u sharraxaya iyadoo si fudud loo yareeyo kolestaroolka LDL. Sababtan awgeed, hypothesis hypothesis, ugu yaraan qaabkeeda caadiga ah, hadda waxay ku jirtaa shaki aad u daran.
Shaki la'aanta sii kordhaya ee ku saabsan shucaacda kolestaroolka ayaa si cad u cadeeyay sannadkii 2013, iyada oo la daabacayo tilmaamaha cusub ee daaweynta kolestaroolka. Burbur weyn oo la leh tilmaamaha hore ee kolesteroolka, version 2013 ayaa ka tanaasulay taladii si loo yareeyo kolestaroolka LDL si heerar gaar ah loo bartilmaameedsado. Taa baddalkeeda, tilmaamaha waxa ay diiradda saaraan go'aansiga dadka ay tahay in lagu daaweeyo statins. Xaqiiqdii, badi bukaanjiifka, tilmaamahaasi guud ahaan waxay kugula talinayaan isticmaalka mukhaadaraadka aan dawada lahayn si loo yareeyo kolestaroolka. Ugu yaraan si taxadar leh, tilmaamahaani waxay ka tageen habka caadiga ah ee cholesterol, sidaa darteed waxay abuureen muran weyn oo ka dhex jira bulshada wadnaha.
Xaaladda si buuxda looga saaro sharraxa "Cholesterol"
Xaaladda lagu dhawaaqayo dhimista hypothesis-ka ayaa sidan oo kale ah: Haddii kolesteroolka sare ee LDL uu dhab ahaantii ahaa sabab toos ah ee atherosclerosis, ka dibna hoos u dhigo heerarka LDL ee kolesteroolka hab kasta oo ay tahay in la horumariyo natiijooyinka wadnaha. Hase yeeshee, ka dib marka la barbardhigo tijaabooyinka kiliinikada yar-yar ee kiliinikada oo isticmaalaya waxyaabo badan oo kala duwan oo loo yaqaan 'cholesterol-lowering agents', natiijadan la filayo maahan waxa la arkay. Sidaa daraadeed, hypothesis waa in ay khalad tahay.
Statins waxay u taagan tahay kiis gaar ah marka ay timaado daaweynta dufanka "cholesterol-lowering". Statins waxay leedahay saameyn badan oo ku saabsan habka wadnaha iyo xididada marka laga reebo hoos u dhigidda heerarka kolesteroolka, iyo waxyaabahan kale (kuwaas oo si wadajir ah u qaadaaya xasilloonida wadnaha atherosclerotic) waxay sharxi karaan wax badan, haddii aysan ahayn, ugu badnaan faa'iidadooda caafimaad. Maandooriyeyaasha ka hooseeya kolestaroolka iyaga oo aan lahayn kuwa kale, dabeecadaha xasaasiga ah waxay u muuqdaan inayan keenin faa'iidada noocan ah. Sidaa daraadeed, waxaa macquul ah in dib loo dhigo in statins aysan dhab ahaantii horumarin khatarta wadnaha oo ay hoos u dhigto heerarka kolestaroolka, laakiin halkii, waxaa laga yaabaa in ay sidaas sameeyaan iyadoo la isticmaalayo waxyaabahan kale ee aan ahayn kolestaroolka.
Dhakhaatiir badan, iyo tiro sax ah ee khubarada baruurta, waxay u muuqdaan inay diyaar u yihiin in ay aqbalaan khadadkaas fekerka iyo inay ka tagaan hypothesis hypothesis.
Kiiskii loogu talagalay in dib loo eego sharraxa "Cholesterol"
Khabiiro kale oo laga yaabo inay badankoodu weli aad u diidaan fikirka ah in heerarka kolesteroolka aysan ahayn muhiim. Waxay qabtaan aragtidan sababtoo ah xaqiiqada sahlan, iyada oo aan loo eegin sida aad u gooyey, marka ay timaado cudurada wadnaha ee atherosclerotic, kolestaroolku waa arin.
