{"id":22632,"date":"2023-04-17T07:52:22","date_gmt":"2023-04-17T00:52:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22632"},"modified":"2023-04-17T11:03:24","modified_gmt":"2023-04-17T04:03:24","slug":"chuyen-hoa-lipid-va-dieu-tri-roi-loan-lipid-mau","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/chuyen-hoa-lipid-va-dieu-tri-roi-loan-lipid-mau\/","title":{"rendered":"Chuy\u1ec3n h\u00f3a lipid v\u00e0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u"},"content":{"rendered":"<p><strong>Chuy\u1ec3n h\u00f3a lipid l\u00e0 ho\u1ea1t \u0111\u1ed9ng quan tr\u1ecdng c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 r\u1ed1i lo\u1ea1n lipid m\u00e1u l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u0103ng c\u1ee7a m\u1ed9t ho\u1eb7c nhi\u1ec1u th\u00e0nh ph\u1ea7n lipid trong huy\u1ebft t\u01b0\u01a1ng: triglyceride, cholesterol, cholesterol ester, phospholipid v\u00e0 lipoprotein huy\u1ebft t\u01b0\u01a1ng bao g\u1ed3m VLDL v\u00e0 LDL c\u00f9ng v\u1edbi gi\u1ea3m n\u1ed3ng \u0111\u1ed9 HDL. T\u0103ng c\u00e1c th\u00e0nh ph\u1ea7n lipid huy\u1ebft t\u01b0\u01a1ng n\u00e0y l\u00e0 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00ecnh th\u00e0nh c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/strong><\/p>\n<h2><strong>1.Vai tr\u00f2 c\u1ee7a lipid trong c\u01a1 th\u1ec3<\/strong><\/h2>\n<p>Lipid l\u00e0 ngu\u1ed3n n\u0103ng l\u01b0\u1ee3ng tr\u1ef1c ti\u1ebfp cho c\u01a1 th\u1ec3. V\u1edbi c\u00e1c kh\u1ea9u ph\u1ea7n \u0103n h\u1ee3p l\u00fd lipid cung c\u1ea5p 25-30% n\u0103ng l\u01b0\u1ee3ng cho c\u01a1 th\u1ec3. Lipid l\u00e0 nguy\u00ean li\u1ec7u t\u1ea1o n\u0103ng l\u01b0\u1ee3ng t\u1ea1i c\u00e1c t\u1ebf b\u00e0o c\u01a1 th\u1ec3 d\u01b0\u1edbi d\u1ea1ng c\u00e1c acetyl coenzyme A t\u1eeb s\u1ef1 tho\u00e1i bi\u1ebfn c\u00e1c acid b\u00e9o. Ri\u00eang t\u1ea1i gan, m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf acetyl coenzyme A \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh c\u00e1c th\u1ec3 ketone (acetoacetate, \u03b2- hydroxybutyrate v\u00e0 acetone). C\u00e1c th\u1ec3 ketone m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c c\u00e1c t\u1ebf b\u00e0o n\u00e3o, th\u1eadn v\u00e0 c\u01a1 tim chuy\u1ec3n ho\u00e1, ph\u1ea7n c\u00f2n l\u1ea1i \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i qua ph\u1ed5i (aceton) v\u00e0 ra n\u01b0\u1edbc ti\u1ec3u.<\/p>\n<p>Lipid ngo\u00e0i ra c\u00f2n l\u00e0 ngu\u1ed3n n\u0103ng l\u01b0\u1ee3ng d\u1ef1 tr\u1eef l\u1edbn nh\u1ea5t trong c\u01a1 th\u1ec3. D\u1ea1ng d\u1ef1 tr\u1eef l\u00e0 triglyceride (hay c\u00f2n g\u1ecdi l\u00e0 m\u1ee1 trung t\u00ednh) t\u1ea1i m\u00f4 m\u1ee1 chi\u1ebfm kho\u1ea3ng 15 \u2013 20% tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh.<\/p>\n<p>Lipid tham gia c\u1ea5u tr\u00fac c\u01a1 th\u1ec3 nh\u01b0 m\u00f4 m\u1ee1 \u0111\u1ec7m d\u01b0\u1edbi da v\u00e0 b\u1ecdc quanh c\u00e1c ph\u1ee7 t\u1ea1ng. Lipid l\u00e0 th\u00e0nh ph\u1ea7n m\u00e0ng t\u1ebf b\u00e0o (phospholipid) v\u00e0 m\u1ed9t s\u1ed1 ho\u1ea1t ch\u1ea5t sinh h\u1ecdc quan tr\u1ecdng nh\u01b0 prostaglandin v\u00e0 leucotrien. Cholesterol c\u1ea7n cho s\u1ef1 t\u1ed5ng h\u1ee3p acid m\u1eadt, c\u00e1c hormon steroid c\u1ee7a tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn v\u00e0 sinh d\u1ee5c.