{"id":30742,"date":"2023-05-03T14:54:53","date_gmt":"2023-05-03T07:54:53","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30742"},"modified":"2023-05-03T14:55:18","modified_gmt":"2023-05-03T07:55:18","slug":"vai-tro-cua-lipid-va-lipoprotein-trong-xo-vua-dong-mach-esc-2019","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/vai-tro-cua-lipid-va-lipoprotein-trong-xo-vua-dong-mach-esc-2019\/","title":{"rendered":"Vai tr\u00f2 c\u1ee7a lipid v\u00e0 lipoprotein\u00a0trong x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch \u2013 ESC 2019"},"content":{"rendered":"

B\u1edfi v\u00ec c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ph\u00e1t tri\u1ec3n theo th\u1eddi gian khi ng\u00e0y c\u00e0ng nhi\u1ec1u\u00a0 c\u00e1c h\u1ea1t lipoprotein ch\u1ee9a ApoB \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i, n\u00ean k\u00edch th\u01b0\u1edbc c\u1ee7a t\u1ed5ng c\u00e1c m\u1ea3ng x\u01a1\u00a0 v\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi n\u1ed3ng \u0111\u1ed9 LDL-C l\u01b0u h\u00e0nh v\u00e0 c\u00e1c lipoprotein\u00a0 ch\u1ee9a ApoB kh\u00e1c c\u0169ng nh\u01b0 t\u1ed5ng th\u1eddi gian ti\u1ebfp x\u00fac v\u1edbi c\u00e1c lipoprotein n\u00e0y.<\/strong><\/p>\n

1. Vai tr\u00f2 sinh h\u1ecdc c\u1ee7a lipid v\u00e0 lipoprotein\u00a0<\/strong><\/h2>\n

Lipoprotein trong huy\u1ebft t\u01b0\u01a1ng v\u1eadn chuy\u1ec3n lipid \u0111\u1ebfn c\u00e1c m\u00f4 \u0111\u1ec3 s\u1eed d\u1ee5ng n\u0103ng l\u01b0\u1ee3ng,\u00a0 l\u1eafng \u0111\u1ecdng lipid, s\u1ea3n xu\u1ea5t hormone steroid v\u00e0 t\u1ea1o acid m\u1eadt. Lipoprotein bao g\u1ed3m\u00a0 cholesterol ester h\u00f3a v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c ester h\u00f3a, TG, phospholipid v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n\u00a0 protein c\u00f3 t\u00ean l\u00e0 apolipoprotein ho\u1ea1t \u0111\u1ed9ng nh\u01b0 c\u00e1c th\u00e0nh ph\u1ea7n c\u1ea5u tr\u00fac, ph\u1ed1i t\u1eed \u0111\u1ec3\u00a0 li\u00ean k\u1ebft v\u1edbi th\u1ee5 th\u1ec3 t\u1ebf b\u00e0o v\u00e0 c\u00e1c ch\u1ea5t k\u00edch ho\u1ea1t ho\u1eb7c \u1ee9c ch\u1ebf enzyme. C\u00f3 s\u00e1u lo\u1ea1i lipoprotein ch\u00ednh trong m\u00e1u: chylomicron, lipoprotein m\u1eadt \u0111\u1ed9 r\u1ea5t\u00a0 th\u1ea5p (VLDL), lipoprotein m\u1eadt \u0111\u1ed9 trung b\u00ecnh (IDL), LDL; Lp v\u00e0 cao high-density lipoprotein (HDL).<\/p>\n

\"xo-vua-dong-mach\"<\/p>\n

2. Vai tr\u00f2 c\u1ee7a lipid v\u00e0 lipoprotein trong sinh l\u00fd b\u1ec7nh x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch <\/strong><\/h2>\n