Qeybaha Atherosclerotic waxaa si fudud loo buuxiyaa kolestaroolka. Waxaan sidoo kale haynaa cadeyn xooggan oo ah in kolestaroolka uu ku dhammaado dabaqyada waxaa ku jira qaybo LDL ah. Waxaa intaa dheer, waxaa jira ugu yaraan qaar caddayn ah, marka aad hoos u dhigto kolestaroolka LDL ee dhiiga si aad u hooseeya, waxaad xitaa billaabi kartaa inaad bedesho geeddi-socodka atherosclerotic- oo ka dhigo xakamaynta. Marka la eego caddaynta caddaynta, waxay u muuqataa mid si degdeg ah loo ogaado in heerarka kolestaroolka aysan wax muhiim ah lahayn.
Inkastoo astaamaha asaasiga ah ee "cholesterol asal ahaan" si quruxsan u baahan yahay in dib loo eego, waa nooca loo yaqaan hypotheses. Mala-awaalku waa wax aan ka badnayn habka shaqada. Markaad wax badan ka barato, waxaad bedeshaa nooca. Sababtan awgeed, waa waqtigii loogu talagalay hypothesis hypothesis in dib loo eego, looma tagin.
Maxaa dib loo saxay?
Waxay u muuqataa inay hubaal tahay in kolestaroolku uu muhiim u yahay dhismaha hargabka atherosclerotic. Waxa kale oo ay u muuqataa in ay cadahay, marka la kordhiyo kolestaroolka LDL ee ku jira dhiigga si khatar ah khatarta ugu jirta atherosclerosis, waxaa jira sheekooyin badan oo ka badan heerka dhiigga.
Maxay dadka qaarkiis qaba heerarka "kolesterol" ee LDL-da ee marnaba aysan waligood horumarinin atherosclerosis? Maxay dadka qaarkiis qaba heerarka "kolestaroolka" ee caadiga ah ee "LDL" kolesteroolka ay leeyihiin baruur-wadareed oo ballaaran oo kolesterool ah oo buuxa? Maxay hoos ugu dhacaysaa heerarka "kolestaroolka LDL" oo leh hal daroogo oo kobciya natiijada, iyada oo hoos u dhigeysa heerarka LDL ee daroogada kale?
Hadda waa wax iska cad in aaney ahayn heerarka dhiiga ee kolestaroolka oo keliya oo muhiim ah-sidoo kale waa nooca iyo habdhaqanka qaybaha lipoprotein ee qaadaya kolestaroolka. Gaar ahaan, waa sidee iyo marka qaybaha lipoprotein ee kala duwan ay la falgalaan endothelium ee marinnada dhiigga si kor loogu qaado (ama dib u ceshado) dhirta. Tusaale ahaan, hadda waxaan ognahay in qayb ka mid ah kolestaroolka LDL ay ku yimaadaan noocyo kala duwan "dhadhan." Qaar ka mid ah waa kuwa yaryar, cufan oo xoog leh , qaarna waa weyn, "qalafsanaan" qaybo ka mid ah, kuwa horay ugu sii badanaa waxay u badan yihiin inay keenaan atherosclerosis marka loo eego kuwa dambe. Intaas waxaa sii dheer, qaybaha LDL ee kudhaca oxidized ayaa ah kuwa sunta ah ee ku dhaca caafimaadka wadnaha, waxayna aad ugu dhowdahay inay sii xumaato atherosclerosis. Qurxinta iyo "dabeecadda" ee qaybaha LDL-gu waxay u egtahay in ay saameyn ku yeelanayaan heerarka dhaqdhaqaaqa, nooca cuntada aan cunno, heerarka hoormoonka, daawooyinka aan ku qorno, iyo waxyaabaha kale ee aan weli la qeexin.
Cilmi-baadhayaashu si dhaqso ah ayey u baranayaan waxyaabo badan oo ku saabsan lipoprotein kala duwan, iyo waxa ka dhigaya inay u dhaqmaan siyaabo kala duwan, iyo xaalado kala duwan.
Waqtiga qaarkood, waxaa laga yaabaa in aanu yeelanay shey cusub oo la cusbooneysiiyey ee "cholesterol" oo lagu xisaabtamayo waxbarashadayada cusub ee ku saabsan dabeecadaha LDL, HDL iyo dabeecadaha kale ee lipoproteins ee go'aaminaya goorta, iyo inta ay le'eg tahay, kolestaroolka ay qaataan waxaa lagu darayaa jibbaar . Tilmaamahan cusub ee dib loo eegay (inuu noqdo mid waxtar leh) wuxuu soo jeedin doonaa siyaabo cusub oo wax looga beddelo dabeecadaha lipoproteins si loo yareeyo cudurka wadnaha.
