Disturbance of a lipometabolism
Contents:
Description:
A number of diseases is caused by disturbance of lipidic exchange. The major among them it is necessary to call atherosclerosis and obesity. Diseases of cardiovascular system, as a result of atherosclerosis, win first place in structure of mortality in the world. One of the most widespread displays of atherosclerosis - defeat of coronary vessels of heart. Accumulation of cholesterol in walls of vessels leads to formation of atherosclerotic plaques. They, increasing in a size over time, can block a gleam of a vessel and interfere with a normal blood-groove. If thereof the blood stream is broken in coronary arteries, then there is stenocardia or a myocardial infarction. Predisposition to atherosclerosis depends on concentration of transport forms of lipids of blood of alpha lipoproteins of plasma.
Accumulation of cholesterol (XC) in a vascular wall happens owing to an imbalance between receipt it in an intima of vessels and its exit. As a result of such imbalance cholesterol collects there. In the centers of accumulation of cholesterol structures - atheromas form. Two factors which cause disturbance of lipidic exchange are most known.
1. First, it changes of particles of LPNP (a glycosylation, peroxide oxidation of lipids, hydrolysis of phospholipids, oxidation апо In). Therefore they are captured special cells - "dustmen" (mainly, macrophages). Capture of lipoprotein particles by means of "garbage" receptors proceeds uncontrolledly. Unlike апо В/Е - the mediated endocytosis it does not cause the regulatory effects directed to decrease in receipt in a cell of XC, described above. As a result macrophages are overflowed with lipids, lose function of absorption of waste and turn into foamy cells. The last are late in a wall of blood vessels and begin to cosecrete the growth factors accelerating cellular division. There is an atherosclerotic proliferation of cells.
2. Secondly, this inefficient release of cholesterol from an endothelium of a vascular wall circulating in LPVP blood.
The factors influencing the increased LPNP level at the person
- A floor - at men is higher, than at women in a premenopauza, and below, than at women in a postmenopause
- Aging
- Saturated fats in a diet
- High consumption of cholesterol
- A diet with the low maintenance of rough fibrous products
- Alcohol consumption
- Pregnancy
- Obesity
- Diabetes
- Hypothyroidism
- Cushing's disease
- Uraemia
- Nephrosis
- Hereditary lipidemias
The disturbances of lipidic exchange (dislipidemiya) which are characterized first of all by the increased content in blood of cholesterol and triglycerides are the most important risk factors of atherosclerosis and the related diseases of cardiovascular system. Concentration in a blood plasma of the general cholesterol (XC) or its fractions, closely correlates with incidence and mortality from an ischemic heart disease and other complications of atherosclerosis. Therefore the characteristic of disturbances of lipidic exchange is an indispensable condition of effective prevention of cardiovascular diseases.
Disturbance of lipidic exchange can be primary and secondary and are characterized only by increase in content of cholesterol (the isolated hypercholesterolemia), triglycerides (the isolated gipertriglitseridemiya), triglycerides and cholesterol (the mixed lipidemia).
Primary disturbance of lipidic exchange is determined by single or multiple mutations of the corresponding genes as a result of which hyperproduction or disturbance of utilization of triglycerides and LPNP cholesterol or hyperproduction and disturbances of clearance of LPVP is observed.
Primary disturbance of lipidic exchange can be diagnosed for patients with clinical symptoms of these disturbances, at the early beginning of atherosclerosis (up to 60 years), for persons with the family anamnesis of atherosclerosis or at increase in content of cholesterol of serum> 240 mg/dl (> 6,2 mmol/l).
Secondary disturbance of lipidic exchange arises, as a rule, at the population of the developed countries as a result of a slow-moving way of life, consumption of the food containing a large amount of cholesterol, saturated fatty acids.
Can be other reasons of secondary disturbance of lipidic exchange:
1. Diabetes mellitus.
2. Alcohol abuse.
3. Chronic renal failure.
4. Hyper thyroidism.
5. Primary biliary cirrhosis.
6. Reception of some drugs (beta-blockers, anti-retrovirus drugs, estrogen, progestins, glucocorticoids).
Inherited disorders of lipidic exchange:
At a small number of people the inherited disorders of exchange of lipoproteins which are shown in hyper - or gipolipoproteinemiya are observed. Them disturbance of synthesis, transport or splitting of lipoproteins is the reason.
