{"id":29324,"date":"2023-04-29T18:21:22","date_gmt":"2023-04-29T11:21:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29324"},"modified":"2023-04-29T18:21:22","modified_gmt":"2023-04-29T11:21:22","slug":"benh-tang-cholesterol-mau-gia-dinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/benh-tang-cholesterol-mau-gia-dinh\/","title":{"rendered":"B\u1ec7nh t\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh"},"content":{"rendered":"

T\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh<\/a> (Familial Hypercholesterolemia, vi\u1ebft t\u1eaft: FH) l\u00e0 b\u1ec7nh l\u00fd di truy\u1ec1n gen tr\u1ed9i tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng, \u0111\u1eb7c tr\u01b0ng b\u1edfi hi\u1ec7n t\u01b0\u1ee3ng LDL – cholesterol huy\u1ebft t\u01b0\u01a1ng t\u0103ng cao, c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u xu\u1ea5t hi\u1ec7n s\u1edbm g\u00e2y ra b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/strong><\/p>\n

1.T\u1ed5ng quan<\/h2>\n

B\u1ec7nh t\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh (Familial Hypercholesterolemia, vi\u1ebft t\u1eaft: FH) l\u00e0 b\u1ec7nh l\u00fd di truy\u1ec1n gen tr\u1ed9i tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng, \u0111\u1eb7c tr\u01b0ng b\u1edfi hi\u1ec7n t\u01b0\u1ee3ng LDL – cholesterol huy\u1ebft t\u01b0\u01a1ng t\u0103ng cao, c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u xu\u1ea5t hi\u1ec7n s\u1edbm g\u00e2y ra b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5 n\u00e3o. T\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh c\u1ee7a b\u1ec7nh FH trong c\u1ed9ng \u0111\u1ed3ng l\u00e0 1\/500 – 1\/200 v\u1edbi \u01b0\u1edbc t\u00ednh kho\u1ea3ng 20 tri\u1ec7u ng\u01b0\u1eddi tr\u00ean th\u1ebf gi\u1edbi m\u1eafc b\u1ec7nh.<\/p>\n

2. C\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh FH<\/h2>\n

Ti\u1ec1n s\u1eed gia \u0111\u00ecnh: Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n FH c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh t\u0103ng cholesterol m\u00e1u v\u00e0\/ho\u1eb7c m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh s\u1edbm.<\/p>\n

X\u01a1 v\u1eefa m\u1ea1ch m\u00e1u: <\/strong>T\u00ecnh tr\u1ea1ng x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u xu\u1ea5t hi\u1ec7n s\u1edbm v\u00e0 n\u1eb7ng. Trong nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y t\u1ea1i Vi\u1ec7n Tim m\u1ea1ch, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai, 3% b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch v\u00e0nh s\u1edbm \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn m\u1eafc FH.<\/p>\n

    \n
  • T\u0103ng b\u1ec1 d\u00e0y n\u1ed9i – trung m\u1ea1c \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh v\u00e0 s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean si\u00eau \u00e2m \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh.<\/li>\n
  • H\u00ecnh \u1ea3nh canxi h\u00f3a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn l\u00f2ng \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1edfi ch\u1ee5p h\u00ecnh c\u1eaft l\u1edbp vi t\u00ednh tim hay ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ch\u1ecdn l\u1ecdc qua da.<\/li>\n<\/ul>\n

    Si\u00eau \u00e2m tim ph\u00e1t hi\u1ec7n h\u1eb9p tr\u00ean van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do x\u01a1 v\u1eefa. X\u01a1 v\u1eefa m\u1ea1ch ngo\u1ea1i vi c\u00f9ng th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n FH.<\/p>\n

    X\u00e9t nghi\u1ec7m \u0111\u1ed9t bi\u1ebfn gen: <\/strong>95% c\u00f3 \u0111\u1ed9t bi\u1ebfn gen LDLR, 5% gen ApoB, < 1% gen PCSK9.<\/p>\n

