CHITSANZO CHA LIPID METABOLISM NDI ATHEROSCLEROSIS: kuthamangitsa vutoli komanso kuzindikira

Kusintha kwa mitsempha ya Atherossteotic kuli kofanana ndi anthu pafupifupi onse azaka zopitilira 40, kusiyana kumangosintha. Kukula kwa atherosulinosis kumakhudzana kwambiri ndi kayendedwe ka cholesterol kupita ku khoma lozungulira ngati gawo la lipoproteins yotsika komanso yotsika kwambiri komanso njira za kuchotsedwa kwa cholesterol ku khoma la arterial pogwiritsa ntchito lipoproteins yapamwamba. Ngati kuchuluka kwa "lipids otsika kwambiri komanso otsika kwambiri a lipids" kumayesedwa ngati 3: 1, atherosclerosis sizichitika ngakhale zili ndi zambiri (zoposa 6.21 mmol / L) ya plasma cholesterol. Muzochita zamankhwala, cholesterol coeffokwanira wa atherogenicity imagwiritsidwa ntchito:

kumene CO ndi kuchuluka kwa cholesterol yathunthu, SLVP ndiye kuchuluka kwa osachulukitsa lipid cholesterol.

Chiwerengerochi ndichabwino kwa akhanda, mwa anthu azaka zapakati pa 20-30, mtengo wake umachokera pa 2 mpaka 2.8, wamkulu kuposa zaka 30 (wopanda zizindikiro za atherosclerosis), uli pamtunda wa 3.0-3.5, komanso mwa anthu ndi matenda a mtima opitilira 4, omwe nthawi zambiri amafika pa 5-6 kapena kupitirira.

Pakadali pano, akukhulupirira kuti choyambirira pakukula kwa atherosulinosis ndi kusintha kwapangidwe kapangidwe ka maselo am'mimba a endothelial cell. Zowonongeka zilizonse za endothelium (zochita za poizoni, maofesi owononga chitetezo, othandizira okoka, cholesterol, lipoproteins zosinthidwa, ndi zina) kumawonjezera kupezeka kwake, kumabweretsa kulowa kwa monocytes pansi pa endothelium ndikusintha kwawo kukhala macrophages.

Pamaso pa ma macrophage pali ma receptor onse osapangidwa komanso osinthika otsika osalimba lipids. Izi zolandirira sizimachepetsa ntchito pakudzikundikira kwa cholesterol muma macrophages. Ma lipids omalizirawa, omwe amadzisonkhanitsa, amasanduka maselo ofunda (amakhala ndi cholesterol yambiri). Endothelium, yodzaza ndimaselo a thovu, imayamba kugwira ntchito, ndipo macrophages amakumana ndi magazi. Amayika zinthu zambiri zodziwitsa zachilengedwe, kuphatikizapo kusintha maselo osalala omwe ali ndi maselo ofunikira kukula. Kukula kwa minofu yosalala ya masentimita apakati ndikusunthira kwawo mkati. Zomwe zimapangika m'maselo osalala osalala omwe amadzaza ndi mafuta m'malo amodzi nthawi zambiri amasintha kukhala zolembera.

Maselo osalala osinthika amapanga collagen, elastin ndi zigawo zina za matrix osakanikirana a zolembedwa za atherosranceotic. Fomu lamkaka lamkati. Mtsogolomo, kuwonongeka kwa mapangidwe a zolembera, mpweya wamakedzana ndi mafuta amchere a calcium, omwe amakhumudwitsa minofu yoyandikana, amachititsa kuchepa kwa lumen ya ziwiya ndi thrombosis, zomwe zingayambitse kugunda kwa mtima komanso sitiroko. Mu magawo oyamba a atherosulinosis, kuchepa kwamthupi ndi kayendedwe ka metabolic ka cholesterol ndi lipoproteins - dyslipo-proteinemia - zimachitika. Mwambiri, zomwe zili atherogenic tinthu tomwe timagazi m'magazi, chomwe chimakhala chofunikira kwambiri chomwe ndi cholesterol, zimachulukanso ngati mapuloteni - apoprotein B. Izi zimapangitsa kuti lipoprotein asinthidwe kwambiri, kuphatikizidwa kwa mapangidwe a milomo ya lipoprotein osinthika komanso mapangidwe a mapangidwe a atherosselotic. Ndi otsika kuchuluka kwa osachulukirapo antiatherogenic lipoproteins m'mwazi (mu 30% ya milandu), atherosulinosis yofulumira imachitika ngakhale ndi cholesterol yotsika kwambiri (osakwana 5.18 mmol / l).

