{"id":55763,"date":"2023-11-08T10:27:32","date_gmt":"2023-11-08T03:27:32","guid":{"rendered":"https:\/\/hmm88i.com\/drug\/?p=55763"},"modified":"2024-05-06T11:05:39","modified_gmt":"2024-05-06T04:05:39","slug":"thuoc-ha-mo-mau-va-nhung-luu-y-khi-su-dung","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/thuoc-ha-mo-mau-va-nhung-luu-y-khi-su-dung\/","title":{"rendered":"Thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u v\u00e0 nh\u1eefng l\u01b0u \u00fd khi s\u1eed d\u1ee5ng"},"content":{"rendered":"
T\u0103ng lipid m\u00e1u l\u00e0 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 ph\u00e1t tri\u1ec3n b\u1ec7nh tim m\u1ea1ch. Thu\u1ed1c h\u1ea1 lipid m\u00e1u l\u00e0 g\u00ec? C\u00f3 nh\u1eefng l\u01b0u \u00fd g\u00ec khi s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y? B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, D\u01b0\u1ee3c s\u0129 L\u01b0u V\u0103n Ho\u00e0ng s\u1ebd cung c\u1ea5p cho b\u1ea1n \u0111\u1ecdc nh\u1eefng th\u00f4ng tin c\u1ea7n thi\u1ebft v\u1ec1 thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u<\/b><\/p>\n T\u0103ng lipid m\u00e1u \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh g\u00e2y ra c\u00e1c b\u1ec7nh tim m\u1ea1ch (CVD). CVD chi\u1ebfm 1\/3 t\u1ed5ng s\u1ed1 ca t\u1eed vong tr\u00ean to\u00e0n th\u1ebf gi\u1edbi, c\u00e1c nh\u00e0 khoa h\u1ecdc tin r\u1eb1ng CVD (c\u00e1c b\u1ec7nh tim m\u1ea1ch) s\u1ebd tr\u1edf th\u00e0nh nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong v\u00e0 t\u00e0n t\u1eadt tr\u00ean to\u00e0n th\u1ebf gi\u1edbi v\u00e0o n\u0103m 2020.<\/span><\/p>\n T\u0103ng lipid m\u00e1u l\u00e0 s\u1ef1 gia t\u0103ng m\u1ed9t ho\u1eb7c nhi\u1ec1u lipid trong huy\u1ebft t\u01b0\u01a1ng, bao g\u1ed3m triglycerid, cholesterol, este cholesterol v\u00e0 phospholipid v\u00e0 ho\u1eb7c lipoprotein huy\u1ebft t\u01b0\u01a1ng bao g\u1ed3m lipoprotein m\u1eadt \u0111\u1ed9 r\u1ea5t th\u1ea5p v\u00e0 lipoprotein m\u1eadt \u0111\u1ed9 th\u1ea5p, v\u00e0 gi\u1ea3m m\u1ee9c lipoprotein m\u1eadt \u0111\u1ed9 cao.<\/span><\/p>\n T\u0103ng cholesterol m\u00e1u v\u00e0 t\u0103ng triglycerid m\u00e1u l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch, li\u00ean quan ch\u1eb7t ch\u1ebd \u0111\u1ebfn b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 (IHD). C\u00f3 m\u1ed1i li\u00ean h\u1ec7 ch\u1eb7t ch\u1ebd gi\u1eefa b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong cao. H\u01a1n n\u1eefa, n\u1ed3ng \u0111\u1ed9 cholesterol trong huy\u1ebft t\u01b0\u01a1ng t\u0103ng cao g\u00e2y ra h\u01a1n 4 tri\u1ec7u ca t\u1eed vong trong m\u1ed9t n\u0103m.<\/span><\/p>\n X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh x\u01a1 c\u1ee9ng \u0111\u1ed9ng m\u1ea1ch do s\u1ef1 l\u1eafng \u0111\u1ecdng cholesterol trong th\u00e0nh \u0111\u1ed9ng m\u1ea1ch g\u00e2y h\u1eb9p \u0111\u1ed9ng m\u1ea1ch. X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n li\u00ean quan \u0111\u1ebfn x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch nh\u01b0 b\u1ec7nh m\u1ea1ch v\u00e0nh, m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean \u0111\u01b0\u1ee3c \u0111\u1ea9y nhanh do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u0103ng lipid m\u00e1u.