<\/p>\n<h2><strong>2.Qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a lipid trong c\u01a1 th\u1ec3<\/strong><\/h2>\n<p>M\u1ee1 trong th\u1ef1c ph\u1ea9m h\u1eb1ng ng\u00e0y ch\u1ee7 y\u1ebfu l\u00e0 d\u1ea1ng triglyceride. D\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a acid m\u1eadt v\u00e0 lipase d\u1ecbch t\u1ee5y, triglycerid b\u1ecb th\u1ee7y ph\u00e2n th\u00e0nh acid b\u00e9o v\u00e0 monoglycerid. T\u1ea1i t\u1ebf b\u00e0o ni\u00eam m\u1ea1c ru\u1ed9t non, h\u1ea7u h\u1ebft c\u00e1c acid b\u00e9o v\u00e0 monoglyceride \u0111\u01b0\u1ee3c t\u00e1i t\u1ed5ng h\u1ee3p th\u00e0nh triglycerid r\u1ed3i k\u1ebft h\u1ee3p v\u1edbi apo \u2013 B48, phospholipid v\u00e0 cholesterol \u0111\u1ec3 t\u1ea1o th\u00e0nh c\u00e1c h\u1ea1t d\u01b0\u1ee1ng ch\u1ea5p (chylomicron).<\/p>\n<p>H\u1ea1t d\u01b0\u1ee1ng ch\u1ea5p \u0111\u01b0\u1ee3c h\u1ea5p thu v\u00e0o m\u1ea1ch b\u1ea1ch huy\u1ebft r\u1ed3i qua \u1ed1ng ng\u1ef1c \u0111\u1ed5 v\u00e0o tu\u1ea7n ho\u00e0n chung. H\u1ea1t d\u01b0\u1ee1ng ch\u1ea5p ch\u1ee9a nhi\u1ec1u triglycerid, khi v\u00e0o m\u00e1u th\u00ec nh\u1eadn th\u00eam apo-CII t\u1eeb HDL (lipoprotein t\u1ef7 tr\u1ecdng cao). Apo-CII l\u00e0 cofactor c\u1ee7a lipoprotein lipase th\u1ee7y ph\u00e2n triglycerid \u0111\u01b0a acid b\u00e9o \u0111\u1ebfn c\u00e1c t\u1ebf b\u00e0o ngo\u1ea1i vi \u0111\u1ec3 ti\u00eau th\u1ee5. Sau \u0111\u00f3 h\u1ea1t d\u01b0\u1ee1ng ch\u1ea5p \u0111\u01b0\u1ee3c b\u1ed5 sung apo-E r\u1ed3i \u0111\u01b0\u1ee3c gan thu nh\u1eadn (qua trung gian th\u1ee5 th\u1ec3 c\u1ee7a LDL v\u00e0 th\u1ee5 th\u1ec3 c\u1ee7a apo-E tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o gan v\u1edbi apo-E tr\u00ean h\u1ea1t d\u01b0\u1ee1ng ch\u1ea5p).<\/p>\n<p>T\u1ebf b\u00e0o gan thu nh\u1eadn acid b\u00e9o t\u1eeb h\u1ea1t d\u01b0\u1ee1ng ch\u1ea5p v\u00e0 m\u00f4 m\u1ee1, t\u1ed5ng h\u1ee3p th\u00eam acid b\u00e9o t\u1eeb c\u00e1c m\u1eabu acetyl coenzyme A, k\u1ebft h\u1ee3p acid b\u00e9o v\u1edbi glycerolphosphat \u0111\u1ec3 t\u1ea1o triglyceride. Sau \u0111\u00f3 t\u1ebf b\u00e0o gan k\u1ebft h\u1ee3p triglycerid v\u1edbi apo-B100, phospholipid v\u00e0 cholesterol \u0111\u01b0a v\u00e0o m\u00e1u d\u01b0\u1edbi d\u1ea1ng VLDL (lipoprotein t\u1ef7 tr\u1ecdng r\u1ea5t th\u1ea5p). VLDL c\u0169ng ch\u1ee9a nhi\u1ec1u triglycerid, \u0111\u01b0\u1ee3c HDL chuy\u1ec3n apo-CII qua \u0111\u1ec3 k\u00edch ho\u1ea1t lipoprotein lipase nh\u1eb1m th\u1ee7y ph\u00e2n triglycerid \u0111\u01b0a acid b\u00e9o \u0111\u1ebfn c\u00e1c t\u1ebf b\u00e0o ngo\u1ea1i vi ti\u00eau th\u1ee5. Sau \u0111\u00f3, VLDL do gi\u1ea3m t\u1ef7 l\u1ec7 triglycerid chuy\u1ec3n th\u00e0nh IDL (lipoprotein t\u1ef7 tr\u1ecdng trung gian). IDL ch\u1ecbu hai kh\u1ea3 n\u0103ng chuy\u1ec3n h\u00f3a: (1) chuy\u1ec3n tr\u1edf l\u1ea1i t\u1ebf b\u00e0o gan (qua trung gian th\u1ee5 th\u1ec3 c\u1ee7a LDL v\u00e0 th\u1ee5 th\u1ec3 c\u1ee7a apo-E tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o gan v\u1edbi apo-B100 v\u00e0 apo-E tr\u00ean IDL), (2) chuy\u1ec3n th\u00e0nh LDL (lipoprotein t\u1ef7 tr\u1ecdng th\u1ea5p) nh\u1edd t\u00e1c d\u1ee5ng c\u1ee7a HTGL (hepatic triglyceride lipase) th\u1ee7y ph\u00e2n b\u1edbt triglycerid tr\u00ean IDL.