Muddo labaatameeyo sano ah, waxa uu ahaa dogma-ga oo ah in kolestaroolka HDL uu yahay nooca "wanaagsan" ee kolestaroolka, in heerarkaaga HDL-daagu uu sarreeyo halista wadnahaaga, iyo in kor loo qaado heerarka HDL ee kolestaroolka waa fikrad aad u wanaagsan. Laakiin natiijooyinka niyadjabsan ee tijaabooyin dhowr ah oo dhowaan la sameeyey ayaa waxa loo yaqaan dogma su'aasha.
Waa maxay sababta HDL loo tixgeliyo "wanaagsan"
Kolestaroolka HDL waxaa loo maleynayaa inuu kor u qaadayo kolestaroolka xad-dhaafka ah ee darbiyada xididdada dhiigga, sidaa darteed ka saara meeshii ay ka qayb qaadan karto atherosclerosis .
Waxaa intaa dheer, baadhitaanada epidemiological ee ku lug leh in ka badan 100,000 shakhsiyood, dadka qaba heerarka kolestaroolka HDL ee ka hooseeya 40 mg / dL waxay leeyihiin khatar aad u sareysa wadnaha oo ka sarreeya kuwa leh heerar sare HDL. Tani waa xitaa marka xitaa marka kolestaroolka LDL ("kolesterol" badhkeedu hooseeyo). Heerarka sare ee HDL ayaa sidoo kale lala xiriiriyay khatarta dhimista naasaha, xiidanka iyo kansarka sanbabada.
Laga soo bilaabo daraasadahan oo kale waxay aaminsan yihiin in qaadashada tallaabooyin lagu kordhinayo heerarka HDL waa fikrad wanaagsan. Tani waa waxa loogu yeero "HDL hypothesis": heerarkaaga HDL-ga oo sarreeya, khatarta hoose ee wadnahaaga.
Sidee Loo Qaadi Karaa Heerarka HDL?
Heerarka HDL waxay u muuqdaan inay si aad ah u saameeyeen isku darka waxyaabo hiddaha iyo deegaanka. Dumarka waxay u muuqdaan inay heerarka HDL-ka ka badan yihiin ragga (celcelis ahaan 10 mg / dL).
Dadka u culus, suuxdin, ama qaba sonkorowga ama dheef-shiid kiimikaad hooseeya waxay u muuqdaan inay leeyihiin heerar hoose HDL.
Aalkoladu wuxuu u muuqdaa inuu kordhayo HDL qaddar yar; dufanka trans -ka ee cuntada ayaa hoos u dhigta.
Daawooyinka caadi ahaan loo isticmaalo in lagu yareeyo kolestaroolka LDL ayaa saameyn yar ku leh heerka HDL. Statins , oo ah kuwa ugu badan ee loo isticmaalo daroogooyinka yar-yar ee daroogada, waxay kor u qaadaan HDL keliya oo keliya.
Fibrates iyo niacin waxay kor u qaadaan HDL qadar dhexe.
Qeybta ugu badan, sababtoo ah ma jiraan daroogo si qumman u soo saari kara korodhka HDL, talooyinka sii kordhaya ee kolestaroolka HDL waxay ku salaysan yihiin xakamaynta miisaanka iyo helitaanka jimicsiyo badan, iyada oo la jahawareerayo talooyinka cuntada ee lagu tuurayo.
Burburinta biyaha on Hypothesis HDL
Sababtoo ah kordhinta heerarka HDL waxaa loo maleynayaa inay tahay wax faa'iido leh, iyo maadaama aysan jirin hab fudud oo lagu kalsoonaan karo oo lagu sameeyn karo, horumarinta mukhaadaraadka oo si xoog leh kor u qaata heerarka HDL ayaa noqdey ujeedo weyn oo loogu talagalay dhowr shirkadood oo daawo. Xaqiiqdii, dhowr ka mid ah daroogooyinkaas ayaa la sameeyay, waxaana ay keeneen tijaabooyin caafimaad si ay u muujiyaan amaankooda iyo waxtarkooda.