T\u1ea5t c\u1ea3 c\u00e1c lipoprotein ch\u1ee9a ApoB c\u00f3 \u0111\u01b0\u1eddng k\u00ednh <70 nm, bao g\u1ed3m c\u00e1c lipoprotein\u00a0 gi\u00e0u TG nh\u1ecf h\u01a1n v\u00e0 c\u00e1c h\u1ea1t c\u00f2n s\u00f3t l\u1ea1i c\u1ee7a ch\u00fang, c\u00f3 th\u1ec3 v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o n\u1ed9i m\u00f4,\u00a0 \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u00f4, n\u01a1i ch\u00fang c\u00f3 th\u1ec3 b\u1ecb b\u1eaft gi\u1eef l\u1ea1i sau khi\u00a0 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c c\u1ea5u tr\u00fac ngo\u1ea1i b\u00e0o nh\u01b0 proteoglycan. Lipoprotein ch\u1ee9a ApoB\u00a0 \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i trong th\u00e0nh \u0111\u1ed9ng m\u1ea1ch g\u00e2y ra m\u1ed9t qu\u00e1 tr\u00ecnh ph\u1ee9c t\u1ea1p d\u1eabn \u0111\u1ebfn s\u1ef1 l\u1eafng\u00a0 \u0111\u1ecdng lipid v\u00e0 \u0111\u00e2y l\u00e0 s\u1ef1 kh\u1edfi \u0111\u1ea7u c\u1ee7a m\u1ed9t m\u1ea3ng x\u01a1 v\u1eefa .<\/p>\n

Ti\u1ebfp x\u00fac l\u00e2u d\u00e0i v\u1edbi c\u00e1c lipoprotein ch\u1ee9a ApoB l\u00e0m cho c\u00e1c h\u1ea1t \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i ng\u00e0y c\u00e0ng nhi\u1ec1u trong th\u00e0nh \u0111\u1ed9ng m\u1ea1ch theo th\u1eddi gian, d\u1eabn \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n v\u00e0 ti\u1ebfn\u00a0 tri\u1ec3n c\u1ee7a c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch. Trung b\u00ecnh, nh\u1eefng ng\u01b0\u1eddi c\u00f3 n\u1ed3ng \u0111\u1ed9 lipoprotein ch\u1ee9a ApoB trong huy\u1ebft t\u01b0\u01a1ng cao h\u01a1n s\u1ebd gi\u1eef l\u1ea1i nhi\u1ec1u h\u1ea1t h\u01a1n v\u00e0 t\u00edch l\u0169y lipid nhanh h\u01a1n, khi\u1ebfn cho s\u1ef1 t\u0103ng tr\u01b0\u1edfng v\u00e0 ti\u1ebfn tri\u1ec3n c\u1ee7a c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa\u00a0 \u0111\u1ed9ng m\u1ea1ch nhanh h\u01a1n.<\/p>\n

B\u1edfi v\u00ec c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ph\u00e1t tri\u1ec3n theo th\u1eddi gian khi ng\u00e0y c\u00e0ng nhi\u1ec1u\u00a0 c\u00e1c h\u1ea1t lipoprotein ch\u1ee9a ApoB \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i, n\u00ean k\u00edch th\u01b0\u1edbc c\u1ee7a t\u1ed5ng c\u00e1c m\u1ea3ng x\u01a1\u00a0 v\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi n\u1ed3ng \u0111\u1ed9 LDL-C l\u01b0u h\u00e0nh v\u00e0 c\u00e1c lipoprotein\u00a0 ch\u1ee9a ApoB kh\u00e1c c\u0169ng nh\u01b0 t\u1ed5ng th\u1eddi gian ti\u1ebfp x\u00fac v\u1edbi c\u00e1c lipoprotein n\u00e0y. Do \u0111\u00f3,\u00a0 t\u1ed5ng k\u00edch th\u01b0\u1edbc m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u1ee7a m\u1ed9t ng\u01b0\u1eddi c\u00f3 th\u1ec3 t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi kh\u1ea3 n\u0103ng ti\u1ebfp x\u00fac t\u00edch l\u0169y v\u1edbi c\u00e1c lipoprotein n\u00e0y.<\/p>\n

