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儿科医生实践中的血脂异常。

Dyslipidemia in pediatrician's practice.

机构信息

Department of Pediatrics №2, Kuban State Medical University, 350063 Krasnodar, Russia.

Department of Therapy №2, Kuban State Medical University, 350063 Krasnodar, Russia.

出版信息

Rev Cardiovasc Med. 2021 Sep 24;22(3):817-834. doi: 10.31083/j.rcm2203088.

Abstract

Atherosclerosis ranks first among cardiovascular system diseases. It is the "disease of the century", and more than 50% of people with circulatory pathology die of it. The clinical manifestation of atherosclerosis is observed at the middle and older ages, but it is known that the pathological process develops much earlier. There has been a clear trend in theoretical and practical cardiology in recent years to study the earliest atherogenic markers. Epidemiological, clinical, and morphological studies have proved the presence in children and adolescents of sexual, endogenous, exogenous, primary, and potentiating risk factors contributing to an early formation of a pathogenic foundation for atherosclerotic cardiovascular diseases. Disorders of lipid metabolism - dyslipidemias are attributed to the most significant risk factor for atherosclerotic cardiovascular diseases. The DLP prevalence in the pediatric population is extremely high. According to the results of conducted global studies, lipid metabolism disorders occur in more than 70% of children and adolescents. It causes the need for timely diagnostic, therapeutic and preventive measures. The need to extrapolate the risk factor concept to childhood age is justified by several reasons, the main of which include the broadest spread of atherosclerosis that has become a global pandemic, genetic determinism, and low variability of the lipid spectrum of blood serum: the levels of lipids and lipoproteins discovered in childhood are stable throughout life and have an independent prognostic value. That is why the most practical significance is inherent to the study of lipid and lipoprotein metabolism, starting in the early periods of lipid and lipoprotein ontogenesis. Since risk factors can be identified at the preclinical stage of the atherosclerotic process, dyslipidemia phenotyping will facilitate identifying children and adolescents at risk of developing cardiovascular pathologies in the future. The study objective is to examine the pathophysiological aspects of lipid and lipoprotein metabolism and examine DLP epidemiology - as the leading atherosclerotic cardiovascular disease risk factor in children and adolescents, DLP classification, modern approaches to DLP diagnosis and management.

摘要

动脉粥样硬化在心血管系统疾病中排名第一。它是“世纪之病”,超过 50%的循环系统疾病患者死于该病。动脉粥样硬化的临床表现发生在中老年人,但已知其病理过程发生得更早。近年来,理论和实践心脏病学有一个明显的趋势,即研究最早的动脉粥样硬化致病标志物。流行病学、临床和形态学研究证明,儿童和青少年存在性、内源性、外源性、原发性和增强性的风险因素,这些因素导致动脉粥样硬化性心血管疾病的致病基础早期形成。脂质代谢紊乱——血脂异常被认为是动脉粥样硬化性心血管疾病最重要的危险因素。DLP 在儿科人群中的患病率极高。根据进行的全球研究结果,脂质代谢紊乱在超过 70%的儿童和青少年中发生。这需要及时进行诊断、治疗和预防措施。将危险因素的概念外推到儿童年龄是合理的,原因有几个,其中主要包括:动脉粥样硬化的广泛传播已成为全球性流行,遗传决定论,以及血清脂质谱的低可变性:在儿童时期发现的血脂和脂蛋白水平在整个生命过程中都是稳定的,具有独立的预后价值。这就是为什么研究脂质和脂蛋白代谢具有最实际的意义,从脂质和脂蛋白的个体发生的早期阶段开始。由于可以在动脉粥样硬化过程的临床前阶段识别出危险因素,因此血脂异常表型将有助于识别未来有发生心血管病理风险的儿童和青少年。研究目的是检查脂质和脂蛋白代谢的病理生理方面,并研究 DLP 流行病学——作为儿童和青少年中主要的动脉粥样硬化心血管疾病危险因素,DLP 分类,DLP 诊断和管理的现代方法。

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