{"id":35787,"date":"2023-06-29T00:43:34","date_gmt":"2023-06-28T17:43:34","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=35787"},"modified":"2023-06-29T00:43:34","modified_gmt":"2023-06-28T17:43:34","slug":"co-che-va-cac-phuong-phap-dieu-tri-roi-loan-lipid-mau-esc-2019","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/29\/co-che-va-cac-phuong-phap-dieu-tri-roi-loan-lipid-mau-esc-2019\/","title":{"rendered":"C\u01a1 ch\u1ebf v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u ESC 2019"},"content":{"rendered":"<p><strong>\u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a lipid m\u00e1u l\u00e0 b\u01b0\u1edbc quan tr\u1ecdng \u0111\u1ec3 ph\u00f2ng ng\u1eeba c\u00e1c bi\u1ebfn c\u1ed1 c\u1ee7a b\u1ec7nh tim m\u1ea1ch v\u00e0 gi\u1ea3m thi\u1ebfu nguy c\u01a1 \u0111\u1ed9t qu\u1ef5, \u0111\u1eb7c bi\u1ec7t tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1. C\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch do x\u01a1 v\u1eefa l\u00e0m gia t\u0103ng g\u00e1nh n\u1eb7ng \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n v\u00e0 nguy c\u01a1 t\u1eed vong. R\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 nh\u1ea5t l\u00e0 t\u0103ng LDL-C l\u00e0 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 quan tr\u1ecdng nh\u1ea5t. \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u c\u1ea3i thi\u1ec7n t\u00edch c\u1ef1c c\u00e1c ch\u1ec9 s\u1ed1 lipid g\u00e2y x\u01a1 v\u1eefa, gi\u1ea3m ti\u1ebfn tri\u1ec3n m\u1ea3ng x\u01a1 v\u1eefa, gi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-35788 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/9b0a1da2-37d6-4b7d-b5cd-fbc257e0e45a-300x300.jpg\" alt=\"dieu-tri-roi-loan-lipid-mau\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/9b0a1da2-37d6-4b7d-b5cd-fbc257e0e45a-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/9b0a1da2-37d6-4b7d-b5cd-fbc257e0e45a-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/9b0a1da2-37d6-4b7d-b5cd-fbc257e0e45a-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/9b0a1da2-37d6-4b7d-b5cd-fbc257e0e45a.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a lipid<\/h2>\n<p>Lipid \u1edf ng\u01b0\u1eddi bao g\u1ed3m 3 nh\u00f3m ch\u00ednh:<\/p>\n<p>&#8211; Triglycerid (m\u1ee1 trung t\u00ednh): c\u1ea5u tr\u00fac g\u1ed3m 1 ph\u00e2n t\u1eed glycerol v\u00e0 3 acid b\u00e9o<\/p>\n<p>&#8211; Phospholipid: g\u1ed3m acid b\u00e9o g\u1eafn v\u1edbi phospho nh\u1edd ph\u1ea3n \u1ee9ng ester h\u00f3a<\/p>\n<p>&#8211; Cholesterol<\/p>\n<p>Lipid to\u00e0n ph\u1ea7n trong m\u00e1u \u1ed5n \u0111\u1ecbnh trong kho\u1ea3ng t\u1eeb 600 &#8211; 800mg\/dl,<\/p>\n<p>\u2219\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110i\u1ec1u h\u00f2a chuy\u1ec3n h\u00f3a lipid:<\/p>\n<p>&#8211; Hocmon