Dadka qaba xanuunka loo yaqaan 'coronary artery disease' (CAD) da'da yar ayaa laga yaabaa in ay qabaan dhibaatada dhalata ee leh kolestaroolka, gaar ahaan haddii cudurka wadnaha ee hore uu u muuqdo inuu qoysku ku jiro. Nooca ugu caansan ee xaalad hidda ah ee saameeya kolestaroolka waa hypercholesterolemia.
Cudurka hypercholesterolemia waa shaybaar hidde ah kaas oo heerarka LDL ee kolesteroolka ay ka sarreeyaan waqtiga dhalashada.
Dadka qaba xanuunka 'hypercholesterolemia familial' waxay leeyihiin khatar aad u daran oo ah CAD-da hore, istaroogga , iyo cudur ku dhaca halbowlaha . Xaqiiqdii, dad badan oo qaba infakshanka miyokardiyanka ah ee da'doodu yartahay ayaa u muuqda inay xaaladdaan ku dhacdo.
Nasiib wanaag, ula socoshada daaweynta gardarrada ah ee hoos udhaca heerarka kolestaroolka , khatarta cudurka wadnaha ayaa si weyn hoos loogu dhigi karaa. Sababtan awgeed, waxaa muhiim ah in la ogaado xanuunka loo yaqaan 'hypercholesterolemia' sida ugu macquulsan - iyo inaad hubiso in xubnaha qoyska ee qofkasta oo qaba xaaladdan sidoo kale ay baaritaan ku sameeyaan dhiigga.
Sababaha
Cudurka hypercholesterolemia ee qoysku wuxuu sababi karaa dhowr cillado hidde ah, badankooduna saameyn ku yeeshay baraha loogu talagalay kolestaroolka LDL. Marka daaweeye LDL uusan si caadi ah u shaqeynin, kolestaroolka LDL looma hubin si kaamil ah dhiigga. Sidaas daraadeed, kolestaroolka LDL wuxuu ku jiraa dhiigga. Heerarkan xad-dhaafka ah ee kolestaroolka LDL ayaa si aad ah u dardar- galiya cudurka atherosclerosis iyo cudurada wadnaha.
Calaamadaha hidde-keena ee keena hypercholesterolemia waa mid dhaxli kara aabaha, hooyada ama labada waalidba. Dadka ka dhaxlay xaalada u dhaxeeya labada waalid ayaa la sheegay inay noqdaan kuwo uurka ku jira ee loogu talagalay hypercholesterolemia. Nooca ugu caansan ee foosha 'hypercholesterolemia' waa nooc aad u daran oo cudur ah.
Waxay ku dhacdaa hal qof 250,000 oo qof.
Dadka u dhaxeeya hidda-wadaha aan caadiga ahayn ee waalidka kaliya ayaa la sheegay inay tahay heterozygous for familial hypercholesterolemia. Tani waa nooc ka mid ah cudurkaan, laakiin waxay si weyn u kordhisaa halista wadnaha ee qofka. Qiyaastii hal qof oo ah 500 oo qof ayaa leh hargab-ku-caabinta foosha-xun ee "hypercholesterolemia".
Taasi waa dad badan.
In ka badan 1000 nooc oo isku-dhafan oo kala duwan oo lagu saameeyo hiddo-qaadeyaasha LDL ayaa la ogaaday, mid walbana wuxuu saameyn ku yeeshay maqaariyaha LDL si kala duwan. Sababtan awgeed, ma aha dhammaanba hypercholesterolemia waa isku mid. Xanuunku aad ayuu u kala duwanaan karaa, taas oo ku xidhan nooca gaarka ah ee isbeddelka hidde-wadaha qofku leeyahay.
Ciladeynta
Dhakhaatiirtu waxay sameeyaan baaritaanka foosha 'hypercholesterolemia' ayadoo lagu qiyaaso heerarka dhiigga ee dhiigga, iyo tixgelinta taariikhda qoyska iyo imtixaanka jirka.
Imtixaanka dhiigga ee dadka qaba foosha 'hypercholesterolemia' ayaa muujiya heerarka sarreeya ee kolestaroolka iyo heerarka sare ee kolesteroolka LDL. Heerka wadarta guud ee kolestaroolka leh xaaladdan badanaa wuxuu ka weyn yahay 300 mg / dl dadka waaweyn, oo ka weyn 250 mg / dl carruurta. Heerka LDL wuxuu caadi ahaan ka weyn yahay 200 mg / dl dadka waaweyn, iyo in ka badan 170 mg / dl carruurta.