Symptoms of Disturbance of a lipometabolism:
In an epithelium of a small bowel continuous processes of synthesis of fats from the fatty acids and glycerin which is soaked up from intestines proceed. At colitis, dysentery and other diseases of a small bowel absorption of fats and fat-soluble vitamins is broken. Lipodistophies can arise in the course of digestion and absorption of fats. These diseases are of especially great importance at children's age. Fats are not digested at pancreas diseases (for example, at acute and chronic pancreatitis), etc. Disorders of digestion of fats can be connected also with the insufficient intake of bile in intestines caused by various reasons. And, at last, digestion and absorption of fats are broken at the gastrointestinal diseases which are followed by the accelerated passing of food on went. - киш. to a path, and also at organic and functional lesion of a mucous membrane of guts.
There is one more group of diseases which reasons are not clear: a Gee's disease at children (organism poisoning with products of incomplete digestion of some proteins), a "spontaneous" fatty diarrhea at adults, etc. At these diseases digestion and absorption of fats are also broken. For definition of extent of digestion of fats investigate kcal on availability of fat.
Blood of the person contains significant amounts of neutral fats, free fatty acids, phosphatides, sterols, etc. The quantity them changes N of dependence on age, food loading, fatness and a physiological condition of an organism. Normal it fluctuates from 400 to 600 mg of %. However the general maintenance of lipids is defined seldom, measure the number of separate fractions and a ratio between them more often. The increased content of neutral fats is a sign of disturbance of mechanisms of use of the fats arriving with food for creation of fats of an organism; besides, it can demonstrate transfer of a part of these mechanisms into the increased cholesterol synthesis. The increased maintenance of lipids in blood (hyperlipemia) is observed at starvation, a diabetes mellitus, nefroza, acute hepatitises, exudative diathesis and some other diseases. In the latter case it is necessary to remember that loading fats of sick children can lead to strengthening of skin rashes.
Hyperlipemias are observed at poisonings and intoxications, especially if the liver is involved in pathological process. Concentration of lipil in blood increases at insufficiency of closed glands (a thyroid gland, adrenal glands, gonads). The lowered maintenance of lipids (hypo-lipemia) is observed at dystrophy as result of use of fat depos, at a hyperthyroidism as a result of the strengthened oxidation of fats.
Urine of the healthy person contains only traces of fats - apprx. 2 mg in 1 l (at the expense of lipoblasts of an epithelium of urinary tract). The hyperlipemia which resulted from plentiful intake of fat with food can be followed by emergence of fat in urine (an alimentary lppuriya). The lipuria can be observed after reception of fish oil. It quite often accompanies diabetes, a heavy pulmonary tuberculosis, an urolithiasis, nefroza, phosphoric and alcoholic poisoning.
Lipometabolism causes of infringement:
A number of diseases is caused by disturbance of lipidic exchange. The major among them it is necessary to call atherosclerosis and obesity. Diseases of cardiovascular system, as a result of atherosclerosis, win first place in structure of mortality in the world. One of the most widespread displays of atherosclerosis - defeat of coronary vessels of heart. Accumulation of cholesterol in walls of vessels leads to formation of atherosclerotic plaques. They, increasing in a size over time, can block a gleam of a vessel and interfere with a normal blood-groove. If thereof the blood stream is broken in coronary arteries, then there is stenocardia or a myocardial infarction. Predisposition to atherosclerosis depends on concentration of transport forms of lipids of blood of alpha lipoproteins of plasma.
Accumulation of cholesterol (XC) in a vascular wall happens owing to an imbalance between receipt it in an intima of vessels and its exit. As a result of such imbalance cholesterol collects there. In the centers of accumulation of cholesterol structures - atheromas form. Two factors which cause disturbance of lipidic exchange are most known.
1. First, it changes of particles of LPNP (a glycosylation, peroxide oxidation of lipids, hydrolysis of phospholipids, oxidation апо In). Therefore they are captured special cells - "dustmen" (mainly, macrophages). Capture of lipoprotein particles by means of "garbage" receptors proceeds uncontrolledly. Unlike апо В/Е - the mediated endocytosis it does not cause the regulatory effects directed to decrease in receipt in a cell of XC, described above. As a result macrophages are overflowed with lipids, lose function of absorption of waste and turn into foamy cells. The last are late in a wall of blood vessels and begin to cosecrete the growth factors accelerating cellular division. There is an atherosclerotic proliferation of cells.
2. Secondly, this inefficient release of cholesterol from an endothelium of a vascular wall circulating in LPVP blood.
The factors influencing the increased LPNP level at the person
- A floor - at men is higher, than at women in a premenopauza, and below, than at women in a postmenopause
- Aging
- Saturated fats in a diet
- High consumption of cholesterol
- A diet with the low maintenance of rough fibrous products
- Alcohol consumption
- Pregnancy
- Obesity
- Diabetes
- Hypothyroidism
- Cushing's disease
- Uraemia
- Nephrosis
- Hereditary lipidemias
The disturbances of lipidic exchange (dislipidemiya) which are characterized first of all by the increased content in blood of cholesterol and triglycerides are the most important risk factors of atherosclerosis and the related diseases of cardiovascular system. Concentration in a blood plasma of the general cholesterol (XC) or its fractions, closely correlates with incidence and mortality from an ischemic heart disease and other complications of atherosclerosis. Therefore the characteristic of disturbances of lipidic exchange is an indispensable condition of effective prevention of cardiovascular diseases.
