Dyslipidemia

Introduction to dyslipidemia Blood lipids mainly refer to cholesterol and triglycerides in plasma. Although blood lipids only account for a very small part of the body's lipids, they are closely related to the occurrence and development of atherosclerosis. Hyperlipidemia is not uncommon in China. According to the survey, the total blood cholesterol (TC) or triglyceride (TG) in adults is about 10% to 20%, and even 10% of children have elevated blood lipids. The incidence of hyperlipidemia is also on the rise, which is closely related to the reasons for the significant improvement in the living standards of our people and changes in dietary habits. Because patients often have a decrease in high-density lipoprotein-cholesterol (HDL-C), it is more appropriate to change "hyperlipidemia" to "dyslipidemia." basic knowledge The proportion of illness: 18.16% Susceptible people: no special people Mode of infection: non-infectious Complications: fatty liver, diabetes, coronary heart disease

Causes of dyslipidemia

From the reasons, one is determined by genetic factors; the other depends on the environmental factors of the day after tomorrow. The latter category accounts for the majority. Mainly caused by four factors:

1 lifestyle, including dietary nutrition, physical activity, mental stress, emotional changes, tobacco and alcohol hobbies, etc.;

2 drug effects, such as thiazide diuretics, beta blockers, adrenocortical hormones, oral contraceptives, etc.;

3 endocrine and metabolic disorders, mainly diabetes, thyroid dysfunction, obesity, hyperuricemia, etc.;

4 certain diseases, such as kidney disease, combined with lupus erythematosus, bone marrow disease, etc.

In addition, the determination of blood lipids (proteins) can be significantly affected by the condition of the laboratory and the subject taking blood. Blood should be taken after maintaining a normal diet for half a month and fasting for 12 hours. The previous day does not drink alcohol or exercise vigorously; under normal circumstances, the blood lipid (protein) level may increase or decrease by 10%, and the laboratory allows 3 %-5% variation.

Diabetes: especially in type 2 diabetes with obesity, blood cholesterol, low-density lipoprotein cholesterol, triglycerides are elevated, while high-density lipoprotein cholesterol and apolipoprotein a are decreased.

Nephrotic syndrome: In total nephrotic syndrome, blood total cholesterol and low-density lipoprotein cholesterol are significantly elevated, and triglycerides are also elevated.

Relationship with obesity The fat metabolism of obese people is characterized by elevated plasma free fatty acids and a general increase in blood lipids such as cholesterol, triglycerides and total lipids. Explain the disorder of fat metabolism. The obese person's plasma cholesterol level may be 55.8% above 5.2 mmol/L. After the age of 60, women's plasma cholesterol levels will increase significantly after the age of 50.

In the case of obesity, the body's mobilization of free fatty acids is reduced, free fatty acids in the blood are accumulated, and blood lipid capacity is increased. Patients with high triglycerideemia caused by carbohydrates are prone to obesity. When these patients eat more or normal carbohydrates, plasma triglycerides increase; while reducing carbohydrate intake, hyperlipidemia can be improved or even disappeared. Similarly, weight loss can also reduce plasma triglycerides in these patients to normal levels. The rise in plasma cholesterol and triglycerides is directly proportional to the degree of obesity. Decreased blood lipid levels are important for preventing atherosclerosis and coronary heart disease. Therefore, it is necessary for obese people to control their diet and lose weight.

Dyslipidemia prevention

A reasonable diet

Human lipids include both fat and lipids. Hyperlipidemia is most closely related to diet. The accumulation of body fat and the source of some lipids are mainly from diet. Only a portion of the lipids are synthesized in the body and are called endogenous lipids.

Controlling diet is important for the prevention and treatment of hyperlipidemia.

1, diet advocates light, basic vegetarian.

However, it is not advisable to be vegetarian for a long time, otherwise the dietary ingredients are not perfect, but it may cause endogenous cholesterol to increase.

2, should limit high-fat, high-cholesterol diets, such as animal brain, egg yolk, chicken liver, butter and so on.

3, fat intake is limited to 30 to 50 grams per day.

4. Limit sugary foods, do not eat sweets and snacks.

5. Eat more vegetables and fruits.

6, should be low-salt diet, cooking oil should use soybean oil, peanut oil, vegetable oil, sesame oil and so on.

7, hunger and moderate.

Each meal has the following hunger for half an hour before eating. It is not appropriate to use hunger therapy. Excessive hunger will accelerate the decomposition of body fat and increase the fatty acid in the blood.

2. Quit smoking and avoid alcohol

Nicotine in cigarettes can increase peripheral blood vessel contraction and myocardial stress, increase blood pressure, and cause angina pectoris. Inappropriate drinking can reduce heart function and damage the gastrointestinal tract, liver, nervous system and endocrine system.

3. Moderate tea consumption

The catechins contained in tea have the effect of enhancing vascular flexibility, elasticity and permeability, and can prevent hardening of blood vessels. Theophylline and caffeine in tea can excite the spirit, promote blood circulation, reduce fatigue and have diuretic effects. Moderate tea consumption can eliminate greasy diet and lose weight. But drinking too much tea will stimulate the heart, make the heart beat faster, and be harmful to the body.

4. Appropriate exercise

Controlling obesity is one of the important measures to prevent hyperlipidemia. In addition to diet control, it is recommended to adhere to physical exercise, such as jogging, Wu Qin Xi, Tai Chi, playing table tennis, old disco and so on. Usually participate in manual labor. To control the growth of weight.

Five, limit coffee

Caffeine increases cholesterol in the body. Therefore, you should pay attention to drinking as little coffee as possible and banned drugs containing caffeine.

Cook properly.