Ilaa hadda, daraasaddan ayaa niyadjabay, in la yiraahdo ugu yaraan. Markii ugu horeysay ee tijaabo ah (oo lagu dhameeyo 2006) oo la yiraahdo daroogada ugu horeysa ee CETP, torcetrapib (laga soo bilaabo Pfizer), ma aha oo keliya inay ku fashilmeen inay hoos u dhigto khatarta marka HDL la kordhiyay, laakiin dhab ahaantii waxay muujinaysaa koror ku yimid khatarta wadnaha. Daraasad kale oo lala yeeshay CETP horjooge kale - dalcetrapib (laga bilaabo Roche) - ayaa la joojiyay bishii May 2012 sababtoo ah wax ka qabasho la'aanta. Labada daawadood ee la xidhiidha ayaa si weyn u kordhiyay heerarka HDL, laakiin sidaas darteed ma aysan dhicin wax faa'iido caafimaad ah.
Daraasad kale oo niyadjab leh (AIM-HIGH) ayaa la daabacay sannadkii 2011-kii, oo lagu qiimeeyay faa'iidada niacin (si loo kordhiyo heerarka HDL) ee daaweynta daweynta. Daraasadani ma aha oo keliya inay muujiso wax faa'iido leh oo ka timaadda heerarka HDL ee niacin laakiin waxay sidoo kale soo jeedisay in halista istaroogga la kordhiyay bukaannada qaadanaya niacin.
Ugu dambeyntiina, baaritaan ka soo baxay Lancet 2012 ayaa qiimeeyay faa'idada ka dhalatay mid ka mid ah noocyada kala duwan ee hidde-yada ee kordhiya heerka HDL. Cilmi baadhayaashu ma awoodin inay muujiyaan in dadka haysta noocaan oo kale ah ay ku riyaaqeen hoos u dhaca khatarta wadnaha.
Natiijooyinka daraasaddan waxay leeyihiin qof walba (xitaa saynisyahanno kuwaas oo u goynayay xirfadahooda cilmi-baarista HDL) iyagoo shaki ka qaba in hufnaanta HDL ay sax tahay.
A New Hypothesis Hypothesis
Marka ugu yaryar, waxay u muuqataa in maadada 'HDL hypothesis' (oo ah heerarka sii kordhaya ee "kolestaroolka HDL") waa wax aan caadi ahayn. Marka kolestaroolka HDL lagu guuleysto by CETP -hibayaasha, by niacin, ama noocyo kala duwan oo hidde ah, wax faa'iido ah lama soo bandhigin.
Cilmi-baarayaasha HDL waxay ku jiraan habka dib-u-eegista sawir-qaadkooda fudud ee HDL. Waxaa soo baxday in marka aan cabirno "kolestaroolka HDL," dhab ahaantii waxaannu cabirnaa noocyo badan oo kala duwan. Waxaa macquul ah, waxaa jira qaybo waaweyn oo HDL iyo kuwa yaryar, kuwaas oo metelaya wejiyada kala duwan ee dheef-shiid kiimikaadka HDL.
Qaybaha HDL yaryar waxay ka kooban yihiin lipoprotein ApoA-1 , oo aan lahayn kolestarool badan. Sidaa daraadeed, qaybaha yar yar ee HDL ayaa loo maleyn karaa inay yihiin "lipoproteins" madhan, kuwaas oo ku socda si ay u xoqaan kolesteroolka xad-dhaafka ah ee unugyada. Taa bedelkeeda, qaybo badan oo HDL ah ayaa ku jira baruur badan. Qaybahaani waxay horey u sameeyeen shaqadooda qallafsan, waxayna sugayaan in dib loo celiyo beerka.
Marka la eego fahankan cusub, kordhinta tirada qaybaha waaweyn ee HDL waxay keeni kartaa in heerka dhiigga HDL-da uu sarreeyo - laakiin ma wanaajineyno "" xajinta "" cholesterol ". Dhinaca kale, kordhinta qaybaha HDL-yada yar waa inay hagaajiyaan qaadista kolesteroolka xad-dhaafka ah ee dhiigga derbiyada saaran.