l\u00e0m t\u0103ng tho\u00e1i bi\u1ebfn lipid:<\/p>\n<p>Adrenalin v\u00e0 Noradrenalin l\u00e0m t\u0103ng tho\u00e1i bi\u1ebfn lipid m\u1ea1nh nh\u1ea5t (t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp tr\u00ean c\u00e1c lipase ph\u1ee5 thu\u1ed9c hocmon c\u1ee7a m\u00f4 m\u1ee1) d\u1eabn \u0111\u1ebfn \u00a0l\u00e0m t\u0103ng axit b\u00e9o t\u1ef1 do trong m\u00e1u, c\u00f3 th\u1ec3 l\u00e0m t\u0103ng r\u1ea5t cao (7 &#8211; 8 l\u1ea7n b\u00ecnh th\u01b0\u1eddng).\u00a0 Ngo\u00e0i ra c\u00f2n c\u00f3 ACTH, c\u00e1c glucocorticoid, GH, thyroxin. . .<\/p>\n<ul>\n<li>Hocmon l\u00e0m t\u0103ng t\u1ed5ng h\u1ee3p lipid:<\/li>\n<\/ul>\n<p>Insulin: t\u0103ng qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p L t\u1eeb G, \u2193 tho\u00e1i h\u00f3a lipid. Ngo\u00e0i ra c\u00f2n c\u00f3 prostaglandin E t\u00e1c \u0111\u1ed9ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 Insulin.<\/p>\n<p>B\u00e9o ph\u00ec:<\/p>\n<p>T\u00ecnh tr\u1ea1ng t\u00edch l\u1ee7y m\u1ee1 qu\u00e1 m\u1ee9c l\u00e0m tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 th\u00eam 20% m\u1ee9c quy \u0111\u1ecbnh, \u0111\u00e1nh gi\u00e1 qua ch\u1ec9 s\u1ed1 BMI (Body Mass Index = Ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3). B\u00ecnh th\u01b0\u1eddng BMI \u00a0t\u1eeb 18,5 \u201323.<\/p>\n<p>C\u01a1 ch\u1ebf :<\/p>\n<p>&#8211; \u0102n nhi\u1ec1u:<\/p>\n<p>&#8211; Gi\u1ea3m huy \u0111\u1ed9ng m\u1ee1<\/p>\n<p>&#8211; V\u1ea5n \u0111\u1ec1 b\u00e9o di truy\u1ec1n<\/p>\n<p>Nguy\u00ean nh\u00e2n t\u0103ng Lipid m\u00e1u:<\/p>\n<p>T\u0103ng do \u0103n u\u1ed1ng: sau khi \u0103n 2 h<\/p>\n<p>T\u0103ng do huy \u0111\u1ed9ng: \u0111\u00f3i, s\u1ed1t, ti\u1ec3u \u0111\u01b0\u1eddng, n\u00f3ng, l\u1ea1nh, ch\u1ea5n th\u01b0\u01a1ng, shock, m\u1ec7t m\u00f5i, HC th\u1eadn h\u01b0<\/p>\n<p>T\u0103ng do gi\u1ea3m s\u1eed d\u1ee5ng: c\u00e1c b\u1ec7nh l\u00e0m suy t\u1ebf b\u00e0o gan, ng\u1ed9 \u0111\u1ed9c r\u01b0\u1ee3u, thu\u1ed1c\u2026<\/p>\n<p>T\u0103ng lipid m\u00e1u c\u00f3 y\u1ebfu t\u1ed1 gia \u0111\u00ecnh<\/p>\n<p><strong>1.1 \u00a0R\u1ed1i lo\u1ea1n Lipo \u2013 protein (LP):<\/strong><\/p>\n<ul>\n<li>\u00a095% lipid m\u00e1u v\u1eadn chuy\u1ec3n d\u01b0\u1edbi d\u1ea1ng LP<\/li>\n<li>\u00a0Th\u00e0nh ph\u1ea7n c\u1ee7a LP bao g\u1ed3m apo-protein, triglycerid, phospholipid v\u00e0 cholesterol<\/li>\n<li>\u00a0N\u1ed3ng \u0111\u1ed9 trung b\u00ecnh c\u1ee7a LP l\u00e0 700mg% trong \u0111\u00f3 cholesterol 180, phospholipid 160, triglycerid 160 v\u00e0 protein 200 mg%<\/li>\n<li>\u00a0T\u00f9y theo t\u1ef7 l\u1ec7 c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n n\u00e0y m\u00e0 LP m\u00e1u s\u1ebd c\u00f3 c\u00e1c t\u1ef7 tr\u1ecdng kh\u00e1c nhau: VLDL, LDL, IDL, HDL<\/li>\n<\/ul>\n<p><strong>1.2 . R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a cholesteron:<\/strong><\/p>\n<ul>\n<li>\u00a0Gi\u1ea3m cholesteron: Do gi\u1ea3m h\u1ea5p thu, \u0111\u00e0o th\u1ea3i qu\u00e1 nhanh<\/li>\n<li>\u00a0T\u0103ng cholesteron: \u0103n c\u00e1c ch\u1ea5t gi\u00e0u cholesteron (tr\u1ee9ng, gan, da \u0111\u1ed9ng v\u1eadt, t\u00f4m\u2026), t\u1eafc m\u1eadt, t\u0103ng lipid huy\u1ebft, thi\u1ec3u n\u0103ng gi\u00e1p<\/li>\n<li>\u00a0H\u1eadu qu\u1ea3 c\u1ee7a t\u0103ng cholesteron:<\/li>\n<li>G\u00e2y x\u01a1 gan, u v\u00e0ng d\u01b0\u1edbi da, x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch<\/li>\n<\/ul>\n<p>C\u01a1 ch\u1ebf g\u00e2y x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch:<\/p>\n<p>L\u00e0 s\u1ef1 t\u00edch \u0111\u1ecdng cholesteron d\u01b0\u1edbi l\u1edbp \u00e1o trong c\u1ee7a \u0111\u1ed9ng m\u1ea1ch t\u1eeb \u0111\u00f3 th\u00e0nh m\u1ea1ch d\u1ea7y l\u00ean v\u00e0 l\u1eafng \u0111\u1ecdng calci d\u1ea7n d\u1eabn \u0111\u1ebfn tho\u00e1i h\u00f3a, l\u00f3et, s\u00f9i t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c (do thi\u1ec3u d\u01b0\u1ee1ng) sau \u0111\u00f3 c\u00e1c m\u00f4 x\u01a1 ph\u00e1t tri\u1ec3n t\u1ea1i ch\u1ed7 v\u00e0 \u00a0n\u1ed9i m\u1ea1c th\u00e0nh m\u1ea1ch m\u1ea5t s\u1ef1 tr\u01a1n l\u00e1ng, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ti\u1ec3u c\u1ea7u b\u00e1m v\u00e0o t\u1eeb \u0111\u00f3 kh\u1edfi \u0111\u1ed9ng qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u d\u1eabn \u0111\u1ebfn t\u1eafc m\u1ea1ch.<\/p>\n<p>Vai tr\u00f2 c\u1ee7a HDL v\u00e0 LDL trong v\u1eefa x\u01a1 th\u00e0nh m\u1ea1ch<\/p>\n<p>HDL: gi\u00fap v\u1eadn chuy\u1ec3n cholesterol t\u1eeb t\u1ed5 ch\u1ee9c \u0111\u1ebfn c\u00e1c t\u1ebf b\u00e0o gan, c\u00f3 t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 th\u00e0nh m\u1ea1ch<\/p>\n<p>LDL: gi\u00fap v\u1eadn chuy\u1ec3n cholesterol t\u1eeb m\u00e1u \u0111\u1ebfn c\u00e1c m\u00f4<\/p>\n<p>V\u1eefa x\u01a1 \u0111\u1ed9ng m\u1ea1ch l\u00e0 do:<\/p>\n<p>. T\u1ebf b\u00e0o thi\u1ebfu th\u1ee5 th\u1ec3 ti\u1ebfp nh\u1eadn: th\u01b0\u1eddng l\u00e0 b\u1ea9m sinh, do m\u1ed9t s\u1ed1 gien chi ph\u1ed1i, th\u01b0\u1eddng g\u00e2y v\u1eefa x\u01a1 \u0111\u1ed9ng m\u1ea1ch r\u1ea5t s\u1edbm, nh\u1ea5t l\u00e0 th\u1ec3 \u0111\u1ed3ng h\u1ee3p t\u1eed<\/p>\n<p>. T\u0103ng cholesterol m\u00e1u: l\u00e0m t\u0103ng LDL m\u00e1u v\u01b0\u1ee3t kh\u1ea3 n\u0103ng b\u1eaft gi\u1eef c\u1ee7a th\u1ee5 th\u1ec3 v\u00e0 s\u1ef1 ti\u00eau th\u1ee5 c\u1ee7a t\u1ebf b\u00e0o<\/p>\n<p>H\u1eadu qu\u1ea3 c\u1ee7a v\u1eefa x\u01a1 \u0111\u1ed9ng m\u1ea1ch: t\u0103ng huy\u1ebft \u00e1p, t\u1eafc m\u1ea1ch v\u00e0 v\u1ee1 m\u1ea1ch (t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed v\u00e0 m\u1ee9c \u0111\u1ed9 