Maxaa ku saabsan Ka Hortagga PCSK9?
Khubarada qaarkood waxay sheegteen in natiijooyinka kiliinikada ee hadda la soo sheego ka hortagga PCSK9 ay badbaadiyeen hypothesis hypertesis, gaar ahaan, dib u eegis la'aan wax kasta oo ka mid ah sharuudaha kolestaroolka ayaa loo baahan yahay marka la eego natiijooyinkaas.
Tijaaboadani waxay muujiyeen in marka daaweynta PCSK9 lagu daro daaweynta maximal statin, heerka heerarka hoose ee LDL kolesteroolka ayaa caadi ahaan la gaarsiiyey, heerarkan hooseeya ee hoos udhaca heerka kolesteroolka ayaa kor u kac weyn ku yeeshay natiijooyinka kiliinikada.
Laakiin natiijadani micnaheedu maahan in gogol-celinta caadiga ah ee cholesterol ay dib-u-dhisto. Shakhsiyaadka la soo bartay ee tijaabooyinkaas, ka dib, waxay weli ahaayeen helitaanka daawo sare oo daweyn ah oo daweyn, sidaas darteedna waxay heleen dhammaan faa'iidooyinka "dabeecada" ee dawooyinka dabiiciga ah ee daawada loo yaqaan statin. Sidaa darteed, jawaabtooda kiliinikadooda ma ahan sabab u ah "daahirsanaanta" kolestaroolka. Intaa waxaa dheer, natiijooyinka wanaagsan ee la helay daawooyinka PCSK9 + statins ma diidaan xaqiiqda ah in kolestarool hoos loo dhigo daawooyinka kale iyo hababka kale guud ahaan ku fashilmeen inay muujiyaan faa'iido.
Inkasta oo natiijada hadda la arko inhibitorsada PCSK9, maadada 'hypothesis hypertesis' kuma filna inay sharaxdo waxa la arkay ee tijaabooyinka bukaan socodka.
Khadadka hoose
Muxuu u muuqda inuu yahay mid ku salaysan hypertesis-heerka hoose ee heerarka kolestaroolkaaga hoos u dhigo khatartaada yar -waxaa aad u fudud in la sharaxo nooca natiijooyinka aynu ku aragnay tijaabooyinka hooseeya ee hoos u dhaca ama hababka ugu wanaagsan ee loo yareeyo hoos-u-dhaca kolesteroolka halista wadnaha.
Intaas waxaa dheer, khabiirada ayaa ku haray meel aan fiicneyn halkaasoo falsafad ay nagu qaadeen muddo tobanaan sano ah ay si cad ujireen-laakiin weli diyaar uma aha inay bedelaan.
Iyadoo maskaxda lagu hayo, waxaa muhiim ah in aad xasuusato in isbeddelka hab-nololeedka iyo daawooyinka loo qoray si loo daaweeyo cudurka loo yaqaan 'coronary disease', oo ay ku jiraan daroogooyinka hooseeya ee lipid-, waxay leeyihiin faa'iido la xaqiijiyay. Marna ha joojin koorsada daaweynta adiga oo aan marka hore la hadal dhakhtarkaaga.
> Ilo:
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> Ray KK, Seshasai SR, Erqou S, iyo al. Statins iyo Dhammaan sababaha dhimashada ee Ka Hortagga Aasaasiga Heerka Sare: Falanqaynta Meta-11 ee Maxkamadaynta Xakamaysan ee ku lug leh 65,229 Ka qaybgalayaasha. Arc Intern Med 2010; 170: 1024-31.
> Sabatine MS, Giugliano RP, Kaining AC, et al. Evolocumab iyo Natiijooyinka Kiliiniga ee bukaanka qaba Cudurka Wadnaha. N Engl J Med 2017; DOI: 10.1056 / NEJMoa1615664.
> Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC / AHA Tilmaamaha ku saabsan Daaweynta Dhiigxinjirta Dhiigga si loo yareeyo Khatarta Wadnaha ee Atherosclerotic ee Dadka Qaangaarka ah: Warbixin ka timid Kulliyoolajiyada Mareykanka ee Wadnaha / Isku-kalsoonida Mareykanka. J Am Coll Cardiol 2013.