Hyperlipidemia and Hyperlipoproteinemia

As outlined in fat metabolism or abnormal functioning of the plasma so that one or more higher than normal lipid known as hyperlipidemia. Lipid-soluble or insoluble water, it combines with protein to form lipoproteins, therefore, Hyperlipidemia often Hyperlipoproteinemia (hyperlipoproteinemia). Performance of hypercholesterolemia, hypertriglyceridemia or both, clinical divided into two categories : ① primary, a rare, Fat is a genetic metabolic disorder; ② secondary, common in poorly controlled diabetes, drinking, hypothyroidism, Nephrotic syndrome, kidney dialysis and renal transplantation, biliary obstruction, such as oral contraceptives. Lipoprotein divided into : 1. Chylomicrons CM; 2. VLDL very low density lipoprotein; 3. LDL, low-density lipoprotein; 4. HDL high-density lipoprotein. A clinical performance. Ⅰ Hyperlipoproteinemia (high-CM hypercholesterolemia) (1) plasma triglyceride Serious increased (up to 11 .3-45.2 mmol / L), mildly elevated cholesterol. (2) 4 ° C overnight serum chylomicrons (CM). Very low density lipoprotein (VLDL) and low-density lipoprotein (LDL) ≥ normal. This type of pediatric clinical found in non-obese diabetic or non-serious young patients with hypertriglyceridemia, recurring pancreatitis, hepatosplenomegaly, and lipid gutsy Retinitis eruptive yellow tumor. 2. Type II Hyperlipoproteinemia : (hyperlipidemia high LDL) cholesterol increased (TC ≥ 5.7mmol / L) and low-density lipoprotein-cholesterol increased (LDL-C "3.90mmol / L). Of this type are common in familial hypercholesterolemia, in a small number of secondary hypothyroidism. 3. Type III Hyperlipoproteinemia (high beta-VLDL hyperlipidemia) : (a) cholesterol (TC) and triglyceride (TG) also increased and TC : TG = 1. (2) the patient very low density lipoprotein-cholesterol (VLDL-C) and triglyceride (TG), the ratio of "0.3 (normal "0.25); (3) gel electrophoresis showed wide beta belt, it is also called the disease wide beta disease; (4) The disease is common in familial or not found in the control of diabetes, coronary heart disease complicated easy. 4. Ⅳ Hyperlipoproteinemia (high VLDL hyperlipidemia) : (1) mildly elevated triglyceride (TG "1.69mmol / L) and cholesterol (TC) normal. (2) The disease often obesity, diabetes or hyperuricemia, but no yellow tumor. 5. V-Hyperlipoproteinemia : (1) significantly higher triglyceride (TG "4.52mmol / L, often greater than 11.3 mmol / L), moderately elevated cholesterol. (2) 4 ° C overnight with plasma chylomicrons, plasma turbidity, increased VLDL, LDL less than normal. (3) The type more common in adults, obesity, and hyperuricemia in patients with diabetes, drinking, use of exogenous estrogen and renal dysfunction can increase the disease. A diagnosis. According blood lipoprotein electrophoresis, serum appearance to judge, a doctor from the disease, family history, eating habits among explore causes of the disease. Serum appearance : Serum placed in 4 ℃ refrigerator 18 -20 hours after the observation of its turbidity. Clarify who is a class type I; Fully clarified may normal serum or II, collagen type; Turbidity uniform were found in IV and III type; Top "butter layer", whose V-for turbidity. 2. Lipoprotein electrophoresis : When beta with deeply stained lipoprotein cholesterol alone increased TG normal, is a Type II; Cholesterol increased, TG150-400mg/dl Ⅱ type b; normal cholesterol, TG simply increased with the former band deep into beta is a type IV, is a dual type III; cholesterol increased, TG400-1000mg/dl, an IV or V-type. Treatment should adhere to a comprehensive long-term treatment to control stress diet and physical exercise mainly the result is not only an ideal mixture of medication. Secondary (such as diabetes, hypothyroidism), should actively treatment of the primary disease. 1, diet, exercise therapy : The aim is to reduce the plasma cholesterol, maintain a balanced diet. Movement and the lower weight addition to lowering cholesterol, but also triglycerides and hypertension and increase HDL cholesterol. Second, drug treatment : diet and exercise therapy, as there is still one of the following circumstances, should consider the use of drug therapy : ① no other risk factors, LDL cholesterol ≥ 4.9mmol / L (190mg/dl); ② with two risk factors (such as smoking, hypertension, low HDL cholesterol, family history of early coronary artery disease, etc.) LDL cholesterol ≥ 4.1mmol / L (mg); ③ triglycerides ≥ 5.5mmol / L (500mg/dl). Male under the age of 35 or women before menopause, in the absence of other risk factors, may be suspended drug treatment. Lipid-lowering drugs are : (1) acid resin If they combine to enamine (cholestyramine), Oral each four - 5g, 3 times / d, take back those (colestipol), each 4 - 5g, 3 /. During regular medication to make blood, liver function and blood electrolyte checks. (2) niacin (nicotinic acid, niacin) for the treatment of high cholesterol and hypertriglyceridemia exist, started 0.1 g, 3 times /, According to subsequent changes in blood lipid levels and tolerance increased to a ~ 2 g, 3 times / d, skin flushing, itching, stomach discomfort, dyspepsia, elevated blood sugar, elevated blood uric acid, peptic ulcer, and other side effects of long-term attention to check liver function. Eximo (acipimox), every night before bed served 250 ~ 500mg, If the condition of patients can increase breakfast served 250 mg. (3) phenoxy-acid (fibrate) category fibrate (clofibrate) Oral each 0.5 g, 3 times / d. A drug. Diet therapy : low-fat diet; V - are required to control cholesterol, sugar and fat; For endogenous hypertriglyceridemia (II, IV, V-type) should limit sugar and calories and reduce weight. Hypercholesterolemia (type II) : low-cholesterol, low-saturated fatty acid diet. 2. Drug treatment. 3. Exercise therapy.