Ma phospholipids ndi ma polyunsaturated mafuta acids ali ndi antiatherogenic katundu. Amachepetsa mayamwidwe chakudya mafuta m'thupi laling'ono matumbo, zimapangitsa kaphatikizidwe wa bile acid mu chiwindi, ziletsa kaphatikizidwe ndi katulutsidwe kwambiri otsika lipoprotein ndi hepatocytes, kuchepetsa ndende ya otsika osalimba lipoproteinon mu plasma, ziletsa synthetromboxane A ndi kuphatikizika kwa maselo.

Cholesterol, triglycerides ndi mafuta anachuma okhala ndi zinthu zina za atherogenic. Kuchulukitsidwa kwa lipotrotein ya atherogenic m'magazi kumatha kuchuluka chifukwa chakuchepa kwa magazi awo kuchokera ku chiwindi, kuwonjezeka kwa chiwopsezo ndi kaphatikizidwe, ndi kuphwanya kwa plasma lipoprotein metabolism, kuphatikizapo mapangidwe a lipoprotein osasintha.

Kusokonezeka kwa kagayidwe ka cholesterol kumachitika pansi pa zinthu zotsatirazi: pakalibe kuchepa kwa mphamvu ya lipoprotein zolandirana pamaselo a cell. Mwachindunji: endocytosis ndiosatheka, chifukwa: mulingo wa lipoproteins mu plasma ukuwonjezeka (cholowa cha hypercholesterolemia ndi mtundu II hyperlipoproteinemia) ndipo endocytosis yosakhala yodziwika imapangidwira: maselo a reticuloendothelial system amajambula lipoproteins, omwe amatsogolera pakukula kwa cell.

kuchuluka kwa kuphatikizana kwa lipoproteins ku nembanemba chifukwa cholesterol machulukitsidwe akunja a otsika kwambiri osadzipika a lipoproteins (mtundu wa III hyperlipoproteinemia): kuwonongeka kochulukirapo kwa cholesterol owonjezera pamitsempha yosalala minofu endothelium. Pazinthu zowonongeka, mapulateleti omatira komanso kumasulidwa kwa chinthu chokula kumachitika. Kuwonjezeka kwa mpweya wopatsirana kumapangitsa kuti ma cell apangidwe a lipoprotein, kuchitika kwa microdamage, kusuntha kwa leukocytes kuchokera pabedi lamitsempha kulowa khoma la chotengera, mapangidwe a atherosranceotic plaque apa,

kupsinjika, komwe kumathandizira kukulitsa kwa atherosulinosis. Kuwonjezeka kwa kuchuluka kwa adrenaline ndi angiotensin m'magazi kumayambitsa kuchepa kwa maselo a endothelial, kuwonjezeka kwa mipata pakati pawo ndikupeza ochepa kwambiri komanso otsika kwambiri a lipoproteins mu medial wosanjikiza,

kuchuluka kwa otsika osalimba lipoproteins mu madzi am'magazi (awo mu plasma amalumikizana ndi kuchuluka kwa mafuta m'thupi). Ma lipoproteins otsika kwambiri angapangitse kuti pakhale mapangidwe apangidwe a rosette, chitetezo cha mthupi chimakhudzidwa ndipo khoma lamitsempha limawonongeka,

otsika kwambiri osachulukitsa lipoproteins, omwe, mogwirizana ndi mawonekedwe a fibroblasts, endothelial ndi maselo osalala a minofu, amagwira cholesterol. Cholesterol imapangidwa ndikusunthidwa ngati gawo la lipoprotein yapamwamba kwambiri ku chiwindi. Ma lipoprotein amenewa amapikisana ndi ma receptor okhala ndi ma lipoprotein otsika komanso otsika kwambiri, kuletsa cholesterol kulowa maselo. Amatha kuthamangitsa cholesterol kudzera mumadzimadzi am'magazi molingana ndi gradient yagalasi, ndipo amaperekanso zakudya zochulukirapo za triglycerides ndi cholesterol kudzera pama receptors kupita ku subcutaneous mafuta (depot),

kuphwanya njira za cholesterol esterization mu mkulu osalimba lipoproteins ndi kayendedwe pakati pa magulu a lipoproteins. Izi zimachepetsa kuthekera kwa lipoproteins yapamwamba kwambiri yochotsa mafuta m'thupi. Odwala omwe ali ndi coronary atherosulinosis, lipoproteins yapamwamba imapangidwa mu cholesterol yopanda mafuta, ndipo lipoproteins yotsika imaphatikizidwa mu cholesterol esters.

