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},
"code": "E78",
"name": "Нарушения обмена липопротеидов и другие липидемии",
"icd_name": "Нарушения обмена липопротеидов и другие липидемии",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "e78_narusheniya_obmena_lipoproteidov_i_drugie_lipidemii",
"lead": "Нарушение здоровья, относящееся к группе нарушения обмена веществ",
"description": "Это врожденная или приобретенная патология обмена жиров, которая сопровождается нарушением синтеза, транспорта и выведения жиров из крови. Именно по этой причине, наблюдается повышенное их содержание в циркулирующей крови.",
"etiology": "<p>В этиологии нарушений липидного обмена выделяют первичные и вторичные факторы.</p>\r\n<p>Причинами первичной природы является генетическая предрасположенность.</p>\r\n<p>К причинам вторичной природы относятся:</p>\r\n<ul>\r\n<li>малоподвижный образ жизни;</li>\r\n<li>особенности личности и поведения – стрессовый тип характера (наличие бурной эмоциональной реакции на различные раздражители);</li>\r\n<li>курение;</li>\r\n<li>алкоголизм.</li>\r\n</ul>\r\n<p> К развитию вторичных дислипидемий могут привести и ряд патологических процессов:</p>\r\n<ul>\r\n<li>единичные или множественные мутации соответствующих генов, с нарушением продуцирования и утилизации липидов;</li>\r\n</ul>\r\n<p>атеросклероз (в том числе и наследственная предрасположенность); побочный эффект от приема ряда лекарственных препаратов;</p>\r\n<ul>\r\n<li>эндокринные заболевания (гипотиреоз, гипертиреоидизм, сахарный диабет);</li>\r\n<li>обструктивные заболевания печения (заболевания, при которых нарушается отток из печени желчи – жидкости, выделяемой печенью и накапливаемой в желчном пузыре), например, желчно-каменная болезнь (образование камней в желчном пузыре);</li>\r\n<li>хроническая печеночная недостаточность;</li>\r\n<li>первичный билиарный цирроз; артериальная гипертензия;</li>\r\n<li>длительный прием медикаментозных препаратов (мочегонные, иммунодепрессанты, бета-адреноблокаторы).</li>\r\n</ul>\r\n<p>В этиологии нарушений липидного обмена выделяют первичные и вторичные факторы.</p>\r\n<p>Так, причинами первичной природы является генетическая предрасположенность.</p>\r\n<p>К причинам вторичной природы относятся:</p>\r\n<ul>\r\n<li>малоподвижный образ жизни;</li>\r\n<li>особенности личности и поведения – стрессовый тип характера (наличие бурной эмоциональной реакции на различные раздражители);</li>\r\n<li>курение;</li>\r\n<li>алкоголизм.</li>\r\n</ul>\r\n<p> </p>\r\n<p>К развитию вторичных дислипидемий могут привести и ряд патологических процессов:</p>\r\n<ul>\r\n<li>единичные или множественные мутации соответствующих генов, с нарушением продуцирования и утилизации липидов;</li>\r\n</ul>\r\n<p>атеросклероз (в том числе и наследственная предрасположенность); побочный эффект от приема ряда лекарственных препаратов;</p>\r\n<ul>\r\n<li>эндокринные заболевания (гипотиреоз, гипертиреоидизм, сахарный диабет);</li>\r\n</ul>\r\n<p>обструктивные заболевания печения (заболевания, при которых нарушается отток из печени желчи – жидкости, выделяемой печенью и накапливаемой в желчном пузыре), например, желчно-каменная болезнь (образование камней в желчном пузыре); хроническая печеночная недостаточность; первичный билиарный цирроз; артериальная гипертензия; длительный прием медикаментозных препаратов (мочегонные, иммунодепрессанты, бета-адреноблокаторы);</p>\r\n<p>В отдельную группу выделяют алиментарную дислипидемию, вызванную чрезмерным включением в рацион продуктов, содержащих животные жиры. Она бывает двух типов: транзиторная — развивающаяся после однократного употребления жирной пищи, и постоянная — вызванная ее регулярным приемом.</p>",