x\u01a1 v\u1eefa)<\/p>\n<h2>2. C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u ESC-2019:<\/h2>\n<p><strong>2.1 Statin<\/strong><\/p>\n<p><strong>\u00a0Statin l\u00e0<\/strong><strong> m\u1ed9t trong nh\u00f3m thu\u1ed1c \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 h\u1ea1 lipid m\u00e1u. <\/strong><strong>Thu\u1ed1c \u0111\u00e3 c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3<\/strong><strong> cao trong vi\u1ec7c d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 tim m\u1ea1ch.<\/strong><\/p>\n<p>T\u00e1c \u0111\u1ed9ng Statin tr\u00ean ti\u1ebfn tr\u00ecnh x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch<\/p>\n<ol>\n<li>C\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng n\u1ed9i m\u1ea1c<\/li>\n<li>T\u00e1c d\u1ee5ng ch\u1ed1ng ox\u00fdt h\u00f3a<\/li>\n<li>\u1ee8c ch\u1ebf t\u0103ng sinh v\u00e0 di tr\u00fa t\u1ebf b\u00e0o c\u01a1 tr\u01a1n<\/li>\n<li>T\u00e1c d\u1ee5ng t\u00e2n t\u1ea1o m\u1ea1ch<\/li>\n<li>K\u00edch th\u00edch t\u1ebf b\u00e0o g\u1ed1c c\u1ee7a n\u1ed9i m\u1ea1c<\/li>\n<li>\u0110i\u1ec1u ho\u00e0 mi\u1ec5n d\u1ecbch<\/li>\n<li>T\u00e1c d\u1ee5ng ch\u1ed1ng huy\u1ebft kh\u1ed1i<\/li>\n<li>\u1ed4n \u0111\u1ecbnh m\u1ea3ng x\u01a1 v\u1eefa<\/li>\n<li>T\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam<\/li>\n<\/ol>\n<p>L\u01b0u \u00fd khi s\u1eed d\u1ee5ng statin:<\/p>\n<ul>\n<li>C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean c\u01a1, tr\u00ean gan v\u00e0 t\u0103ng nguy c\u01a1 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi kh\u1edfi ph\u00e1t.<\/li>\n<li>C\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/li>\n<\/ul>\n<p><strong>. <\/strong><strong>Thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c v\u1edbi statin <\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"359\">Thu\u1ed1c ch\u1ed1ng nhi\u1ec5m khu\u1ea9n<\/td>\n<td width=\"286\">\u0110\u1ed1i kh\u00e1ng calci<\/td>\n<td width=\"201\">Kh\u00e1c<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Itraconazole<\/td>\n<td width=\"286\">Verapamil<\/td>\n<td width=\"201\">Ciclosporin<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Ketoconazole<\/td>\n<td width=\"286\">Diltiazem<\/td>\n<td width=\"201\">Danazol<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Posaconazole<\/td>\n<td width=\"286\">Amlodipine<\/td>\n<td width=\"201\">Amiodarone<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Erythromycin<\/td>\n<td width=\"286\">&nbsp;<\/td>\n<td width=\"201\">Ranolazine<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Clarithromycin<\/td>\n<td width=\"286\">&nbsp;<\/td>\n<td width=\"201\">Grapefruit juice<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Telithromycin<\/td>\n<td width=\"286\">&nbsp;<\/td>\n<td