Cu\u1ed1i c\u00f9ng, s\u1ef1 gia t\u0103ng g\u00e1nh n\u1eb7ng m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u00f9ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i\u00a0 th\u00e0nh ph\u1ea7n c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ea1t \u0111\u1ebfn m\u1ed9t \u0111i\u1ec3m quan tr\u1ecdng m\u00e0 s\u1ef1 ph\u00e1 v\u1ee1 c\u1ee7a m\u1ed9t\u00a0 m\u1ea3ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i b\u00ean tr\u00ean m\u1ea3ng g\u00e2y t\u1eafc ngh\u1ebdn<\/a> d\u00f2ng\u00a0 m\u00e1u ch\u1ea3y c\u1ea5p t\u00ednh d\u1eabn \u0111\u1ebfn \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, nh\u1ed3i m\u00e1u c\u01a1 tim (MI), ho\u1eb7c\u00a0 t\u1eed vong. Do \u0111\u00f3, nguy c\u01a1 g\u1eb7p ph\u1ea3i m\u1ed9t bi\u1ebfn c\u1ed1 ASCVD c\u1ea5p t\u00ednh t\u0103ng nhanh khi\u00a0 nhi\u1ec1u lipoprotein ch\u1ee9a ApoB b\u1ecb gi\u1eef l\u1ea1i v\u00e0 g\u00e1nh n\u1eb7ng m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch t\u0103ng\u00a0 l\u00ean. \u0110i\u1ec1u n\u00e0y cung c\u1ea5p c\u01a1 s\u1edf l\u00fd lu\u1eadn cho vi\u1ec7c khuy\u1ebfn kh\u00edch m\u1ed9t l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh\u00a0 \u0111\u1ec3 duy tr\u00ec n\u1ed3ng \u0111\u1ed9 th\u1ea5p c\u1ee7a c\u00e1c lipoprotein ch\u1ee9a ApoB trong su\u1ed1t cu\u1ed9c \u0111\u1eddi \u0111\u1ec3 l\u00e0m\u00a0 ch\u1eadm ti\u1ebfn tr\u00ecnh x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch; n\u00f3 c\u0169ng gi\u1ea3i th\u00edch \u0111\u1ed9ng c\u01a1 th\u00fac \u0111\u1ea9y khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb l\u00e0m gi\u1ea3m LDL-C v\u00e0 c\u00e1c lipoprotein c\u00f3 ch\u1ee9a ApoB kh\u00e1c, cho c\u1ea3 ph\u00f2ng ng\u1eeba\u00a0 ASCVD nguy\u00ean ph\u00e1t v\u00e0 ph\u00f2ng ng\u1eeba th\u1ee9 ph\u00e1t c\u00e1c bi\u1ebfn c\u1ed1 CV t\u00e1i ph\u00e1t.<\/p>\n

3. B\u1eb1ng ch\u1ee9ng v\u1ec1 \u1ea3nh h\u01b0\u1edfng nh\u00e2n qu\u1ea3 c\u1ee7a lipid v\u00e0 lipoprotein l\u00ean nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch\u00a0<\/strong><\/h2>\n