chibadwa chiletso cha apolipoproteins ndi zolandilira, lipoprotein ndi cholesterol metabolism enzymes (cholowa mitundu yapamwamba ya atherosulinosis). Mu chiwindi, kuchuluka kwa kaphatikizidwe ndi ma lipoproteins omwe amayendayenda m'magazi amasintha. Zovuta zingapo za maselo zimadziwika m'mabanja osiyanasiyana, zomwe zimapangitsa kuti cholesterol ikhale yolakwika m'maselo kapena ma lipoprotein omwe amayenda m'magazi.

Tsiku Lonjezedwa: 2015-11-23, Views: 655 | Kuphwanya lamulo laumwini

Zolemba

1. Libov I. A., Cherkesova S. V., Roitman A. P. Zochitika zamakono za dyslipoproteinemia ndi njira zothandizirana ndi chithandizo chawo // Moscow Medical Journal. No. 3. 1998. S. 34-37.
2. Thompson G. R. Kuwongolera ku Hyperlipidemia. MSD, 1990.
3. Spector A. V., Vasilyeva E. Yu. Vidar, 1996, p. 295-309.
4. Berk B. C., Weintraub W. S., Alexander R. W. Elevation of C-reactive protein in “activ” coronary artery matenda // Am. J. Cardiol. 1990: 98: 2219-2222.
5. Haverkate F., Thompson S. G., Pyke S. D. M. et al, wa European Concerted Action on Thrombosis and Disability Angina Pectoris Study Group. Kupanga kwa mapuloteni a C-reactive komanso chiwopsezo cha zochitika za coronary mu angina okhazikika komanso osakhazikika angina // Lancet. 1997, 349: 462-466.

Endothelial kukanika

Kafukufuku wamakono amakhulupirira kuti gawo loyamba pakupanga atherosulinosis ndi kuwonongeka kwa mkati mwa mtsempha. Pali umboni wambiri pamalingaliro awa:

• Choyamba, zolembera zoyambirira nthawi zonse zimapezeka pamasamba osungira zombo. Pakusiyanitsidwa kwa chotengera chachikulu, malo osokoneza bongo amapangidwa, chifukwa chake, chiopsezo chowonongeka pakupanga kwamkati wam'khumbi m'malo ano chimakhala chokwera.
• Kachiwiri, zidadziwika kale kuti kusuta fodya kumathandizira kuti matendawa akhazikike. Ndipo utsi wa fodya umawononga mphamvu yogwira maselo a endothelial, chifukwa chifukwa cha kuchuluka kwa mpweya wa carbon monoxide womwe umazungulira m'magazi, cell hypoxia imadziwika.
• Chachitatu, matenda oopsa am'mitsempha yamagazi amawonjezera katundu pazotengera komanso zimawonjezera chiopsezo chotenga atherosclerosis.

About cholesterol

Masiku ano pali anthu ochepa omwe sangamve kuti gawo la cholesterol popanga atherosulinosis ndilofunika kwambiri. Koma sikuti aliyense amadziwa kuti thunthu ndi chiyani. Pakadali pano, uyu ndi m'modzi wa oimira kalasi yama sterols, yomwe imagwira gawo lofunikira kwambiri pakubwera kwachilengedwe m'thupi. Ntchito zazikuluzikulu za cholesterol:

• chilengedwe cha bile acid
• kapangidwe ka vitamini D3,
• kupanga mahomoni ogonana ndi mahomoni a adrenal.

Kutengera ndi zakudya, pafupifupi 300-500 mg ya cholesterol imalowa m'thupi la munthu tsiku ndi tsiku. Pazogulitsa, lipid iyi imatha kupezeka mwaulere kapena womangidwa.

Koma ngakhale pankhani yotsirizira, cleavage ndi kutulutsidwa kwa cholesterol yaulere imapezeka m'matumbo ang'onoang'ono. M'matumbo, cholesterol imalowetsedwa, imagwiritsidwa ntchito pochita metabolic ndi njira zina zachilengedwe.