width=\"201\">Nefazodone<\/td>\n<\/tr>\n<tr>\n<td width=\"359\">Ch\u1ea5t \u1ee9c ch\u1ebf HIV protease<\/td>\n<td width=\"286\">&nbsp;<\/td>\n<td width=\"201\">Gemfibrozil<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>C\u00e1c statin theo th\u1ebf h\u1ec7:<\/p>\n<ul>\n<li>Th\u1ebf h\u1ec7 \u0111\u1ea7u: The first (FGS) pravastatin,lovastatin, fluvastatin<\/li>\n<li>Th\u1ebf h\u1ec7 2: The second (SGS) Atorvastatin, simvastatin<\/li>\n<li>Th\u1ebf h\u1ec7 3: The Third (TGS) Rosuvastatin, pitavastatin<\/li>\n<\/ul>\n<p>C\u01b0\u1eddng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb h\u1ea1 lipid v\u00e0 m\u1ee9c \u0111\u1ed9 gi\u1ea3m LDL-C trung b\u00ecnh (Khuy\u1ebfn c\u00e1o 2019 t\u1eeb ESC)<\/p>\n<ul>\n<li>Statin c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh: \u2248 30%<\/li>\n<li>Statin c\u01b0\u1eddng \u0111\u1ed9 cao: \u2248 50%<\/li>\n<li>Statin c\u01b0\u1eddng \u0111\u1ed9 cao c\u1ed9ng ezetimibe: \u2248 65%<\/li>\n<li>Ch\u1ea5t \u1ee9c ch\u1ebf PCSK9: \u2248 60%<\/li>\n<li>Ch\u1ea5t \u1ee9c ch\u1ebf PCSK9 c\u1ed9ng statin c\u01b0\u1eddng \u0111\u1ed9 cao : \u2248 75%<\/li>\n<li>Ch\u1ea5t \u1ee9c ch\u1ebf PCSK9 c\u1ed9ng statin c\u01b0\u1eddng \u0111\u1ed9 cao c\u1ed9ng v\u1edbi ezetimibe: \u2248 85%<\/li>\n<\/ul>\n<p><strong>2.2 Thu\u1ed1c \u1ee9c ch\u1ebf h\u1ea5p thu cholesterol<\/strong><\/p>\n<p>C\u01a1 ch\u1ebf c\u1ee7a thu\u1ed1c Ezetimibe l\u00e0 \u1ee9c ch\u1ebf ru\u1ed9t h\u1ea5p thu cholesterole sau b\u1eefa \u0103n u\u1ed1ng v\u00e0 trong d\u1ecbch m\u1eadt \u1edf khu v\u1ef1c b\u1edd b\u00e0n ch\u1ea3i c\u1ee7a ru\u1ed9t. T\u1eeb vi\u1ec7c \u1ee9c ch\u1ebf h\u1ea5p thu cholesterol, ezetimibe l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng thi\u1ec3u cholesterol \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn gan t\u1eeb \u0111\u00f3 l\u00e0m gi\u1ea3m lipid m\u00e1u.<\/p>\n<p><strong>2.3 Ch\u1ea5t c\u00f4 l\u1eadp acid m\u1eadt<\/strong><\/p>\n<p>C\u00e1c acid m\u1eadt \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p t\u1ea1i gan t\u1eeb cholesterol sau \u0111\u00f3 \u0111\u01b0\u1ee3c ph\u00f3ng th\u00edch v\u00e0o ru\u1ed9t, nh\u01b0ng trong chu tr\u00ecnh gan ru\u1ed9t, c\u00e1c acid m\u1eadt \u0111\u01b0\u1ee3c t\u00e1i h\u1ea5p thu tr\u1edf l\u1ea1i gan t\u1eeb \u0111o\u1ea1n cu\u1ed1i h\u1ed3i tr\u00e0ng th\u00f4ng qua h\u1ea5p thu ch\u1ee7 \u0111\u1ed9ng. D\u1ef1a tr\u00ean c\u01a1 ch\u1ebf n\u00e0y, hai ch\u1ea5t cholestyramine v\u00e0 colestipol, \u0111\u1ec1u l\u00e0 c\u00e1c lo\u1ea1i nh\u1ef1a trao \u0111\u1ed5i li\u00ean k\u1ebft v\u1edbi acid m\u1eadt, l\u00e0 ch\u1ea5t c\u00f4 l\u1eadp acid m\u1eadt.