Disturbance of lipidic exchange can be primary and secondary and are characterized only by increase in content of cholesterol (the isolated hypercholesterolemia), triglycerides (the isolated gipertriglitseridemiya), triglycerides and cholesterol (the mixed lipidemia).
Primary disturbance of lipidic exchange is determined by single or multiple mutations of the corresponding genes as a result of which hyperproduction or disturbance of utilization of triglycerides and LPNP cholesterol or hyperproduction and disturbances of clearance of LPVP is observed.
Primary disturbance of lipidic exchange can be diagnosed for patients with clinical symptoms of these disturbances, at the early beginning of atherosclerosis (up to 60 years), for persons with the family anamnesis of atherosclerosis or at increase in content of cholesterol of serum> 240 mg/dl (> 6,2 mmol/l).
Secondary disturbance of lipidic exchange arises, as a rule, at the population of the developed countries as a result of a slow-moving way of life, consumption of the food containing a large amount of cholesterol, saturated fatty acids.
Can be other reasons of secondary disturbance of lipidic exchange:
1. Diabetes mellitus.
2. Alcohol abuse.
3. Chronic renal failure.
4. Hyper thyroidism.
5. Primary biliary cirrhosis.
6. Reception of some drugs (beta-blockers, anti-retrovirus drugs, estrogen, progestins, glucocorticoids).
Inherited disorders of lipidic exchange:
At a small number of people the inherited disorders of exchange of lipoproteins which are shown in hyper - or gipolipoproteinemiya are observed. Them disturbance of synthesis, transport or splitting of lipoproteins is the reason.
Treatment of Disturbance of a lipometabolism:
Lovastatin — the first of statines which began to be applied in 1987. The initial dose of 20 mg is appointed right after a dinner once a day. Desirable level of LNP cholesterol is usually reached when 40 mg/days are accepted. Now in Russia it is practically not applied as in the pharmaceutical market there are more modern and effective drugs.
Simvastatin — is twice more active than a lovastatin, i.e. reception of 10 mg of this drug causes the same decrease in LNP cholesterol as reception of 20 mg/days of a lovastatin. It is especially shown at the high level of the general cholesterol. The initial dose of a simvastatin makes 20 mg/days and is appointed once a day. The dose of 40 mg/days most often allows to reach the normal level of LNP cholesterol and decrease in risk of cardiovascular diseases. The maximum dose of 80 mg/days is applied seldom in view of risk of development of complications, such as increase in liver enzymes (disturbance of work of hepatocytes) and a rabdomioliz (destruction of muscle fibers).
Pravastatin represents the active agent which is not demanding transformations in a liver. It reduces risk of cardiovascular complications approximately by 30%. Drug is appointed in a dose of 20-40 mg/days. Reception is possible at any time that, certainly, it is convenient for the patient.
Fluvastatin — the first statine received completely synthetic in the way. Drug prevents development of serious cardiovascular complications, for example a myocardial infarction, unstable stenocardia, etc. It is appointed in a dose of 20-40 mg/days. Apply a special form of the slowed-down release more often — on 80 mg once a day. In view of rather sparing action on a liver флувастатин it is possible to accept along with other drugs reducing cholesterol (for example from fibrata).
Atorvastatin — synthetic statine of the third generation. Surpasses in efficiency симвастатин and флувастатин. In a dose of 80 mg/days it is used for bystry decrease in cholesterol in case of need. It happens at patients more often to high and very high risk of cardiovascular complications for which the target objective of LNP cholesterol is lower, than at other patients. In other cases the dosage of 20 mg/days allows to reach the normal level of LNP cholesterol at 95% of patients with coronary heart disease and to reduce risk of complications. It is shown that at moderate arterial hypertension and an easy form of a current of a diabetes mellitus 2 types small increase in cholesterol it is possible to skorregirovat also 10 mg of drug a day.
Rozuvastatin — one of the most effective statines, concerning the speed of decrease in cholesterol. Appoint 5-10 mg/days in a dose. The maximum dose of 40 mg/days is used to reach if necessary quickly normal levels of the general cholesterol and LNP cholesterol. For example, at very high risk of cardiovascular complications.