Heerarka Triglyceride caadi ahaan ma ahan mid sare u kacsan dadka qaba xaaladan.
Qofkasta oo qaba foosha 'hypercholesterolemia' waxay u badan tahay inuu haysto qaraabo kuwaas oo xitaa xaaladdiisa. Sidaas darteed taariikhda qoyseed ee cudurada wadnaha ee hore waxay noqon kartaa mid calaamad u ah dhakhtarka si uu u tixgeliyo cudurkaan.
Xanuunada hypercholesterolemia waxaa kale oo ay sababi kartaa qoyaan dufan leh si ay u hormarsato qoorta, jilbaha, jilicsanaanta, iyo hareeraha indhaha. Kaydinta dufankan waxaa lagu magacaabaa " kedthomas" . Maydhayaasha kolesteroolka ee indhaha, loo yaqaan xanthelasmas , ayaa sidoo kale caadi ah. Mar kasta oo uu bukaanku leeyahay xanthomas ama xandelasmas, ogaanshaha cudurka hypercholesterolemia waa in uu markiiba yimaadaa maskaxda.
Cilad-celinta qanjirka 'hypercholesterolemia' ee qoysku waa la samayn karaa haddii heerarka "LDL" ee heerarka "kolesterol" aad u sarreeyaan, heerarka triglyceride waa caadi, iyo taariikhda qoyskaba waa mid la mid ah. Haddii xitaa daawada xanthomas ama xanthelasmas, waxaa sidoo kale loo tixgelin karaa cilad-celinta si cad. Imtixaanka hiddo-qaadashada wuxuu noqon karaa mid caawimaad leh (laakiin badanaaba lagama-maarmaan maaha) sameynta baaritaanka, wuxuuna noqon karaa mid wax ku ool ah ujeedooyinka la-talinta hidda-socodka.
Cudurada xididada keenta ee ay keento hypercholesterolemia waxay bilaabmaysaa xilliga carruurnimada. Sidaa awgeed carruurta qoysaska qaba cudurkaan waa in si joogto ah loo baaro heerka heerarka sare ee LDL kolesteroolka da'doodu tahay sideed sideed. Haddii heerarka kolesteroolka ay sare u kacaan, daaweyntu waa inay si adag u tixgeliyaan.
La xiriirka Cudurka Wadnaha
Ka hor inta aan la helin dawooyinka dawooyinka Statin , dhacdooyinka cudurrada wadnaha iyo kaadi-socodka ayaa aad u sareeya dadka qaba foosha 'hypercholesterolemia' iyo qoysaskooda. Daraasad ballaadhan oo la sameeyay intii lagu jiray 1970-yadii (kahor statins), 52 boqolkiiba qaraabada ragga ah ee bukaannada qaba hargabku waxay qabaan cudur wadne ah 60 jir (marka loo eego khatarta laga filayo 13 boqolkiiba), iyo boqolkiiba 32 gabadha dumarka ahi waxay qabeen cudurka wadnaha marka loo eego 60 jir (marka la barbardhigo khatarta laga filayo 9 boqolkiiba) Daraasaddan ayaa gurigeeda ku waday dabeecadda qoysaska ee xaaladdan.
Daaweynta
Horumarinta awooda, "daroogada labaad" daawooyinka dawada ee Statin ayaa bedelay maamulka maadada hypercholesterolemia. Ka hor inta aan la helin daawooyinkan xooggan, daaweynta cudurkaan waxay u baahan tahay isticmaalka daawooyin badan, oo ay ka mid yihiin daawooyinka yar yar ee 'ilmo-dhaliye' ah ee dawada. Inkasta oo habkan daroogada badani uu hoos u dhigo khatarta wadnaha ee loo yaqaan 'cardiovascular risk', daaweynta ayaa adkaan karta in la dulqaado, waana ay adag tahay in la maareeyo.
Iyadoo horumarinaysa jiilka labaad ee jilicsan ee loo yaqaan 'statins -atorvastatin' (Lipitor), rosuvastatin (Crestor), ama simvastatin (Zocor) - habka lagu daaweynayo foosha 'hypercholesterolemia' ayaa isbeddelay. Daaweynta ayaa hadda la bilaabay qiyaas aad u sareeya oo ah hal darajo labaad ah oo daawada statin ah. Daawooyinkaan guud ahaan waxay keenaan hoos u dhac ku yimaada heerarka LDL ee kolesteroolka, waxayna sidoo kale soo saari karaan xaddiga dhabta ah ee dabaqyada atherosclerotic .