<\/p>\n<p><strong>2.4 Ch\u1ea5t \u1ee9c ch\u1ebf proprotein convertase subtilisin\/kexin type 9<\/strong><\/p>\n<p>Nh\u00f3m thu\u1ed1c m\u1edbi g\u1ea7n \u0111\u00e2y l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf PCSK9, ch\u1ea5t n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng nh\u1eafm m\u1ee5c ti\u00eau m\u1ed9t protein (PCSK9) tham gia v\u00e0o vi\u1ec7c ki\u1ec3m so\u00e1t LDLR. Ng\u01b0\u1eddi ta nh\u00e2n th\u1ea5y khi l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 ho\u1eb7c ch\u1ee9c n\u0103ng c\u1ee7a ch\u1ea5t PCSK9 c\u00f3 li\u00ean quan \u0111\u1ebfn LDL-C huy\u1ebft t\u01b0\u01a1ng th\u1ea5p.<\/p>\n<p><strong>2.5 Fibrate<\/strong><\/p>\n<p>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a Fibrate: Fibrat l\u00e0 ch\u1ea5t \u0111\u1ed3ng v\u1eadn c\u1ee7a th\u1ee5 th\u1ec3 peroxisome proliferator-a (PPAR- a), c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng th\u00f4ng qua c\u00e1c y\u1ebfu t\u1ed1 phi\u00ean m\u00e3 \u0111\u1ec3 \u0111i\u1ec1u h\u00f2a c\u00e1c b\u01b0\u1edbc\u00a0 trong chuy\u1ec3n qu\u00e1 tr\u00ecnh h\u00f3a lipid v\u00e0 lipoprotein. Fibrate c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1t trong vi\u1ec7c h\u1ea1 triglycerid sau b\u1eefa \u0103n, c\u0169ng nh\u01b0 c\u00e1c h\u1ea1t c\u00f2n s\u00f3t l\u1ea1i c\u1ee7a triglycerid v\u00e0 c\u00e1c h\u1ea1t lipoprotein gi\u00e0u triglycerid.<\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/nhung-luu-y-khi-dung-thuoc-statin-ha-mo-mau\/\">Nh\u1eefng l\u01b0u \u00fd khi d\u00f9ng thu\u1ed1c Statin h\u1ea1 m\u1ee1 m\u00e1u<\/a><\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o: <em>H\u01b0\u1edbng d\u1eabn ESC\/EAS 2019 v\u1ec1 qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n lipid m\u00e1u: \u0111i\u1ec1u ch\u1ec9nh lipid \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a lipid m\u00e1u l\u00e0 b\u01b0\u1edbc quan tr\u1ecdng \u0111\u1ec3 ph\u00f2ng ng\u1eeba c\u00e1c bi\u1ebfn c\u1ed1 c\u1ee7a b\u1ec7nh tim m\u1ea1ch v\u00e0 gi\u1ea3m thi\u1ebfu nguy c\u01a1 \u0111\u1ed9t qu\u1ef5, \u0111\u1eb7c bi\u1ec7t tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1. C\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch do x\u01a1 v\u1eefa l\u00e0m gia t\u0103ng g\u00e1nh n\u1eb7ng \u0111i\u1ec1u tr\u1ecb [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u01a1 ch\u1ebf v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u ESC 2019 - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u l\u00e0 b\u01b0\u1edbc quan tr\u1ecdng \u0111\u1ec3 ph\u00f2ng ng\u1eeba c\u00e1c bi\u1ebfn c\u1ed1 c\u1ee7a b\u1ec7nh tim m\u1ea1ch v\u00e0 gi\u1ea3m thi\u1ebfu nguy c\u01a1 \u0111\u1ed9t qu\u1ef5\" \/>\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=\"C\u01a1 ch\u1ebf v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u ESC 2019 - 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