乌克兰人群中“可能的”家族性高胆固醇血症患者继发性血脂异常的检测

O. Mitchenko, T. Kolesnik, V. Romanov, K. Timokhova, N. M. Chulaevska, G. Kosova, A. V. Nadyuk
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摘要

目的是优化乌克兰家族性高胆固醇血症(FH)的诊断,并确定“可能”FH患者中继发性血脂异常的患病率。材料和方法。这项工作分两个阶段进行人口研究。在第一阶段(2009-2013年),1000名应答者中有81人(8.1%)的LDL-C水平≥5 mmol/l。在II期(2019年),对受访者进行了额外的调查,以确定继发性血脂异常。结果和讨论。在对II期“可能”FH的应答者进行额外检查后,诊断为2型糖尿病的占20.4%,甲状腺功能减退的占14.3%,II - iii级肥胖的占16.3%。在30.6%的受访者中,未检测到未被研究的共病病理,并且LDL-C水平在生活方式改变和他汀类药物治疗的背景下下降。“可能的”FH最终在9例患者中得到证实,这些患者和/或其一级亲属有早期冠状动脉疾病的负担性记忆,并且尽管他汀类药物治疗,但II期LDL-C和总胆固醇水平升高。仅根据ldl - c5 mmol/l的标准,在I期有“可能”FH的应答者的百分比为8.1%。但在继发性血脂异常检测后,城市人群中确诊的FH患病率为0.9%。在其余病例(80%)中,LDL-C水平升高与共病病理相关。该研究证明需要进一步优化对血脂受损患者的管理,以验证原发性和继发性高胆固醇血症。
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Detection of secondary dyslipidemia among people with «possible» familial hypercholesterolemia in Ukrainian population
The aim – to optimize the diagnosis of familial hypercholesterolemia (FH) in Ukraine and determine the prevalence of secondary dyslipidemia among people with «possible» FH.Materials and methods. The work was carried out in two stages of population research. At the I stage (2009–2013), in 81 out of 1000 respondents (8.1 %) the level of LDL-C ≥ 5 mmol/l was registered. At the II stage (2019), additional survey of respondents was conducted to identify secondary dyslipidemia.Results and discussion. After additional examination of respondents with «possible» FH on II stage, type 2 diabetes was diagnosed in 20.4 %, hypothyroidism – in 14.3 %, class II–III obesity – in 16.3 %. In 30.6 % of respondents, the understudied comorbid pathology was not detected, and the level of LDL-C decreased on the background of lifestyle modification and statin therapy. The «possible» FH was finally verified in 9 patients with a burdened anamnesis of early coronary artery disease in them and/or their first-degree relatives, as well as with an increased LDL-C and total cholesterol levels on II stage, despite statin therapy.Conclusions. The percent of respondents with «possible» FH on the I stage, based only on criteria of LDL-C ³ 5 mmol/l, was 8.1 %. But after the detection of secondary dyslipidemia, the prevalence of verified FH within urban population was 0.9 %. In the rest cases (80 %), the elevated level of LDL-C was associated with comorbid pathology. The study proves the need for further optimization of the managment of patients with impaired lipid profile to verify primary and secondary hypercholesterolemia.
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