Kugawa kwa lipid mu thupi sikosiyana. Ambiri mwa cholesterol onse amachitikira mu kotekisi ya adrenal grain, ubongo, minyewa yamanjenje. Chachikulu cha zonse ndi lipids mu minofu ya yolumikizika ndi mafupa.

M'malo mwake, kapangidwe ka cholesterol kakhoza kuchitika mu khungu lililonse la thupi. Komabe, nthawi zambiri mankhwalawa amapangidwa m'chiwindi komanso (ochepa kwambiri) m'matumbo aang'ono. Mothandizidwa ndi zinthu zina, kupanga cholesterol kumachuluka. Izi ndi monga:

• kuyang'anira ma radiation
• kusowa kwa mahomoni ndi kuchuluka kwa mahomoni a chithokomiro, insulin.

Uphungu! Koma ndi kuchuluka kwa glucocorticosteroids (mahomoni opangidwa ndi ma adrenal gland) ndi njala, cholesterol synthesis, m'malo mwake, imachepa.

Zinapezeka kuti sterol mu plasma yamagazi mulibe machitidwe oyera, koma mawonekedwe a lipoproteins (zovuta za cholesterol ndi mapuloteni). Lipoproteins amabwera m'mitundu itatu:

• kachulukidwe kakang'ono kwambiri (kuchuluka kwawo sikuposa 10%),
• kachulukidwe kakang'ono (iyi ndi mtundu wanthawi zambiri wama lipoprotein a plasma pafupifupi 65-70%),
• kukwera kwambiri.

Kutengera chiŵerengero cha mitundu ya lipoprotein, chiopsezo chotukula atherosulinosis chatsimikiza. Kuti muchite izi, kusanthula kwapadera kumachitika ndi kutsimikiza kwa magawo, kenako chokwanira chimawerengedwa pogwiritsa ntchito njira yapadera.

Uphungu! Otetezeka kwambiri pankhani ya kukhazikika kwa atherosulinosis ndi kuchuluka kwa mitundu ya lipoprotein yomwe imawonedwa mwa ana aang'ono, mgwirizano wawo ndi mgwirizano. Mwa anthu achichepere (pafupifupi zaka 20), chiwopsezo choyenera ndichizindikiro kuyambira 2 mpaka 3. Mwa anthu opitilira 30, chokwanira sichokwanira kupitilira 3.5 (chifukwa cha matenda a mtima, amatha kufikira 6).

Mapangidwe a plaque

Popanga zolembera, magawo atatu ndi osiyana:

• lipoidosis: kapangidwe ka malo a lipid kapena Mzere pa makoma a chotengera.
• lipossteosis: mawonekedwe a minofu yam'mimba,
• mapangidwe ovomerezeka, zolembedwa.

Malo a lipid ndi kapangidwe kakang'ono kwambiri (mainchesi osaposa 1.5 mm) komwe kali mkati mwa mtsempha. Maselo achiwonetsero amaphatikizana ndi kupangidwa kwamtunduwu wachikasu, amapangidwa ndi T-lymphocyte ndi mafuta. Kuphatikiza apo, maselo osalala a minofu ndi ma macrophages amapezeka pakapangidwe kamapangidwe.

Kukula kwa milomo ya lipid kumachulukana, kumalumikizana, zomwe zimapangitsa kuti pakhale mzere womwewo. Mabala ndi mikwingwirima amapanga masamba omwe akuwononga koyamba kwa endothelium.

Uphungu! Udindo wina wowonongeka mkati mwa chotengera ndi mapangidwe a dongo la lipid umaperekedwa pazinthu zosavomerezeka. Makamaka, kusuta, chlamydial kapena kachilombo kavairasi, matenda oopsa, etc.

Kupanga pakokha sikubweretsa kuwonongeka kwa chotengera. Komanso, mawanga oterewa amayamba kuubwana. Amakhulupirira kuti pofika zaka 25, mitundu ya lipid imatha kukhala theka la mkati mwa msempha. M'mitsempha yamagazi yomwe imadyetsa ubongo, malo oterewa amawonekera pafupifupi zaka 40.