Taageerada isbedelkan dib loo eegay ayaa ah xaqiiqda ah in CETP xannibaadayaasha (daawooyinka ku fashilmay tijaabooyinka kiliinikada) ay u muuqdaan in ay keenayaan kororka qaybo badan oo HDL ah, oo aan ahayn kuwa yaryar.
Hadafyada cusub ee daaweynta HDL
Tilmaamaha cusub ee HDL wuxuu tilmaamayaa baahida loo qabo in kor loo qaado qaybo yar oo HDL ah.
Si loo dhammaystiro, qaababka suugaaneed ee ApoA-1 ayaa lagu horumariyaa oo laga baaraa bini-aadanka. Nasiib darro, nasiib daro, waxay u baahan tahay faleebo faleebo ah ee ApoA-1 - sidaas darteed waxaa loola jeedaa xaaladaha degdega ah, sida cilladda 'coronary syndrome' . Daraasadaha hore waxay ahaayeen kuwo aad u dhiirri gelinaya, iyo tijaabooyin bini'aadanimo ayaa socda.
Sidoo kale, daroogada tijaabada ah (illaa hadda waxaa lagu magacaabaa RVX-208 - Resverlogix) ayaa la sameeyay kaas oo kordhiya soo-saarka jirka ee ApoA-1. Dawadan afka ah ayaa sidoo kale lagu tijaabiyaa tijaabooyinka aadanaha.
Intaa waxaa dheer, shaqo ayaa la sameeyaa si loo abuuro daroogo dhiirigeliya ABCA1, enzyme ee unugyada ku dhiirigeliya gudbinta kolestaroolka qaybaha HDL.
Sidaa daraadeed, cilmi-baarayaashu waxay diiradda saarayaan sidii ay u heli lahaayeen siyaabo badan oo kor loogu qaado, ama lagu hagaajiyo hawsha, qaybaha yar yar ee HDL (oo ah hoormoonka cusub) ayaa ka mas'uul ah yaraynta khatarta wadnaha.
Waqtiga uu socdo
Inkastoo aan sugeyno aqoonyahanka si ay u xalliyaan arrimahan oo dhan, iyo in la horumariyo loona tijaabiyo habab cusub si loo kordhiyo "nooca saxda ah" ee HDL , dhammaanteen waan sii wadi karnaa waxqabadyada aan ognahay labadaba kor u kaca kolesteroolka HDL oo yarayn kara khatarta wadnaha . Dhammaan waxyaalahan waa kuwo macquul ah, badbaado iyo waxtar leh.
> Ilo:
Voight BF, Peloso GM, Orho-Melander M, iyo al. Plasma HDL ee kolestaroolka iyo khatarta ah xanuunka miyokardiyaanka: Daraasad aan kala go 'lahayn. Lancet 2012; DOI: 10.1016 / S0140-6736 (12) 60312-2.
Roche, Inc. Roche waxay bixisaa cusbooneysiin ku saabsan daraasadda wajiga III ee dalxiiska [saxaafadeed]. May 12, 2012.
Michos ED, Sibley CT, Baer JT, et al. Niacin iyo daaweynta dabiiciga ah ee daaweynta loo yaqaan 'atherosclerosis regression' iyo ka hortagga dhacdooyinka cudurka wadnaha. J Am Coll Cardiol 2012; DOI: 10.1016 / j.jacc.2012.01.045.
Gawaarida M, Bots ML, van Leuven SI, iyo al. Nadiifiyaha borotiinka ee xayawaanka ku saldhigma cholesteryl and torchetrapib off-targetx. Falanqayn ballaaran oo ku saabsan Calaamadaha Atherosclerotic Disease Isbedelka Imtixaanka cusub ee CETP Inhibitor (RADIANCE). Wareegga 2008; DOI: 10.1161 / CIRCULATIONAHA.108.772665.