3.1 Cholesterol lipoprotein m\u1eadt \u0111\u1ed9 th\u1ea5p v\u00e0 nguy c\u01a1 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch <\/strong>LDL-C huy\u1ebft t\u01b0\u01a1ng l\u00e0 ph\u00e9p \u0111o kh\u1ed1i l\u01b0\u1ee3ng cholesterol \u0111\u01b0\u1ee3c mang theo b\u1edfi c\u00e1c h\u1ea1t\u00a0 LDL, m\u00e0 ph\u1ea7n l\u1edbn c\u00e1c lipoprotein ch\u1ee9a ApoB, v\u00e0 l\u00e0 m\u1ed9t \u01b0\u1edbc t\u00ednh v\u1ec1 n\u1ed3ng \u0111\u1ed9 LDL\u00a0 l\u01b0u h\u00e0nh. Nhi\u1ec1u nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc, nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean Mendel v\u00e0 RCT \u0111\u00e3\u00a0 li\u00ean t\u1ee5c ch\u1ee9ng minh m\u1ed1i quan h\u1ec7 tuy\u1ebfn t\u00ednh-log gi\u1eefa thay \u0111\u1ed5i tuy\u1ec7t \u0111\u1ed1i LDL-C huy\u1ebft\u00a0 t\u01b0\u01a1ng v\u00e0 nguy c\u01a1 ASCVD. T\u00ednh nh\u1ea5t qu\u00e1n \u0111\u00e1ng ch\u00fa \u00fd gi\u1eefa c\u00e1c nghi\u00ean\u00a0 c\u1ee9u n\u00e0y, ngo\u00e0i b\u1eb1ng ch\u1ee9ng sinh h\u1ecdc v\u00e0 th\u1ef1c nghi\u1ec7m, cung c\u1ea5p ch\u1ee9ng c\u1ee9 thuy\u1ebft ph\u1ee5c\u00a0 r\u1eb1ng LDL-C c\u00f3 li\u00ean quan nh\u00e2n qu\u1ea3 v\u1edbi nguy c\u01a1 ASCVD v\u00e0 vi\u1ec7c h\u1ea1 LDL-C l\u00e0m\u00a0 gi\u1ea3m nguy c\u01a1 ASCVD t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi m\u1ee9c gi\u1ea3m tuy\u1ec7t \u0111\u1ed1i LDL-C \u0111\u1ea1t \u0111\u01b0\u1ee3c.<\/p>\n

H\u01a1n n\u1eefa, c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean Mendel \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng vi\u1ec7c ti\u1ebfp x\u00fac\u00a0 l\u00e2u d\u00e0i v\u1edbi m\u1ee9c LDL-C c\u00e0ng th\u1ea5p c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 bi\u1ebfn c\u1ed1 CV c\u00e0ng th\u1ea5p\u00a0 h\u01a1n nhi\u1ec1u so v\u1edbi ti\u1ebfp x\u00fac ng\u1eafn h\u1ea1n v\u1edbi LDL-C th\u1ea5p (nh\u01b0 \u0111\u1ea1t \u0111\u01b0\u1ee3c trong c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean). Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y cung c\u1ea5p h\u1ed7 tr\u1ee3 m\u1ea1nh m\u1ebd cho kh\u00e1i\u00a0 ni\u1ec7m r\u1eb1ng c\u00e1c h\u1ea1t LDL c\u00f3 c\u1ea3 \u1ea3nh h\u01b0\u1edfng nh\u00e2n qu\u1ea3 v\u00e0 t\u00edch l\u0169y l\u00ean nguy c\u01a1 ASCVD.\u00a0 Do \u0111\u00f3, \u1ea3nh h\u01b0\u1edfng c\u1ee7a LDL-C \u0111\u1ebfn nguy c\u01a1 ASCVD d\u01b0\u1eddng nh\u01b0 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi\u00a0 c\u1ea3 c\u01b0\u1eddng \u0111\u1ed9 tuy\u1ec7t \u0111\u1ed1i v\u00e0 t\u1ed5ng th\u1eddi gian ti\u1ebfp x\u00fac v\u1edbi LDL-C.<\/p>\n