    3.Ch\u1ea9n \u0111o\u00e1n FH<\/h2>\n

    3.1 Ti\u00eau chu\u1ea9n DUTCH (Dutch Lipid Network Criteria)<\/strong><\/p>\n

    \"Ti\u00eau<\/p>\n

    Ti\u00eau chu\u1ea9n DUTCH (Dutch Lipid Network Criteria)<\/strong><\/p>\n

    \u0110\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n FH. Ti\u00eau chu\u1ea9n n\u00e0y c\u00f3 \u01b0u \u0111i\u1ec3m l\u00e0 \u0111\u01a1n gi\u1ea3n v\u00e0 c\u00f3 \u0111\u1ed9 ch\u00ednh x\u00e1c cao. Ti\u00eau chu\u1ea9n n\u00e0y \u00e1p d\u1ee5ng cho ng\u01b0\u1eddi tr\u00ean 16 tu\u1ed5i. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y ghi nh\u1eadn ti\u00eau chu\u1ea9n DUTCH l\u00e0 ph\u00f9 h\u1ee3p \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n FH \u1edf Vi\u1ec7t Nam.<\/p>\n

    Ti\u00eau chu\u1ea9n DUTCH ch\u1ea9n \u0111o\u00e1n FH<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
     <\/p>\n

    Ti\u00eau chu\u1ea9n<\/strong><\/td>\n

    		 <\/p>\n

    \u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n

    Ti\u1ec1n s\u1eed gia \u0111\u00ecnh<\/strong><\/td>\n<\/tr>\n
    Ng\u01b0\u1eddi th\u00e2n tr\u1ef1c h\u1ec7 ( h\u1ecd h\u00e0ng b\u1eadc 1 ) m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh ho\u1eb7c b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch kh\u00e1c s\u1edbm ( nam <55t , n\u1eefa <60t ) Ho\u1eb7c<\/p>\n

    \u0110\u00e3 tt\u1eebng c\u00f3 k\u1ebft qu\u1ea3 LDL-C cao >95% ph\u00e2n b\u1ed1 theo tu\u1ed5i v\u00e0 gi\u1edbi<\/td>\n

    		 <\/p>\n

     <\/p>\n

    1<\/strong><\/td>\n<\/tr>\n

    H\u1ecd hangf b\u1eadc 1 c\u00f3 h\u00ecnh \u1ea3nh U m\u1ee1 b\u00e1m g\u00e2n v\u00e0\/ho\u1eb7c v\u00f2ng gi\u00e1c m\u1ea1c Ho\u1eb7c tr\u1ebb <18t c\u00f3 LDL-C cao >95% ph\u00e2n b\u1ed1 theo tu\u1ed5i v\u00e0 gi\u1edbi<\/td>\n <\/p>\n

     <\/p>\n

    1<\/strong><\/td>\n<\/tr>\n

    B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng<\/strong><\/td>\n<\/tr>\n
    Ng\u01b0\u1eddi m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh s\u1edbm<\/td>\n <\/p>\n

    2<\/td>\n<\/tr>\n

    Ng\u01b0\u1eddi b\u1ecb \u0111\u1ed9t qu\u1ef5 n\u00e3o ho\u1eb7c b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean s\u1edbm<\/td>\n <\/p>\n

    1<\/td>\n<\/tr>\n

    Kh\u00e1m l\u00e2m s\u00e0ng<\/strong><\/td>\n<\/tr>\n
    C\u00f3 u m\u1ee1 b\u00e1m g\u00e2n<\/td>\n <\/p>\n

    6<\/td>\n<\/tr>\n

    C\u00f3 v\u00f2ng gi\u00e1c m\u1ea1c tr\u01b0\u1edbc 45 tu\u1ed5i<\/td>\n <\/p>\n

    4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n
    LDL-cholesterol (mmol\/L)<\/strong><\/td>\n<\/tr>\n
    LDL-C > 8,5<\/td>\n <\/p>\n

    8<\/td>\n<\/tr>\n

    LDL-C 6,5 – 8,4<\/td>\n <\/p>\n

    5<\/td>\n<\/tr>\n

    LDL-C 5,0 – 6,4<\/td>\n <\/p>\n

    3<\/td>\n<\/tr>\n

    LDL-C 4,0 – 4,9<\/td>\n <\/p>\n

    1<\/td>\n<\/tr>\n

    Ph\u00e1t hi\u1ec7n \u0111\u1ed9t bi\u1ebfn gen LDLR, ho\u1eb7c APOB, ho\u1eb7c PCSK9<\/strong><\/td>\n <\/p>\n