Lipossteosis

Gawo lachiwiri pakupanga mapangidwe a pathological (zolengeza) ndikukula kwa minofu ya fibrous. Pamalo omwe amapangidwira (Mzere), maselo achichepere amayamba kupanga pang'onopang'ono, zomwe zimapangitsa kukula kwa minofu yolumikizika.

Pamene ikukula, kukhazikika kwa khoma kumachitika ndipo zolembera - mawonekedwe ake ophatikizika ndikuwunika kwa chotengera. Izi zimapangitsa cholepheretsa magazi. Pachigawo choyamba cha mapangidwe a atherosulinotic, zolembazo zimakhala ndi maziko a lipid.

Poterepa, mawonekedwe amtundu wolumikizana ndi owonda. Mapangidwe awa amatchedwa "chikasu", amakhudza pang'ono magazi. Popeza kapisolo wa minofu yolumikizirana ndi yopyapyala, imawonongeka mosavuta.

Pakumapeto magawo chitukuko, kupangika komwe kumapangidwa kumakhala ndi mawonekedwe owoneka ngati minofu yolumikizidwa. Amatchedwa "oyera oyera" ndipo amathandizira kwambiri hemodynamics (kuthamanga kwa magazi).

Mapangidwe a plaque

Gawo ili la chitukuko cha matendawa limadziwika ndi kuwonjezeka kwakukulu pa kukula kwa lipid pachimake. Izi zimapangitsa kuti mafupa awonongeke komanso kuwonongeka kwa zotupa.

Dongosolo lokhala ndi zolengedwa likawonongeka, zilonda zam'mimba zimachitika, chomwe ndi chifukwa chachikulu chopanga magazi. Pamapeto omaliza, kuphatikizira kwa calcium kumawonedwa mu minofu ya zolembazo, zomwe zimayambitsa kuphatikizana ndikuwonjezeka kwa kukula kwa zolembazo.

Zotsatira zazikulu za mapangidwe ovuta a atherosselotic ndi mawonekedwe a magazi pamafupa a chotengera. Ndi kupatukana kwa magazi, kumatha kutchinga chotengera, kutsekera kwambiri magazi.

Uphungu! Ndi nthawi iyi yomwe chitukuko cha atherosulinosis chimadwaladwala omwe amakumana ndi zovuta - kukula kwa matenda a ischemic (kuwonongeka kwa ziwongo zamkati), vuto la mtima (ndikupanga atherosulinosis yamitsempha yama coronary), etc.

Mavuto

Njira yomwe ili pamwambapa yopangira zolembera imatithandizira kumvetsetsa zomwe zimachitika chifukwa cha chitukuko cha atherosclerosis. Izi ndi:

• kusintha kwa hemodynamic chifukwa kuchepa kwa mtima lumen,
• Zilonda zam'mimba zikakhazikika, mapangidwe amitsempha yamagazi.
• kuchuluka kwa mchere wa mandimu mu zolengeza, womwe umawonjezera kuchuluka kwake.

Mitundu ya Mapale

Ndi atherosclerosis, zolembera zimatha kukhala zokhazikika koma ayi. Katunduyu amatengera mawonekedwe, kukula kwake komanso kapangidwe kake. Tizilombo tokhala ngati fibrous timakhazikika pachithunzichi chokhazikika, ndipo lipid imakhazikika m'zigawo zosakhazikika. Mawonekedwe okhazikika amakula pang'onopang'ono, kotero, mkhalidwe wa wodwalayo sasintha kwa zaka zambiri. Mapepala osasunthika amakhala ndi nyukiliya yayikulu komanso membrane woonda.

Zisoti zoterezi zimang'ambika mosavuta komanso zilonda, zomwe zimapangitsa magazi. Ndi kukhalapo kwa mapepala osasunthika omwe amatsogolera pakukula kwa zovuta za atherosulinosis.

Chifukwa chake, pathogenesis ya atherosulinosis ndi njira yovuta kwambiri. Udindo wina pakukula kwa matendawa umaseweredwa osati kokha ndi zinthu zamkati, komanso ndi zizolowezi zoyipa za wodwalayo. Imapereka chitukuko cha matenda omwe amayamba chifukwa cha zakudya zamafuta, kusuta, kusachita masewera olimbitsa thupi, komanso matenda opatsirana komanso kusokonekera kwa mahomoni m'thupi. Popewa kukula kwa matendawa, ndikofunikira kuyang'anira kuchuluka kwa cholesterol mu plasma.