<\/span><\/p>\n T\u0103ng lipid m\u00e1u li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng c\u0103ng th\u1eb3ng oxy h\u00f3a g\u00e2y ra s\u1ef1 s\u1ea3n sinh \u0111\u00e1ng k\u1ec3 c\u00e1c g\u1ed1c t\u1ef1 do oxy, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 bi\u1ebfn \u0111\u1ed5i oxy h\u00f3a trong c\u00e1c lipoprotein m\u1eadt \u0111\u1ed9 th\u1ea5p, c\u00f3 ch\u1ee9c n\u0103ng quan tr\u1ecdng trong vi\u1ec7c kh\u1edfi \u0111\u1ea7u v\u00e0 ti\u1ebfn tri\u1ec3n c\u1ee7a ch\u1ee9ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 c\u00e1c b\u1ec7nh tim m\u1ea1ch li\u00ean quan.<\/span><\/p>\n T\u0103ng lipid m\u00e1u \u0111\u01b0\u1ee3c chia th\u00e0nh hai lo\u1ea1i ch\u00ednh: t\u0103ng lipid m\u00e1u nguy\u00ean ph\u00e1t (gia \u0111\u00ecnh) ho\u1eb7c th\u1ee9 ph\u00e1t (m\u1eafc ph\u1ea3i). T\u0103ng lipid m\u00e1u nguy\u00ean ph\u00e1t xu\u1ea5t ph\u00e1t t\u1eeb r\u1ea5t nhi\u1ec1u r\u1ed1i lo\u1ea1n di truy\u1ec1n m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 di truy\u1ec1n qua khi sinh, trong khi t\u0103ng lipid m\u00e1u th\u1ee9 ph\u00e1t th\u01b0\u1eddng b\u1eaft ngu\u1ed3n t\u1eeb m\u1ed9t nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n thay th\u1ebf, ch\u1eb3ng h\u1ea1n nh\u01b0 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng kh\u00f4ng l\u00e0nh m\u1ea1nh, thu\u1ed1c (amiodarone, glucocorticoid), suy gi\u00e1p, ti\u1ec3u \u0111\u01b0\u1eddng kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c v\u00e0\/ho\u1eb7c ch\u1ebf \u0111\u1ed9 sinh ho\u1ea1t k\u00e9m.<\/span><\/p>\n \u0110\u1ec3 gi\u1ea3m t\u1ed1i \u0111a nguy c\u01a1 xu\u1ea5t g\u00e2y b\u1ec7nh tim m\u1ea1ch, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n h\u1ea1 LDL v\u00e0 t\u0103ng HDL trong m\u00e1u.<\/span><\/p>\n Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/span><\/p>\n Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i l\u01b0\u1ee3ng lipoprotein trong m\u00e1u v\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 x\u1ea3y ra.<\/span><\/p>\n D\u1ef1a v\u00e0o c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, c\u00e1c thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u \u0111\u01b0\u1ee3c chia th\u00e0nh 2 nh\u00f3m:<\/span><\/p>\n C\u01a1 ch\u1ebf: H\u1ea5p th\u1ee5 m\u1ea1nh \u0111\u1ed3ng th\u1eddi t\u1ea1o ph\u1ee9c v\u1edbi acid m\u1eadt t\u1eeb \u0111\u00f3 l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh nh\u0169 h\u00f3a lipid \u1edf ru\u1ed9t d\u1eabn \u0111\u1ebfn l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh h\u1ea5p thu v\u00e0 t\u0103ng \u0111\u00e0o th\u1ea3i lipid qua ph\u00e2n. B\u00ean c\u1ea1nh \u0111\u00f3, c\u00e1c thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u nh\u00f3m n\u00e0y c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng gi\u00e1n ti\u1ebfp l\u00e0m t\u0103ng chuy\u1ec3n h\u00f3a cholesterol th\u00e0nh acid m\u1eadt nh\u1edd s\u1ef1 tho\u00e1t \u1ee9c ch\u1ebf hydroxylase \u1edf microsom gan \u0111\u1ed3ng th\u1eddi l\u00e0m t\u0103ng s\u1ed1 l\u01b0\u1ee3ng, t\u0103ng ho\u1ea1t t\u00ednh c\u1ee7a LDL-receptor \u1edf m\u00e0ng t\u1ebf b\u00e0o.<\/span><\/p>\n Cholestyramine \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng cholesterol cao trong m\u00e1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 lipoprotein m\u1eadt \u0111\u1ed9 th\u1ea5p (LDL).<\/span><\/p>\n \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a Cholestyramine:<\/span><\/p>\n C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/span><\/p>\n Sau khi u\u1ed1ng, thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u Cholestyramine c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m LDL trong m\u00e1u sau 4-7 ng\u00e0y, t\u00e1c d\u1ee5ng t\u1ed1i \u0111a trong v\u00f2ng 2 tu\u1ea7n.