    8<\/td>\n<\/tr>\n

    Ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean t\u1ed5ng \u0111i\u1ec3m:<\/em><\/strong><\/p>\n

    Ch\u1ea9n \u0111o\u00e1n ch\u1eafc ch\u1eafn m\u1eafc FH n\u1ebfu t\u1ed5ng \u0111i\u1ec3m > 8; Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 m\u1eafc FH n\u1ebfu t\u1ed5ng<\/p>\n

    \u0111i\u1ec3m 6 – 8<\/p>\n

    Ch\u1ea9n \u0111o\u00e1n nghi ng\u1edd m\u1eafc FH n\u1ebfu t\u1ed5ng \u0111i\u1ec3m 3 – 5; Ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ph\u1ea3i FH n\u1ebfu t\u1ed5ng<\/p>\n

    \u0111i\u1ec3m < 3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Ch\u00fa th\u00edch: DUTCH: Dutch Lipid Network Criteria, FH: familial hypercholesterolemia <\/em>(T\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh); LDL-C: Cholesterol – Lipoprotein t\u1ef7 tr\u1ecdng th\u1ea5p;<\/em><\/p>\n

    3.2 Ti\u00eau chu\u1ea9n Starr<\/h3>\n

    D\u1ef1a tr\u00ean LDL-C d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n FH cho h\u1ecd h\u00e0ng (ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em) c\u1ee7a ca b\u1ec7nh ch\u1ec9 \u0111i\u1ec3m d\u1ef1a tr\u00ean x\u00e9t nghi\u1ec7m lipid m\u00e1u, tu\u1ed5i, gi\u1edbi.<\/p>\n

    3.3 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed (HoFH)<\/h3>\n

    X\u00e1c nh\u1eadn \u0111\u1ed9t bi\u1ebfn \u1edf 2 alen v\u1edbi gen LDLR, APOB, PCSK9, LDLRAP1. Ho\u1eb7c<\/p>\n

    M\u1ee9c LDL-C m\u00e1u khi ch\u01b0a \u0111i\u1ec1u tr\u1ecb > 13 mmol\/L ho\u1eb7c sau khi \u0111i\u1ec1u tr\u1ecb > 8 mmol\/L k\u00e8m u v\u00e0ng xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc 10 tu\u1ed5i ho\u1eb7c c\u1ea3 b\u1ed1 v\u00e0 m\u1eb9 \u0111\u1ec1u l\u00e0 d\u1ecb h\u1ee3p t\u1eed.<\/p>\n

    3.4 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n FH \u1edf tr\u1ebb em<\/h3>\n

    D\u1ef1a v\u00e0o t\u00ecnh tr\u1ea1ng t\u0103ng LDL-C k\u00e8m theo ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 t\u0103ng LDL-C, b\u1ec7nh m\u1ea1ch v\u00e0nh s\u1edbm, v\u00e0\/ho\u1eb7c ph\u00e1t hi\u1ec7n \u0111\u1ed9t bi\u1ebfn gen. M\u1ee9c LDL-C huy\u1ebft t\u01b0\u01a1ng \u0111\u1eb7c hi\u1ec7u theo tu\u1ed5i v\u00e0 gi\u1edbi c\u1ea7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n l\u1ea7n \u0111\u1ea7u cho FH. M\u1ee9c LDL-C huy\u1ebft t\u01b0\u01a1ng \u0111\u01a1n \u0111\u1ed9c c\u00f3 \u0111\u1ed9 ph\u00e2n bi\u1ec7t r\u1ea5t r\u00f5 r\u00e0ng gi\u1eefa c\u00e1c b\u1ec7nh nh\u00e2n FH v\u00e0 ng\u01b0\u1eddi kh\u00f4ng b\u1ecb FH \u1edf \u0111\u1ed9 tu\u1ed5i d\u01b0\u1edbi 10 tu\u1ed5i. Tuy nhi\u00ean, v\u00ec t\u00ecnh tr\u1ea1ng bi\u1ebfn thi\u00ean sinh h\u1ecdc cho n\u00ean c\u1ea7n l\u1ea5y tr\u1ecb s\u1ed1 trung b\u00ecnh c\u1ee7a \u00edt nh\u1ea5t l\u00e0 2 l\u1ea7n x\u00e9t nghi\u1ec7m LDL-C l\u00fac \u0111\u00f3i \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n FH. C\u1ea7n t\u00ednh \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh l\u00e0m h\u1ea1 th\u1ea5p LDL-C v\u00e0 x\u00e9t nghi\u1ec7m l\u1ea1i n\u1ebfu th\u1ea5y c\u1ea7n thi\u1ebft. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n FH \u1edf tr\u1ebb em bao g\u1ed3m:<\/p>\n

