Hyperlipidemia and hyperlipoproteinemia
When the plasma lipid concentration exceeds the normal upper limit, it is called hyperlipidemia. When plasma lipoprotein exceeds normal high level, it is called hyperlipoproteinemia. Hyperlipidemia is often manifested as hyperlipidemia. Clinically, it is common in uncontrolled diabetes, myxedema or hypothyroidism, atherosclerosis, nephrotic syndrome, biliary cirrhosis and pancreatitis. It is a common and important disease in metabolic diseases.
2 Clinical manifestations: 1. Type I hyperlipoproteinemia (hypervolemia) (1) has a severe increase in plasma triglycerides (up to.
1 1.3-
45.2 mmol/L), cholesterol increased slightly. (2) There were chylomicrons in the serum at 4℃ overnight. The values of very low density lipoprotein (VLDL) and low density lipoprotein (LDL) are ≥ normal. This type is more common in children or non-obese non-diabetic young people, accompanied by severe hypertriglyceridemia, which can lead to recurrent pancreatitis, hepatosplenomegaly, seborrheic retinitis and eruptive xanthoma.
2. Type II hyperlipoproteinemia: (high LDL) increased cholesterol (TC ≥ 5.7 mmol/L) and low density lipoprotein-cholesterol (LDL-C > 3.90 mmol/L). This type is more common in familial hypercholesterolemia, and a few are secondary to hypothyroidism.
3. Type Ⅲ hyperlipoproteinemia (high β-VLDL): (1) Cholesterol (TC) and triglyceride (TG) increase at the same time, TC:TG 1. (2) The ratio of very low density lipoprotein-cholesterol (VLDL-C) to triglyceride (TG) in patients is greater than 0.3 (normal people < 0.25); (3) Agar electrophoresis showed wide β band, so this disease is also called wide β disease; (4) This disease is common in familial or uncontrolled diabetes, and it is easy to be complicated with coronary heart disease.
4. type Ⅳ hyperlipoproteinemia: (1) triglyceride slightly increased (TG > 1.69 mmol/L), and cholesterol was normal (TC). (2) The disease is often obese, accompanied by diabetes or hyperuricemia, but without xanthoma.
5. Type ⅴ hyperlipoproteinemia: (1) triglyceride is obviously increased (TG > 4.52 mmol/L, often greater than 1 1.3 mmol/L), and cholesterol is moderately increased. (2) There were chylomicrons in the plasma at 4℃ overnight, the plasma was turbid, VLDL increased, and LDL≤ normal. (3) This type is more common in adults, obese, hyperuricemia and diabetic patients. Drinking alcohol, taking exogenous estrogen and renal insufficiency can aggravate the disease.
3 Diagnostic basis 1. According to the electrophoresis of lipid protein and the appearance of serum, doctors must explore the causes from related diseases, family history, eating habits and so on. Appearance of serum: put the serum in the refrigerator at 4℃ 18-20 hours and observe its turbidity. The ones with low clarity belong to type ⅰ; Those who are completely clarified may be normal serum or type ⅱ and ⅳ; Type Ⅳ and type Ⅳ are uniform turbidity; The top layer is the "cream layer", and its turbidity is V-shaped.
2. Lipoprotein electrophoresis: When β -lipoprotein band is deeply stained, cholesterol increases alone and TG is normal, which belongs to type II; Cholesterol increased, and TG 150-400 mg/dl was ⅱ b; Normal cholesterol, simple TG increase with deep staining of pre-β band belongs to type ⅳ, even to type ⅲ; Cholesterol increased, TG 400- 1000 mg/dl, belonging to type ⅳ or ⅴ.
4 treatment principles 1. Diet therapy: low-fat diet; Patients with type ⅴ need to control cholesterol, sugar and fat; For patients with endogenous hypertriglyceridemia (type Ⅱ, Ⅳ, Ⅴ), sugar and total calories should be restricted to reduce body weight. Hypercholesterolemia (type II): A diet low in cholesterol and saturated fatty acids.
2. medication.
3. Exercise therapy.
Principle of medication: Long-term medication of hyperlipoproteinemia is effective. The blood lipid can return to normal after taking the medicine, but it can rebound after stopping taking the medicine. Therefore, it is best to cooperate with diet therapy in treatment. The selected drugs are linoleic acid drugs in "A" and "B", mainly nicotinic acid, phenolic resin and vitamin C, supplemented by new Chinese medicine in "C".
The auxiliary examination should draw blood to do a full set of blood lipid examination and determination, and at the same time do lipoprotein electrophoresis and apolipoprotein examination to classify hyperlipidemia.
7 efficacy evaluation 1. Cure: Blood lipids completely return to normal.
2. Improvement: After treatment, blood lipid decreased.