<\/span><\/p>\n \u1ede h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n, Cholestyramine c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng triglycerid t\u1eeb 5 \u0111\u1ebfn 20% so v\u1edbi tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, ch\u1ec9 s\u1ed1 n\u00e0y s\u1ebd d\u1ea7n tr\u1edf v\u1ec1 gi\u00e1 tr\u1ecb ban \u0111\u1ea7u trong 4 tu\u1ea7n.<\/span><\/p>\n Cholestyramine c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng HDL – cholesterol kho\u1ea3ng 5%, gi\u1ea3m LDL-cholesterol kho\u1ea3ng 10-30% (c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u l\u01b0\u1ee3ng).<\/span><\/p>\n Do c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng l\u00e0 t\u1ea1o ph\u1ee9c v\u1edbi acid m\u1eadt n\u00ean khi s\u1eed d\u1ee5ng Cholestyramine, m\u1ed9t s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 g\u1eb7p t\u00ecnh tr\u1ea1ng bu\u1ed3n n\u00f4n, kh\u00f3 ch\u1ecbu v\u00f9ng b\u1ee5ng, h\u1ea1 prothrombin.<\/span><\/p>\n Cholestyramine c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m h\u1ea5p thu m\u1ed9t s\u1ed1 thu\u1ed1c d\u00f9ng \u0111\u1ed3ng th\u1eddi bao g\u1ed3m:<\/span><\/p>\n \u0110\u1eb7c \u0111i\u1ec3m:<\/span><\/p>\n C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, t\u00e1c d\u1ee5ng, t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 Cholestyramin.<\/span><\/p>\n L\u00e0 kh\u00e1ng sinh nh\u00f3m aminoglycosid c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m h\u1ea1 lipoprotein m\u00e1u (\u0111\u1eb7c bi\u1ec7t l\u00e0 LDL-cholesterol).<\/span><\/p>\n T\u00e1c d\u1ee5ng h\u1ea1 m\u1ee1 m\u00e1u kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u00e1c d\u1ee5ng kh\u00e1ng khu\u1ea9n.<\/span><\/p>\n L\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf h\u1ea5p thu cholesterol \u1edf ru\u1ed9t.<\/span><\/p>\n Th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi statin cho nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng cholesterol m\u00e1u do ch\u1ebf \u0111\u1ed9 \u0103n ho\u1eb7c di truy\u1ec1n. Li\u1ec1u d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 10mg\/ng\u00e0y.<\/span><\/p>\n C\u00e1c thu\u1ed1c nh\u00f3m n\u00e0y bao g\u1ed3m:<\/span><\/p>\n C\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a acid fibric c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh c\u1ee7a lipoprotein lipase.<\/span><\/p>\n C\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a statin c\u00f3 c\u1ea5u tr\u00fac t\u01b0\u01a1ng t\u1ef1 v\u1edbi HMG-CoA n\u00ean c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf c\u1ea1nh tranh v\u1edbi HMG-CoA-reductase t\u1eeb \u0111\u00f3 l\u00e0m gi\u1ea3m t\u1ed5ng h\u1ee3p cholesterol, \u0111\u1ed3ng th\u1eddi thu\u1ed1c c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng sinh LDL-receptor \u1edf m\u00e0ng t\u1ebf b\u00e0o.<\/span><\/p>\n Acid nicotinic l\u00e0 m\u1ed9t vitamin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh Pellagra. Tuy nhi\u00ean, acid nicotinic c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m h\u1ea1 lipoprotein m\u00e1u. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u00e0 do l\u00e0m t\u0103ng sinh LDL-receptor \u0111\u1ed3ng th\u1eddi \u1ee9c ch\u1ebf s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a AMP trong m\u1ee1, t\u0103ng ho\u1ea1t t\u00ednh c\u1ee7a triglyceride lipase.