      \n
    • M\u1ee9c LDL-C > 5 mmol\/L sau 3 th\u00e1ng d\u00f9ng ch\u1ebf \u0111\u1ed9 \u0103n gi\u1ea3m cholesterol, ngay c\u1ea3 khi kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh t\u0103ng cholesterol m\u00e1u v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh s\u1edbm.<\/li>\n
    • M\u1ee9c LDL-C > 4,0 mmol\/L k\u00e8m ti\u1ec1n s\u1eed gia \u0111\u00ecnh t\u0103ng cholesterol m\u00e1u ho\u1eb7c b\u1ec7nh m\u1ea1ch v\u00e0nh s\u1edbm.<\/li>\n
    • N\u1ebfu cha m\u1eb9 tr\u1ebb \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn c\u00f3 \u0111\u1ed9t bi\u1ebfn gen g\u00e2y b\u1ec7nh FH, th\u00ec ng\u01b0\u1ee1ng LDL-C m\u00e1u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh FH cho tr\u1ebb l\u00e0 > 3,5 mmol\/L.<\/li>\n<\/ul>\n

      4.\u0110i\u1ec1u tr\u1ecb FH<\/h2>\n

      4.1 M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n
        \n
      • B\u1ec7nh nh\u00e2n FH kh\u00f4ng c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u do x\u01a1 v\u1eefa (b\u1ec7nh m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi), kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch nghi\u00eam tr\u1ecdng, m\u1ee9c LDL-C c\u1ea7n gi\u1ea3m > 50% so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u v\u00e0 \u0111\u00edch LDL-C < 1,8 mmol\/L.<\/li>\n
      • B\u1ec7nh nh\u00e2n FH c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u do x\u01a1 v\u1eefa (b\u1ec7nh m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi) ho\u1eb7c c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch nghi\u00eam tr\u1ecdng, m\u1ee9c LDL-C c\u1ea7n gi\u1ea3m > 50% so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u v\u00e0 \u0111\u00edch LDL-C < 1,4 mmol\/L.<\/li>\n
      • B\u1ec7nh nh\u00e2n FH c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u do x\u01a1 v\u1eefa (b\u1ec7nh m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi) v\u1edbi bi\u1ebfn c\u1ed1 tim m\u1ea1ch t\u00e1i ph\u00e1t l\u1ea7n 2 trong v\u00f2ng 2 n\u0103m g\u1ea7n \u0111\u00e2y m\u00e0 \u0111\u00e3 d\u00f9ng statin li\u1ec1u cao nh\u1ea5t c\u00f3 th\u1ec3 dung n\u1ea1p \u0111\u01b0\u1ee3c th\u00ec m\u1ee9c LDL-C c\u1ea7n \u0111i\u1ec1u tr\u1ecb gi\u1ea3m xu\u1ed1ng < 1,0 mmol\/L.<\/li>\n
      • V\u1edbi tr\u1ebb 8 – 10 tu\u1ed5i, m\u1ee9c LDL-C c\u1ea7n gi\u1ea3m > 50% so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u. Trong khi v\u1edbi tr\u1ebb > 10 tu\u1ed5i, m\u1ee9c LDL-C c\u1ea7n \u0111\u1ea1t < 3,5 mmol\/L.<\/li>\n<\/ul>\n