L\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u1ee7a vi\u1ec7c gi\u1ea3m LDL-C \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng vi\u1ec7c l\u00e0m gi\u1ea3m c\u00e1c\u00a0 h\u1ea1t LDL l\u01b0u h\u00e0nh theo \u01b0\u1edbc t\u00ednh b\u1edfi ApoB, th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u1ea3n chi\u1ebfu th\u00f4ng qua vi\u1ec7c gi\u1ea3m cholesterol do c\u00e1c h\u1ea1t \u0111\u00f3 mang theo. V\u00ec v\u1eady, l\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u1ee7a c\u00e1c\u00a0 li\u1ec7u ph\u00e1p nh\u1eb1m h\u1ea1 LDL-C b\u1eb1ng c\u00e1ch l\u00e0m gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng h\u1ea1t LDL s\u1ebd t\u1ef7 l\u1ec7 thu\u1eadn\u00a0 v\u1edbi m\u1ee9c gi\u1ea3m tuy\u1ec7t \u0111\u1ed1i c\u1ee7a LDL-C, b\u1edfi v\u00ec \u2013 v\u1ec1 m\u1eb7t trung b\u00ecnh – vi\u1ec7c gi\u1ea3m c\u00e1c h\u1ea1t\u00a0 LDL-C v\u00e0 LDL s\u1ebd l\u00e0 \u0111\u1ed3ng th\u1eddi. Ng\u01b0\u1ee3c l\u1ea1i, l\u00e2m s\u00e0ng l\u1ee3i \u00edch c\u1ee7a c\u00e1c\u00a0 li\u1ec7u ph\u00e1p nh\u1eb1m h\u1ea1 LDL-C theo c\u01a1 ch\u1ebf l\u00e0m thay \u0111\u1ed5i th\u00e0nh ph\u1ea7n th\u1ef1c t\u1ebf c\u1ee7a ch\u00fang\u00a0 c\u00f3 th\u1ec3 kh\u00f4ng t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi m\u1ee9c gi\u1ea3m tuy\u1ec7t \u0111\u1ed1i LDL-C quan s\u00e1t \u0111\u01b0\u1ee3c, nh\u01b0ng thay\u00a0 v\u00e0o \u0111\u00f3 n\u00f3 \u0111\u01b0\u1ee3c k\u1ef3 v\u1ecdng s\u1ebd t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi s\u1ef1 thay \u0111\u1ed5i tuy\u1ec7t \u0111\u1ed1i v\u1ec1 n\u1ed3ng \u0111\u1ed9 h\u1ea1t LDL\u00a0 th\u00f4ng qua vi\u1ec7c gi\u1ea3m ApoB \u0111o \u0111\u01b0\u1ee3c.<\/p>\n

3.2 Lipoprotein gi\u00e0u triglyceride v\u00e0 nguy c\u01a1 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch <\/strong><\/p>\n

C\u00e1c h\u1ea1t VLDL gi\u00e0u TG v\u00e0 ph\u1ea7n c\u00f2n s\u00f3t l\u1ea1i c\u1ee7a ch\u00fang mang h\u1ea7u h\u1ebft c\u00e1c TG l\u01b0u\u00a0 h\u00e0nh. Do \u0111\u00f3, n\u1ed3ng \u0111\u1ed9 TG huy\u1ebft t\u01b0\u01a1ng ph\u1ea3n \u00e1nh n\u1ed3ng \u0111\u1ed9 lipoprotein gi\u00e0u TG ch\u1ee9a\u00a0 ApoB l\u01b0u h\u00e0nh.<\/p>\n