Cilmi-baarisyada eegay in ay ku daraan daroogooyin dheeraad ah (gaar ahaan, Ezitimibe / Vytorin ), illaa jiilalka labaad ayaa ku fashilmay inay muujiyaan wixii horumar ah ee dheeraad ah ee natiijooyinka kiliinikada. Sidaa darteed, bukaanka qaba heterozygous familial hypercholesterolemia (foomka "fudud"), daawo qiyaas ah, daaweyn hal dawo ah oo leh dawooyinka labaad ee jiilka ayaa weli ah daaweynta lagu taliyey.
Sannadka 2015, FDA waxay ogolaatay daroogo cusub oo daroogo ah - PCSK9 inhibitor - loogu talagalay bukaanada qaba hurgun-cholesterol. Marka mid ka mid ah daroogooyinkaas lagu daro statin, hoos u dhaca qiimaha leh ee heerarka LDL ee kolesteroolka ayaa la gaari karaa. Doorka ka hortagga PCSK9 ee lagu daaweeyo hargabka xun ee hargabka xun ee "hypercholesterolemia" waa mid aan caddayn, tan iyo markii tijaabooyinka bukaan socodka ee loogu talagalay muujinta in isku-dhafkan uu hagaajiyo natiijooyinka caafimaad ee wali wali socdo. Weli, daroogooyinka cusub ee xooggan ayaa laga yaabaa in lagu daro qiyaasta tallaalka dheeraadka ah haddii kolestaroolka LDL uu si weyn kor ugu kaco daaweynta statin oo kali ah.
Inkastoo heerarka kolesteroolka ee sareeya ay aad u kordhinayaan khatarta cudurka wadnaha ee dadka qaba foosha 'hypercholesterolemia', isbeddellada kale ee wadnaha iyo xididada ayaa weli muhiim ah. Sidaa daraadeed waa arrin muhiim ah oo daaweynteedu tahay in si taxadar leh loo xakameeyo dhammaan waxyaabaha keena khatarta cudurada wadnaha, gaar ahaan sigaarcabka, buurnaanta, jimicsi la'aanta, iyo cadaadiska dhiigga .
Foomka Homozygous
Bukaannada qaba qaabdhismeedka cagaarshowga (familial hypercholesterolemia), khatarta wadnaha iyo dhiig-baxa waa mid aad u sareysa in daaweyn degdeg ah lagu taliyo isla markiiba marka xaaladda la ogaado. Sababtoo ah heerarka sarreeya ee kolestaroolka lagu arko bukaankan, talooyinka hadda jira ayaa ah inay bilaabaan daweynta leh labadaba dawooyinka sare iyo daawada PCSK9.
Xitaa haddii noocaan daaweynta gardarada ah ee dagaalka, haddana, mararka qaarkood, heerarka kolestaroolka ayaa weli sarreeya. Xaaladahan, daaweynta xanuunka ' apheresis' waxaa laga yaabaa in looga baahdo in ay hoos u dhigto heerka kolesteroolka.
Soo koobid
Qanjirka 'hypercholesterolemia' waa xummad halis ah oo ka timaadda dheef-shiid kiimikaadiyadeed. Dadka qaba xanuunka 'hypercholesterolemia' waxay u baahan yihiin daaweyn gardarrada ah si loo yareeyo heerarka kolestaroolka iyo in la xakameeyo waxyaabaha kale ee khatarta wadnaha, si loo yareeyo khatarta cudurka wadnaha ee hore. Sidoo kale aad ayey muhiim u tahay xubnaha qoyskooda in lagu baaro xaaladaas.
Ilaha:
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Wiegman A, Rodenburg J, de Jongh S, iyo al. Taariikhda qoyska iyo khatarta wadnaha ee wadnaha lagu magacaabo hypercholesterolemia: macluumaadka in ka badan 1000 carruur ah. Wareegga 2003; 107: 1473.
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Sabatine MS, Guigliano RP, Wiviott SD, et al. Waxtarka iyo nabadgelyada evolocumab ee yareynta lipids iyo dhacdooyinka wadnaha. N Engl J Med 2015; DOI: 10.1056 / NEJMoa1500858.