        4.2 \u0110i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng, lo\u1ea1i b\u1ecf c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch (Theo ESC 2019)<\/h3>\n
          \n
        • Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 ki\u1ec3m so\u00e1t c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay khi ch\u1ea9n \u0111o\u00e1n FH, bao g\u1ed3m:<\/li>\n
        • B\u1ecf thu\u1ed1c l\u00e1.<\/li>\n
        • Ch\u1ebf \u0111\u1ed9 \u0103n ki\u00eang, gi\u1ea3m ti\u00eau th\u1ee5 l\u01b0\u1ee3ng ch\u1ea5t b\u00e9o b\u00e3o h\u00f2a, t\u0103ng kh\u1ea9u ph\u1ea7n hoa qu\u1ea3, rau, h\u1ea1t c\u00f2n l\u1edbp \u00e1o v\u1ecf, h\u1ea1nh nh\u00e2n, c\u00e1c ch\u1ebf ph\u1ea9m s\u1eefa \u00edt ho\u1eb7c kh\u00f4ng ch\u1ee9a ch\u1ea5t b\u00e9o, c\u00e1c lo\u1ea1i \u0111\u1eadu, c\u00e1.<\/li>\n
        • T\u0103ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c: Trung b\u00ecnh duy tr\u00ec 3,5 – 7 gi\u1edd ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c m\u1ed7i tu\u1ea7n ho\u1eb7c 30 – 60 ph\u00fat m\u1ed7i ng\u00e0y.<\/li>\n
        • Ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng, v\u00f2ng b\u1ee5ng: BMI duy tr\u00ec 20 – 25 kg\/m 2 , v\u00f2ng b\u1ee5ng < 94 cm (nam) v\u00e0 < 80 cm (n\u1eef).<\/li>\n
        • Ki\u1ec3m so\u00e1t ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p < 140\/90 mmHg. Ki\u1ec3m so\u00e1t ch\u1ec9 s\u1ed1 HbA1c < 7%.<\/li>\n<\/ul>\n

          4.3 \u0110i\u1ec1u tr\u1ecb h\u1ea1 LDL-C<\/h3>\n
            \n
          • Statin m\u1ea1nh: <\/strong>C\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n s\u1edbm nh\u1ea5t v\u00e0 duy tr\u00ec \u0111\u1ec1u \u0111\u1eb7n \u1edf b\u1ec7nh nh\u00e2n FH, \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn statin m\u1ea1nh nh\u01b0 rosuvastatin, atorvastatin. \u0110a s\u1ed1 b\u1ec7nh nh\u00e2n c\u1ea7n duy tr\u00ec statin m\u1ea1nh \u1edf li\u1ec1u cao nh\u1ea5t m\u00e0 c\u00f3 th\u1ec3 dung n\u1ea1p. Tr\u1ebb em m\u1eafc FH c\u00f3 th\u1ec3 c\u1ea7n s\u1eed d\u1ee5ng statin t\u1eeb 8 – 10 tu\u1ed5i, v\u1edbi kh\u1edfi \u0111\u1ea7u \u1edf li\u1ec1u th\u1ea5p v\u00e0 t\u0103ng d\u1ea7n li\u1ec1u cho ng\u01b0\u1ee1ng t\u1ed1i \u0111a c\u00f3 th\u1ec3 dung n\u1ea1p \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C.<\/li>\n
          • Ezetimibe: <\/strong>C\u00f3 th\u1ec3 d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi statin \u0111\u1ec3 \u0111\u1ea1t LDL-C m\u1ee5c ti\u00eau. Li\u1ec1u ezetimibe 10 mg\/24h ph\u1ed1i h\u1ee3p v\u1edbi statin gi\u00fap gi\u1ea3m th\u00eam 10 – 20% m\u1ee9c LDL-C.<\/li>\n
          • Thu\u1ed1c \u1ee9c ch\u1ebf PCSK9: <\/strong>N\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed ho\u1eb7c th\u1ec3 d\u1ecb h\u1ee3p t\u1eed c\u00f3 bi\u1ebfn c\u1ed1 tim m\u1ea1ch n\u1ebfu kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00edch LDL-C sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng statin li\u1ec1u t\u1ed1i \u0111a > 6 th\u00e1ng ho\u1eb7c kh\u00f4ng dung n\u1ea1p v\u1edbi statin. Thu\u1ed1c \u1ee9c ch\u1ebf PCSK9 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1edbi 50 – 70% m\u1ee9c LDL-C \u1edf c\u00e1c b\u1ec7nh nh\u00e2n FH. \u0110i\u1ec1u tr\u1ecb h\u1ea1 LDL-C b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf PCSK9 c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi FH c\u00f3 \u0111\u1ed9t bi\u1ebfn gen t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a PCSK9.<\/li>\n
          • Lomitapide: <\/strong>\u0110\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed > 18 tu\u1ed5i.<\/li>\n
          • Mipomersen: <\/strong>\u0110\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed > 12 tu\u1ed5i.<\/li>\n<\/ul>\n