<\/p>\n<p>HDL do gan v\u00e0 ru\u1ed9t t\u1ea1o. Vai tr\u00f2 c\u1ee7a HDL l\u00e0 thu nh\u1eadn cholesterol th\u1eeba t\u1eeb c\u00e1c t\u1ebf b\u00e0o ngo\u1ea1i vi (vai tr\u00f2 c\u1ee7a HDL3). Khi cholesterol \u0111\u01b0\u1ee3c h\u1ea5p ph\u1ee5 v\u00e0o b\u1ec1 m\u1eb7t HDL3 th\u00ec \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh este cholesterol nh\u1edd t\u00e1c d\u1ee5ng c\u1ee7a LCAT (lecithin cholesterol acyltransferase). Khi este cholesterol di chuy\u1ec3n v\u00e0o b\u00ean trong l\u00f5i HDL th\u00ec HDL3 tr\u1edf th\u00e0nh HDL2. Sau \u0111\u00f3 HDL2 \u0111\u01b0\u1ee3c thu nh\u1eadn tr\u1edf l\u1ea1i v\u00e0o gan ho\u1eb7c chuy\u1ec3n este cholesterol qua VLDL \u0111\u1ec3 tr\u1edf th\u00e0nh HDL3. S\u1ef1 chuy\u1ec3n este cholesterol t\u1eeb HDL2 qua VLDL c\u1ea7n t\u00e1c d\u1ee5ng c\u1ee7a CETP (cholesterol ester transfer protein).<\/p>\n<p>Apo-A do gan t\u1ea1o, k\u1ebft h\u1ee3p v\u1edbi apo-B100 tr\u00ean LDL h\u00ecnh th\u00e0nh lipoprotein-A. Vai tr\u00f2 c\u1ee7a lipoprotein-A ch\u01b0a r\u00f5 nh\u01b0ng khi t\u0103ng th\u00ec d\u1ec5 g\u00e2y nguy c\u01a1 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch. M\u1ed7i lo\u1ea1i lipoprotein m\u00e1u c\u1ea5u t\u1ea1o b\u1edfi m\u1ed9t l\u00f5i k\u1ef5 n\u01b0\u1edbc g\u1ed3m triglyceride v\u00e0 este cholesterol, m\u1ed9t v\u1ecf b\u1ecdc \u00e1i n\u01b0\u1edbc g\u1ed3m phospholipid, cholesterol t\u1ef1 do v\u00e0 apolipoprotein (g\u1ecdi t\u1eaft l\u00e0 apo). Triglyceride v\u00e0 cholesterol kh\u00f4ng h\u00f2a tan trong n\u01b0\u1edbc, do v\u1eady ch\u00fang ph\u1ea3i \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n trong c\u00e1c h\u1ea1t lipoprotein, n\u00f3i c\u00e1ch kh\u00e1c lipoprotein l\u00e0 d\u1ea1ng v\u1eadn chuy\u1ec3n triglycerid v\u00e0 cholesterol trong m\u00e1u. LDL ch\u1ee9a t\u1ef7 l\u1ec7 cholesterol cao nh\u1ea5t (45%) so v\u1edbi c\u00e1c lo\u1ea1i lipoprotein kh\u00e1c, t\u1ea3i 70% l\u01b0\u1ee3ng cholesterol m\u00e1u.<\/p>\n<h2><strong>3.R\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 c\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/strong><\/h2>\n<p>R\u1ed1i lo\u1ea1n lipid m\u00e1u l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u0103ng c\u1ee7a m\u1ed9t ho\u1eb7c nhi\u1ec1u th\u00e0nh ph\u1ea7n lipid trong huy\u1ebft t\u01b0\u01a1ng: triglyceride, cholesterol, cholesterol ester, phospholipid v\u00e0 lipoprotein huy\u1ebft t\u01b0\u01a1ng bao g\u1ed3m VLDL v\u00e0 LDL c\u00f9ng v\u1edbi gi\u1ea3m n\u1ed3ng \u0111\u1ed9 HDL. T\u0103ng c\u00e1c th\u00e0nh ph\u1ea7n lipid huy\u1ebft