In cooking animal foods, frying is absolutely avoided. A preferred method is steaming and roasting in order to allow the oil in the food to drip out.

Seven, elderly people over the age of 70 years old, high blood cholesterol, diet therapy is not significant, because for them, more important is nutrition.

Dyslipidemia complications Complications, fatty liver, diabetes, coronary heart disease

It can cause a series of complications such as fatty liver, diabetes, and coronary heart disease.

Symptoms of dyslipidemia Common symptoms Plasma cholesterol levels High blood lipid vascular damage Atherosclerosis

The clinical manifestations of dyslipidemia mainly include two major aspects:

(1) yellow tumor caused by deposition of lipids in the dermis;

(2) Atherosclerosis caused by lipid deposition in the vascular endothelium, resulting in coronary heart disease and peripheral vascular disease. The incidence of jaundice is not very high due to dyslipidemia. The occurrence and development of atherosclerosis takes a long time, so most patients with dyslipidemia do not have any symptoms or abnormal signs. Patients with dyslipidemia are often found when performing blood biochemical tests (measuring blood cholesterol and triglycerides).

Examination of dyslipidemia

There are many clinical tests for detecting blood lipids. The basic tests for blood lipids are TC, TG, high density Lipoprotein-cholesterol (HDL-C) and LDL-C. Other blood lipids such as apoA I, apoB, and Lp(a) are among the research items and are not included in the clinical basic testing program.

1. TC: TC refers to the sum of cholesterol contained in each lipoprotein in the blood. The main factors affecting TC levels are: (1) Age and gender: TC levels often increase with age, but do not rise or even decline after 70 years of age, younger women are younger than men, and postmenopausal TC levels are lower. Male of the same age. (2) Eating habits: Long-term high cholesterol and high saturated fatty acid intake can cause TC to rise. (3) Genetic factors: mutations in enzymes related to lipoprotein metabolism or receptor genes are the main causes of significant increase in TC.

2. TG: The clinically determined TG is the sum of TG contained in each lipoprotein in plasma. TG levels are also affected by both genetic and environmental factors. Unlike TC, the TG level of the same individual is greatly affected by factors such as diet and different time, so the TG value may be significantly different in the same individual when it is measured multiple times. Serum TG levels in the population showed a significant positive skew distribution.

3. HDL-C: Basic research confirmed that HDL can transport cholesterol from peripheral tissues such as blood vessel walls to the liver for catabolism, suggesting that HDL has anti-atherosclerotic effects. Since there are many components in HDL, there is no way to comprehensively detect the amount and function of HDL in the clinic. Therefore, by detecting the amount of cholesterol contained in the blood, the amount of HDL in plasma is indirectly understood.

4. LDL-C: LDL metabolism is relatively simple, and cholesterol accounts for about 50% of the weight of LDL, so it is currently believed that the concentration of LDL-C can basically reflect the total amount of blood LDL. Increased LDL-C is a major lipid risk factor for the development and progression of atherosclerosis. In general, LDL-C is parallel to TC, but TC level is also affected by HDL-C level. Therefore, it is best to use LDL-C instead of TC as a risk assessment for coronary heart disease and other atherosclerotic diseases.

5. Apo AI: The serum apo AI level in the normal population is mostly in the range of 1.2-1.6 g/L, and the female is slightly higher than the male.

6. ApoB: Serum Apo B in the normal population is in the range of 0.8 to 1. lg / L.

7. Lp (a): Serum Lp (a) concentration is mainly related to heredity, and is basically independent of gender, age, weight, moderate physical exercise and most cholesterol-lowering drugs. The Lp(a) level in the normal population is obviously skewed. Although some individuals can be as high as 10OOmg/L or above, 80% of normal people are below 2OOmg/L, and the average number in the literature is 120-180mg/L. The number of digits is lower than this value. Usually 300mg / L is an important boundary, above which the risk of coronary heart disease is significantly increased. Clinical methods for Lp(a) detection have not been standardized.

8. sLDL: The particle size of LDL in plasma is not uniform, and each individual has large, medium and small particle LDL. Plasma TG levels have been shown to correlate with LDL particle structure. When TGL (l5Omg/dl), large and light LDL is more, LDL spectrum is A when plasma electrophoresis; when TG>1.7Ommol/L, sLDL level is increased, LDL spectrum is B type. With elevated plasma apo B levels, HDL-C and apo AI levels were reduced. It is currently believed that sLDL has a strong atherogenic effect. However, there is no simple and reliable practical method for detecting sLDL in clinic.

The legal unit of measurement for each blood lipid project is mmol/L, and some countries in the world use mg/dl. The conversion factor of TC, HDL-C, and LDL-C is mg/dl×O.0259=mmol/L: the conversion factor of TG is mg/dl×O.0113=mmol/L.

Diagnosis and diagnosis of dyslipidemia

Diagnostic criteria

The standards set by countries and the reference standards of testing instruments in different countries are not consistent, and thus the confusion of understanding is inevitable. The Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults set new standards for blood lipids according to the actual situation of Chinese people, as follows: TC<200 mg/dl is the appropriate range, and between 200-239 mg/dl is the edge increase, 240 The percentage of milliliters is increased: LDL-C<130 mg is suitable for the range, 130-159 mg/dl is the edge increase, 160 mg/dL is the increase; TG 150 mg/dl is below The appropriate range is between 150-190 mg/dL for edge elevation and 200 mg/dl for elevation. For HDL-C, men should not be <40 mg/dl and women should not <50 mg. Of course, the above criteria refer to normal people, for patients with a variety of cardiovascular risk factors and increased risk of cardiovascular disease, it is another matter.

Differential diagnosis

The three diseases of mixed hyperlipidemia, hyperglycerideemia, and hypercholesterolemia should be identified.

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