            L\u1ecdc m\u00e1u \u0111\u1eb7c hi\u1ec7u cho LDL-C: <\/strong>Gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c t\u1eed vong v\u00e0 gi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch cho b\u1ec7nh nh\u00e2n FH. L\u1ecdc m\u00e1u \u0111\u1eb7c hi\u1ec7u cho LDL-C n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed n\u1ebfu kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00edch LDL-C sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng statin li\u1ec1u t\u1ed1i \u0111a > 6 th\u00e1ng ho\u1eb7c kh\u00f4ng dung n\u1ea1p v\u1edbi statin. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf ph\u1ee5 n\u1eef c\u00f3 thai.<\/p>\n

            Trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng: <\/strong>C\u00f3 th\u1ec3 xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed khi kh\u00f4ng c\u00f3 l\u1ecdc m\u00e1u \u0111\u1eb7c hi\u1ec7u cho LDL\u00acC v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf PCSK9. T\u1ea1o shunt t\u0129nh m\u1ea1ch c\u1eeda – t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi: Hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed \u1edf n\u01a1i kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c l\u1ecdc m\u00e1u \u0111\u1eb7c hi\u1ec7u cho LDL-C.<\/p>\n

             <\/p>\n

            Gh\u00e9p gan: <\/strong>Hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed \u1edf n\u01a1i kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c l\u1ecdc m\u00e1u \u0111\u1eb7c hi\u1ec7u cho LDL-C.<\/p>\n

            4.4 \u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u1edf b\u1ec7nh nh\u00e2n FH<\/h3>\n

            B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh do x\u01a1 v\u1eefa l\u00e0 bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p v\u00e0 nguy hi\u1ec3m nh\u1ea5t trong b\u1ec7nh FH. Nhi\u1ec1u b\u1ec7nh nh\u00e2n FH c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da ho\u1eb7c ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh. Can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 l\u00e0 gi\u1ea3i ph\u00e1p h\u1eefu \u00edch v\u1edbi tr\u1ebb em. M\u1ed9t s\u1ed1 b\u00e1o c\u00e1o ca l\u00e2m s\u00e0ng ghi nh\u1eadn can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh s\u1eed d\u1ee5ng stent ph\u1ee7 thu\u1ed1c c\u00f3 khung t\u1ef1 ti\u00eau (Bioresorbable Vascular Scaffold: BVS) kh\u1ea3 thi cho tr\u1ebb nh\u1ecf m\u1eafc FH th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed.<\/p>\n

             <\/p>\n

             <\/p>\n","protected":false},"excerpt":{"rendered":"

            T\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh (Familial Hypercholesterolemia, vi\u1ebft t\u1eaft: FH) l\u00e0 b\u1ec7nh l\u00fd di truy\u1ec1n gen tr\u1ed9i tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng, \u0111\u1eb7c tr\u01b0ng b\u1edfi hi\u1ec7n t\u01b0\u1ee3ng LDL – cholesterol huy\u1ebft t\u01b0\u01a1ng t\u0103ng cao, c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u xu\u1ea5t hi\u1ec7n s\u1edbm g\u00e2y ra b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5 n\u00e3o. 1.T\u1ed5ng quan B\u1ec7nh […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nB\u1ec7nh t\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh t\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh l\u00e0 b\u1ec7nh l\u00fd di truy\u1ec1n gen tr\u1ed9i tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng, \u0111\u1eb7c tr\u01b0ng LDL - 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