t\u01b0\u01a1ng n\u00e0y l\u00e0 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00ecnh th\u00e0nh c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n<p>Cho t\u1edbi hi\u1ec7n t\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u nh\u00f3m statin v\u00e0 fibrate v\u1eabn l\u00e0 c\u00e1c nh\u00f3m thu\u1ed1c ch\u00ednh \u0111i\u1ec1u tr\u1ecb t\u0103ng cholesterol v\u00e0 triglyceride. Tuy nhi\u00ean, nh\u1eefng nh\u00f3m thu\u1ed1c n\u00e0y \u0111\u1ec1u c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean gan v\u00e0 cho gan, c\u01a1,\u2026 n\u00ean c\u00f3 nh\u1eefng ch\u1ec9 \u0111\u1ecbnh c\u0169ng nh\u01b0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng r\u1ea5t ch\u1eb7t ch\u1ebd trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Ngo\u00e0i ra, c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nh\u01b0 thu\u1ed1c g\u1eafn acid m\u1eadt, nh\u00f3m niacin, ezetimibe c\u0169ng c\u00f3 vai tr\u00f2 r\u1ea5t l\u1edbn v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n<p>M\u1ed9t s\u1ed1 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u <strong>th\u1ebf h\u1ec7 m\u1edbi<\/strong> nh\u01b0: <strong>thu\u1ed1c \u1ee9c ch\u1ebf enzyme CETP<\/strong> (cholesteryl ester transfer protein): Torcetrapib, Dalcetrapib; <strong>thu\u1ed1c \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp apoB<\/strong>: Mipomersen; thu\u1ed1c \u1ee9c ch\u1ebf MTP (microsomal triglyceride transfer protein): Lomitapide; <strong>thu\u1ed1c d\u1ea1ng kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng \u1ee9c ch\u1ebf enzyme PCSK9<\/strong> (Proprotein convertase subtilisin\/kexin type 9): Alirocumab (Praluent), Evolocumab (Repatha); <strong>C\u00e1c acid b\u00e9o n-3 (omega-3):<\/strong> acid Eicosapentaenoic (EPA) v\u00e0 acid Docosahexaenoic (DHA) c\u0169ng h\u1ee9a h\u1eb9n mang t\u1edbi nh\u1eefng li\u1ec7u ph\u00e1p m\u1edbi trong vi\u1ec7c t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Chuy\u1ec3n h\u00f3a lipid l\u00e0 ho\u1ea1t \u0111\u1ed9ng quan tr\u1ecdng c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 r\u1ed1i lo\u1ea1n lipid m\u00e1u l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u0103ng c\u1ee7a m\u1ed9t ho\u1eb7c nhi\u1ec1u th\u00e0nh ph\u1ea7n lipid trong huy\u1ebft t\u01b0\u01a1ng: triglyceride, cholesterol, cholesterol ester, phospholipid v\u00e0 lipoprotein huy\u1ebft t\u01b0\u01a1ng bao g\u1ed3m VLDL v\u00e0 LDL c\u00f9ng v\u1edbi gi\u1ea3m n\u1ed3ng \u0111\u1ed9 [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":22634,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Chuy\u1ec3n h\u00f3a lipid v\u00e0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/title>\n<meta name=\"description\" content=\"Chuy\u1ec3n h\u00f3a lipid l\u00e0 ho\u1ea1t \u0111\u1ed9ng quan tr\u1ecdng c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 r\u1ed1i lo\u1ea1n lipid m\u00e1u l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng th\u01b0\u1eddng g\u1eb7p. 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