<\/span><\/p>\n Probucol c\u00f3 c\u1ea5u tr\u00fac kh\u00e1c v\u1edbi c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a Probucol \u0111\u1ebfn nay v\u1eabn ch\u01b0a th\u1ef1c s\u1ef1 \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y, Probucol l\u00e0m t\u0103ng chuy\u1ec3n h\u00f3a LDL-cholesterol tuy nhi\u00ean kh\u00f4ng th\u00f4ng qua LDL-receptor. C\u00f3 gi\u1ea3 thuy\u1ebft cho r\u1eb1ng, Probucol c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n c\u1ea3n oxy h\u00f3a c\u1ee7a acid b\u00e9o \u0111\u1ed3ng th\u1eddi l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng ti\u1ebfp nh\u1eadn LDL c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4.<\/span><\/p>\n \u0110\u1eb7c \u0111i\u1ec3m:<\/span><\/p>\n Acid Nicotinic c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m lipoprotein m\u00e1u r\u00f5 r\u1ec7t. M\u1ee9c \u0111\u1ed9 gi\u1ea3m triglyceride l\u00e0 20 \u0111\u1ebfn 80% sau 1-4 ng\u00e0y s\u1eed d\u1ee5ng thu\u1ed1c. Acid Nicotinic c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1i \u0111a sau 3 \u0111\u1ebfn 5 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/span><\/p>\n L\u01b0u \u00fd:<\/span><\/p>\n Acid Nicotinic \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n t\u0103ng lipoprotein m\u00e1u typ II, III, IV v\u00e0 V.<\/span><\/p>\n C\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft ph\u1ed1i h\u1ee3p v\u1edbi cholestyramine v\u00e0 colestipol \u0111\u1ec3 gi\u1ea3m t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n.<\/span><\/p>\n \u0110\u1eb7c \u0111i\u1ec3m:<\/span><\/p>\n C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng l\u00e0 l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh lipoprotein lipase \u1edf t\u1ebf b\u00e0o c\u01a1 t\u1eeb \u0111\u00f3 l\u00e0m t\u0103ng th\u1ee7y ph\u00e2n triglyceride v\u00e0 t\u0103ng tho\u00e1i h\u00f3a VLDL.<\/span><\/p>\n C\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a acid fibric c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng HDL nh\u01b0ng c\u01a1 ch\u1ebf ch\u01b0a r\u00f5 r\u00e0ng.<\/span><\/p>\n Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng v\u1edbi b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, suy th\u1eadn, b\u1ec7nh nh\u00e2n c\u00f3 s\u1ecfi \u1edf m\u1eadt, ph\u1ee5 n\u1eef c\u00f3 thai, ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa, tr\u1ebb em < 10 tu\u1ed5i.<\/span><\/p>\nT\u0103ng lipid m\u00e1u l\u00e0 g\u00ec?<\/span><\/h2>\n
Nguy\u00ean nh\u00e2n<\/span><\/h2>\n
Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipoprotein m\u00e1u<\/span><\/h2>\n
<\/a>\n
Ph\u00e2n lo\u1ea1i c\u00e1c thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u<\/span><\/h2>\n
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Thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u l\u00e0m gi\u1ea3m h\u1ea5p thu v\u00e0 t\u0103ng th\u1ea3i tr\u1eeb lipid<\/span><\/h2>\n
<\/a>Cholestyramin<\/span><\/h3>\n
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Colestipol<\/span><\/h3>\n
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Neomycin<\/span><\/h3>\n
Ezetimibe<\/span><\/h3>\n
Thu\u1ed1c h\u1ea1 m\u1ee1 m\u00e1u l\u00e0m gi\u1ea3m t\u1ed5ng h\u1ee3p lipid<\/span><\/h2>\n
\n
Acid Nicotinic (Vitamin PP, Vitamin B3, Niacin)<\/span><\/h3>\n
<\/a>\n
\n
\n
D\u1eabn xu\u1ea5t c\u1ee7a acid fibric<\/span><\/h3>\n
<\/a>\n