"pathogenesis": "<p>При дислипидемиях нарушается качественное и количественное изменение липопротеидов (комплекс белков и липидов) в плазме крови. Это повышение или снижение содержания в плазме крови одного, реже двух, классов липопротеидов или отсутствие какого-нибудь класса липопротеидов (алипопротеинемия).</p>\r\n<p>Гиперлипопротеинемия — это повышение в крови холестерина и липопротеидов низкой плотности (основные переносчики холестерина в крови). Липопротеиды откладываются в сосудистой стенке и бесконтрольно захватываются клетками иммунной системы – макрофагами. На каком-то этапе наступает липидное перенасыщение, и макрофаги меняют структуру, превращаясь в пенистые клетки. Задерживаясь в стенке сосуда, способствуют ускорению процесса деления клеток, атеросклеротической пролиферации в том числе. вызывая развитие атеросклероза. В результате закупорки просвета сосуда атеросклеротической бляшкой нарушается доставка крови к сердцу, головному мозгу, нижним конечностям, почкам, что может привести к развитию таких заболеваний, как ишемическая болезнь сердца, инфаркт миокарда, инсульт, инфаркт почки, облитерирующий атеросклероз и т. д.</p>\r\n<p>Гиполипопротеинемия — это снижение липопротеидов низкой и очень низкой плотности в крови. Встречается очень редко и возникает в результате нарушения процессов всасывания в кишечнике. Характеризуется накоплением холестерина в почках, селезенке, роговице глаза и мембране эритроцитов. </p>\r\n<p>Алипопротеинемия — это снижение или полное отсутствие в крови липопротеидов того или иного класса. Это наследственное заболевание, при котором появляются аномальные липопротеиды. Они накапливаются в ретикулоэндотелиальной системе (селезенке, лимфатических узлах, красном костном мозге). Заболевание сопровождается увеличением печени и селезенки, изменением миндалин (тонзиллитом с оранжевым налетом), а также быстро развиваются атеросклероз и ишемическая болезнь сердца.</p>",
"diagnostics": "<p>Диагностика нарушений обмена липопротеидов включает в себя:</p>\r\n<ul>\r\n<li>Сбор анамнеза жизни и болезни (когда появились первые симптомы болезни, имели ли родственники в анамнезе атеросклероз и другие заболевания сердца и сосудов);</li>\r\n<li>Объективный осмотр пациента (осмотр слизистых и кожных покровов, измерение АТ, которое может быть повышенным);</li>\r\n<li>Общий развернутый и биохимический анализ крови, общий анализ мочи;</li>\r\n<li>Липидограмма – анализ крови, который определяет наличие и уровень содержания в крови пациента жироподобных веществ, которые являются главным признаком дислипидемии (триглицериды, липопротеиды очень низкой, низкой и высокой плотности;</li>\r\n</ul>\r\n<p>Вычисление индекса атерогенности – один из самых эффективных и информативных методов диагностики. В норме он не должен превышать 3,0. Если этот показатель значительно превышает норму, то это значит, что в организме происходит прогрессирование атеросклероза и развитие осложнений данного заболевания.</p>",
"treatment": "<p>Лечение дислипидемии зависит от типа, степени тяжести и вида дислипидемии и подбирается сугубо индивидуально для каждого пациента. Существует несколько видов лечения дислипидемии:</p>\r\n<p> </p>\r\n<ul>\r\n<li>медикаментозное лечение;</li>\r\n<li>немедикаментозное лечение;</li>\r\n<li>диетотерапия;</li>\r\n<li>экстракорпоральная терапия</li>\r\n</ul>\r\n<p> </p>\r\n<p><strong>Немедикаментозное лечение включает:</strong></p>\r\n<ul>\r\n<li>нормализовать вес тела;</li>\r\n<li>снизить количество жиров животного происхождения в ежедневном рационе, а иногда и полностью от них отказаться;</li>\r\n<li>увеличить физическую нагрузку, соответствующую силам и возможностям пациента;</li>\r\n<li>перейти на сбалансированное, витаминизированное и дробное питание;</li>\r\n<li>резко ограничить или полностью отказаться от употребления алкоголя, который увеличивает количество триглицеридов в крови пациента, способствует утолщению стенок сосудов и ускоряет развитие атеросклероза;</li>\r\n<li>ограничить курение.</li>\r\n</ul>\r\n<p><strong>Медикаментозное лечение:</strong></p>\r\n<p> </p>\r\n<ul>\r\n<li>Статины – препараты, действие которых направлено на снижение синтеза клетками печени холестерина и внутриклеточного его содержания, повышают разрушение липидов, обладают противовоспалительным действием, препятствуют повреждению новых участков сосудов. Статины повышают срок жизни пациентов, снижают частоту осложнений атеросклероза и выраженность поражения сосудов. Могут вызывать повреждения печени и мышц, поэтому при приеме статинов необходимо регулярно контролировать анализы крови на предмет появления в них продуктов разрушения печени (аланин-аминотрансфераза – АЛТ) и мышц (креатин-фосфокиназа – КФК);</li>\r\n<li>Ингибиторы адсорбции холестерина – группа препаратов, которые препятствуют кишечному всасыванию холестерина. Эффект этой группы препаратов ограничен, так как холестерин, поступающий с пищей, составляет примерно 1/5 часть всего холестерина в организме, а 4/5 холестерина образуется в печени. Запрещены детям;</li>\r\n<li>Секвестранты желчных кислот — группа фармацевтических препаратов, которые обладают способностью связывать желчные кислоты и содержащийся в них холестерин, и выводят их с просвета кишечника;</li>\r\n<li>Фибраты – препараты, которые снижают уровень триглицеридов в крови и повышают количество защитных веществ ЛПВП, можно использовать совместно со статинами.;</li>\r\n<li>Омега-3 полиненасыщенные жирные кислоты – препараты, синтезированные из мускулатуры рыб, которые предохраняют сердце от инфаркта, уменьшают риск развития аритмий, продлевают срок жизни больных после инфаркта миокарда (гибель участка сердечной мышцы вследствие полного прекращения притока крови к ней).</li>\r\n</ul>\r\n<p> </p>\r\n<p><strong> Диетотерапия</strong></p>\r\n<p>Диета при этом заболевании направлена на снижение уровня холестерина в крови пациента и имеет несколько принципов:</p>\r\n<ul>\r\n<li>ограничить употребление жирных сортов мяса, рыбы, сала, креветок, сливочного масла, жирных сортов кисломолочной продукции, промышленных сыров, колбас и сосисок;</li>\r\n<li>обогатить свой рацион жирами, растительного происхождения, овощами, фруктами, нежирными сортами мяса птицы и рыбы;</li>\r\n<li>обезжиренная кисломолочная продукция также показана при этом виде заболевания;</li>\r\n<li>питание рекомендуется дробное, небольшими порциями через одинаковые промежутки времени.</li>\r\n</ul>\r\n<p><strong>Экстракорпоральное лечение</strong></p>\r\n<p>Такое лечение применяют для изменения свойств и состава крови, вне человеческого организма. Атерогенная дислипидемия тяжелой формы является показанием к применению этого метода. Ведь именно, атерогенная дислипидемия является фактором, способствующим развитию осложнений в виде сердечно-сосудистых заболеваний.</p>\r\n<p> </p>\r\n<p> </p>",
"prevention": "<p> Профилактика дислипидемий включает в себя:</p>\r\n<p> </p>\r\n<ul>\r\n<li>o нормализацию массы тела;</li>\r\n<li>o ведение активного образа жизни;</li>\r\n<li>o избегание стрессов;</li>\r\n<li>o рациональное распределение времени для работы и отдыха;</li>\r\n<li>o регулярный медицинский осмотр с обязате6льной сдачей анализов крови и мочи, а также измерением артериального давления;</li>\r\n<li>o диетотерапию;</li>\r\n<li>o медикаментозную профилактику;</li>\r\n<li>o немедикаментозное воздействие на причину возникновения заболевания.</li>\r\n</ul>",
"clinical_picture": "<p>Особые внешние проявления дислипидемии:</p>\r\n<ul>\r\n<li>ксантомы – плотные узелки, содержащие холестерин, над сухожилиями пациента (плотными структурами, присоединяющими мышцы к костям), например, на кисти. Редко ксантомы могут появляться на подошвах ног, ладонях, коже любого участка тела, особенно спины;</li>\r\n<li>ксантелазмы – отложение холестерина под кожей век в виде плоских узелков желтого цвета или узелков, не отличающихся по цвету от других участков кожи;</li>\r\n<li>липоидная дуга роговицы – белый либо серовато-белый ободок отложившегося холестерина по краям роговицы глаза. Появление липоидной дуги роговицы в возрасте до 50 лет свидетельствует о наличии наследственной дислипидемии.</li>\r\n</ul>\r\n<p>Очень часто такое заболевание сопровождается развитием симптомов напоминающих атеросклероз, ИБС и другие заболевания сердечно-сосудистой системы. Также может проявиться синдром острого панкреатита, что более характерно при высоком содержании триглицеридов.</p>\r\n<p>Говоря о клиническом проявлении дислипидемии, не стоит забывать о таком понятии как метаболический синдром. Метаболический синдром – это комплекс нарушений липидного, жирового обмена, а также дисфункция механизмов регуляции артериального давления. На практике метаболический синдром представлен:</p>\r\n<ul>\r\n<li>абдоминальным ожирением;</li>\r\n<li>гипергликемией (повышенным сахаром в крови);</li>\r\n<li>артериальной гипертензией;</li>\r\n<li>нарушением гемостаза (свертывающей системы крови).</li>\r\n</ul>",
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