N\u1ed3ng \u0111\u1ed9 TG huy\u1ebft t\u01b0\u01a1ng t\u0103ng c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 ASCVD, nh\u01b0ng\u00a0 m\u1ed1i li\u00ean quan n\u00e0y kh\u00f4ng c\u00f2n sau khi \u0111i\u1ec1u ch\u1ec9nh cho non-HDL-C, l\u00e0 m\u1ed9t \u01b0\u1edbc t\u00ednh\u00a0 t\u1ed5ng n\u1ed3ng \u0111\u1ed9 c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c lipoprotein ch\u1ee9a ApoB. T\u01b0\u01a1ng t\u1ef1, h\u1ea1 TG b\u1eb1ng\u00a0 fibrate l\u00e0m gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 CV t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p h\u1ea1 LDL-C khi \u0111\u01b0\u1ee3c \u0111o tr\u00ean m\u1ed7i \u0111\u01a1n v\u1ecb thay \u0111\u1ed5i non-HDL-C, cho th\u1ea5y \u1ea3nh h\u01b0\u1edfng c\u1ee7a TG\u00a0 huy\u1ebft t\u01b0\u01a1ng l\u00ean ASCVD th\u00f4ng qua s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 c\u1ee7a c\u00e1c lipoprotein gi\u00e0u TG\u00a0 theo \u01b0\u1edbc t\u00ednh b\u1edfi non-HDL-C.<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean Mendel c\u0169ng cho th\u1ea5y m\u1ed1i li\u00ean quan gi\u1eefa TG huy\u1ebft\u00a0 t\u01b0\u01a1ng v\u00e0 nguy c\u01a1 CHD c\u00f3 th\u1ec3 l\u00e0 nh\u00e2n qu\u1ea3; tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng n\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c\u00a0 gi\u1ea3i th\u00edch m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng v\u00ec g\u1ea7n nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c bi\u1ebfn th\u1ec3 li\u00ean quan \u0111\u1ebfn TG c\u0169ng\u00a0 li\u00ean quan \u0111\u1ebfn HDL-C, LDL-C ho\u1eb7c Lp. M\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean\u00a0 Mendel g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng bi\u1ebfn th\u1ec3 lipoprotein lipase (LPL) TG th\u1ea5p v\u00e0\u00a0 bi\u1ebfn th\u1ec3 th\u1ee5 th\u1ec3 LDL LDL-C th\u1ea5p c\u00f3 \u1ea3nh h\u01b0\u1edfng nh\u01b0 nhau \u0111\u1ebfn nguy c\u01a1 ASCVD tr\u00ean\u00a0 m\u1ed7i \u0111\u01a1n v\u1ecb thay \u0111\u1ed5i ApoB, cho th\u1ea5y r\u1eb1ng t\u1ea5t c\u1ea3 c\u00e1c lipoprotein ch\u1ee9a ApoB \u0111\u1ec1u c\u00f3\u00a0 \u1ea3nh h\u01b0\u1edfng t\u01b0\u01a1ng t\u1ef1 l\u00ean nguy c\u01a1 CHD .<\/p>\n

3.3 Cholesterol lipoprotein m\u1eadt \u0111\u1ed9 cao v\u00e0 nguy c\u01a1 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch <\/strong><\/p>\n

M\u1ed1i li\u00ean quan ngh\u1ecbch \u0111\u1ea3o gi\u1eefa HDL-C huy\u1ebft t\u01b0\u01a1ng v\u00e0 nguy c\u01a1 ASCVD l\u00e0 m\u1ed9t\u00a0 trong nh\u1eefng m\u1ed1i li\u00ean quan nh\u1ea5t qu\u00e1n v\u00e0 c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i \u0111\u01b0\u1ee3c trong quan s\u00e1t d\u1ecbch t\u1ec5 h\u1ecdc. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean Mendel kh\u00f4ng cung c\u1ea5p b\u1eb1ng\u00a0 ch\u1ee9ng thuy\u1ebft ph\u1ee5c r\u1eb1ng HDL-C c\u00f3 li\u00ean quan \u0111\u1ebfn nguy\u00ean nh\u00e2n nguy c\u01a1 ASCVD. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng n\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng v\u00ec\u00a0 h\u1ea7u h\u1ebft c\u00e1c bi\u1ebfn th\u1ec3 di truy\u1ec1n li\u00ean quan \u0111\u1ebfn HDL-C c\u0169ng li\u00ean quan \u0111\u1ebfn nh\u1eefng thay\u00a0 \u0111\u1ed5i ng\u01b0\u1ee3c chi\u1ec1u v\u1ec1 TG, LDL-C ho\u1eb7c c\u1ea3 hai, do \u0111\u00f3, \u01b0\u1edbc t\u00ednh \u1ea3nh h\u01b0\u1edfng c\u1ee7a HDL-C\u00a0 l\u00ean nguy c\u01a1 ASCVD r\u1ea5t kh\u00f3 s\u1eed d\u1ee5ng thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean Mendel. H\u01a1n\u00a0 n\u1eefa, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean cho th\u1ea5y t\u0103ng HDL-C trong\u00a0 huy\u1ebft t\u01b0\u01a1ng l\u00e0m gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 CV. Trong th\u1eed nghi\u1ec7m dal OUTCOMES g\u1ea7n \u0111\u00e2y, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng dalcetrapib, m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf protein v\u1eadn\u00a0 chuy\u1ec3n cholesteryl ester (CETP) l\u00e0m t\u0103ng HDL-C m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 t\u00e1c d\u1ee5ng n\u00e0o\u00a0 \u0111\u1ed1i v\u1edbi LDL-C ho\u1eb7c ApoB, \u0111\u00e3 kh\u00f4ng l\u00e0m gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 CV ch\u00ednh. T\u01b0\u01a1ng\u00a0 t\u1ef1, trong th\u1eed nghi\u1ec7m ACCELERATE v\u00e0 REVEAL, ch\u1ea5t \u1ee9c ch\u1ebf CETP l\u00e0m t\u0103ng g\u1ea5p\u00a0 \u0111\u00f4i n\u1ed3ng \u0111\u1ed9 HDL-C, nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m nguy c\u01a1 x\u1ea3y ra c\u00e1c bi\u1ebfn c\u1ed1 ASCVD\u00a0 v\u01b0\u1ee3t qu\u00e1 mong \u0111\u1ee3i t\u1eeb vi\u1ec7c l\u00e0m gi\u1ea3m nh\u1eb9 n\u1ed3ng \u0111\u1ed9 ApoB. Ngo\u00e0i ra, m\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean cho th\u1ea5y vi\u1ec7c truy\u1ec1n tr\u1ef1c ti\u1ebfp m\u1ed9t ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 HDL l\u00e0m\u00a0 t\u0103ng n\u1ed3ng \u0111\u1ed9 HDL huy\u1ebft t\u01b0\u01a1ng, nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh x\u01a1\u00a0 v\u1eefa \u0111\u1ed9ng m\u1ea1ch th\u00f4ng qua ph\u00e9p \u0111o b\u1eb1ng si\u00eau \u00e2m n\u1ed9i m\u1ea1ch.<\/p>\n

Vi\u1ebft t\u1eaft:<\/strong> Apo = apolipoprotein; HDL = high-density lipoprotein; IDL = intermediate-density\u00a0 lipoprotein; LDL = low-density lipoprotein; Lp(a) = lipoprotein(a); PL = phospholipid; TG =\u00a0 triglyceride; VLDL = very low-density lipoprotein.<\/p>\n

 <\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O: H\u01b0\u1edbng d\u1eabn ESC\/EAS 2019 v\u1ec1 qu\u1ea3n l\u00fd r\u1ed1i\u00a0 lo\u1ea1n lipid m\u00e1u: \u0111i\u1ec1u ch\u1ec9nh lipid \u0111\u1ec3 gi\u1ea3m\u00a0 nguy c\u01a1 tim m\u1ea1ch<\/strong><\/p>\n

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

B\u1edfi v\u00ec c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ph\u00e1t tri\u1ec3n theo th\u1eddi gian khi ng\u00e0y c\u00e0ng nhi\u1ec1u\u00a0 c\u00e1c h\u1ea1t lipoprotein ch\u1ee9a ApoB \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i, n\u00ean k\u00edch th\u01b0\u1edbc c\u1ee7a t\u1ed5ng c\u00e1c m\u1ea3ng x\u01a1\u00a0 v\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi n\u1ed3ng \u0111\u1ed9 LDL-C l\u01b0u h\u00e0nh v\u00e0 c\u00e1c lipoprotein\u00a0 ch\u1ee9a ApoB kh\u00e1c c\u0169ng nh\u01b0 […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nVai tr\u00f2 c\u1ee7a lipid v\u00e0 lipoprotein\u00a0trong x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch \u2013 ESC 2019 - Vinmec<\/title>\n<meta name=\"description\" content=\"V\u1ec1 t\u1ed5ng quan, c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ph\u00e1t tri\u1ec3n theo th\u1eddi gian khi ng\u00e0y c\u00e0ng nhi\u1ec1u\u00a0 c\u00e1c h\u1ea1t lipoprotein \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Vai tr\u00f2 c\u1ee7a lipid v\u00e0 lipoprotein\u00a0trong x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch \u2013 ESC 2019 - 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