Q. Iminyaka emibini edlulileyo ugqirha wandibeka kwi-80 mg ye-atorvastatin kuba i-cholesterol yam isenyuka, kwaye i-cardiac calcium scan yafaka amanqaku angama-200. Ukususela ngoko i-cholesterol yam isezantsi kakuhle-kodwa xa saphinda siphendule i-calcium evekini iveki umlinganiselo we-calcium wawufikelela kuma-290! Ukuba i-statin isebenza, kutheni inqaku lam calcium linyuka kakhulu? Ingaba isifo somgulo wam sonyango sihamba ngakumbi?
A. Ukutyekela kwinqanaba le-coronary artery calcium ukwenzela ukwandisa kunye ne-statin therapy kuye kwaba yindawo yokuphikisana kunye nokukhathazeka phakathi kwe-cardiologists. Nangona kunjalo, ubungqina obugqithisayo ngoku bubonisa ukuba, njengento engathandekiyo njengoko isenokuvakala, oku kungayinto enhle. Ingabonisa ukuba iimimiselo zizinzisa izixhobo zeeronta ze-coronary.
Esinye isiKhokelo siKhuseleko.
I-atherosclerosis ivelisa iiplati kwiindonga zeetriyeri, kubandakanywa nemithambo ye-coronary. Ezi zihlabayi zinokukhula ezinkulu ngokwaneleyo ukuze ziphazamise umthamo kwaye zivelise iimpawu, ezifana ne- angina okanye i- claudication . Nangona kunjalo, ingxaki yangempela ngala macwecwe kukuba bangakwazi ukuphazamiseka ngokukhawuleza, kubangele ukutshatyalaliswa ngokukhawuleza komthamo - odla ngokukhokelela ekuhlaselweni kwentliziyo , okanye ngesifo .
Iiplac iifake kwizinto ezininzi, kuquka i-lipids, iiseli ezivuthayo, iiseli ze-fibrotic kunye ne-calcium. I-calcium kwi-atherosclerotic plaques efunyenwe yi-cardiac calcium scan-ephezulu kwinqanaba le-calcium, ngokubanzi ngakumbi i-atherosclerosis.
Ngoko, xa ugqirha wakho eqalise kwi-atorvastatin, wayengakhange aphululele iqondo lakho le-cholesterol, kodwa wayiphatha kwakhona i-atherosclerotic plaques.
I-Statins kunye neCalcium Score
Izifundo eziliqela ngoku zibonise ukuba ukunyanga isigulane esinesifo se-atherosclerosis kunye ne-statins kunokunyusa i-cardiac calcium score.
Ekubeni ama-statins acingelwa ukuba ancede ukukhusela kwaye kwanokunceda ukuguqula isifo somgulo we-coronary, esi siboneko sibonakala sisigxina. Ngo-2015, isifundo sanyatheliswa kwi- Journal ye-American College of Cardiology enceda ukucacisa ukuba lithini ukwanda kwe calcium.
Abaphandi bahlalutya izifundo ezi-8 ezihlukeneyo ezazisetyenziselwa i-ultrasound intravascular (IVUS, i-catheter technique) ukuvavanya ubungakanani kunye nokubunjwa kwee-atherosclerotic plaques kwizigulane eziphathwe ngama-statins. Bafumene izinto ezimbini. Okokuqala, unyango lwe-do-high-dose lwe-dose lusetyenziswe ukunciphisa ama-plaque. Okwesibini, ngelixa iiplati zahla, ukubunjwa kwazo kwakuguquka. Emva kokuba unyango lwe-statin, umthamo we-lipid ubeka iipliti ngaphakathi kweeplates, kwaye i-cell fibrotic kunye ne-calcium yanda. Olu tshintsho - ukuguqula i-plaque engaqinisekiyo "esithambileyo" kwisibonda esomeleleyo "esinzima" singenza i-plaque ibe yinto engaphantsi kwayo. (Oku kulandelwayo kuyahambelana nokokuba unyango lwe-statin luyanciphisa kakhulu umngcipheko wokuhlaselwa kwintliziyo kwizigulane ezinezifo zogonyamelo lwe-coronary.)
Isishwankathelo, ubungqina bokuba buxhasa uxhaso lokuba unyango lwe-statin alugcini nje ukunciphisa amazinga e-cholesterol, kodwa kwakhona utshintshe iiplati ezikhoyo ukuba zenze zibe yingozi kakhulu.
Njengenxalenye yale nkqubo, iiplathi zinokuba zibalwa kakhulu-kwaye ke, ikharaliyamu inqaku likhuphuka. I-calcium ekhulayo kunye ne-statin unyango, ngoko, ingabonisa impumelelo yonyango, kwaye akufanele ibe yimbangela ye-alarm.
Nangona le ngcamango ingasetyenziswanga isayensi, ngeli nqaku lilungelelanise ubungqina obukhoyo.
Ngaphantsi
I-scan card ye-calcium isisitye esincedo ekuhloleni ubukho okanye ukungabikho kwe-coronary artery disease. Ukuba i-calcium ikhoyo, i-atherosclerosis ikhoyo - kwaye utshintsho lwezobugwenxa lulungelelaniswa. Ukongezelela, ukuqwalaselwa ngamandla kufuneka kunikwe unyango lwe-statin kunye ne-prophylactic aspirin.
Kodwa, xa sele unyango lwe-statin iqalile, ukutolika i-calcium scans elandelayo iba yingxaki. Ukuba iqela le-calcium liyakhuphuka, lingahle lisibonakalise ukunyuka kwe-CAD, kodwa kunoko, kuya kuba nempembelelo emihle yonyango lomzimba.
Njengomgaqo oqhelekileyo, oogqirha akufanele bahlaziye iimvavanyo abazi ngaphambili kwexesha mhlawumbi abayi kuba nako ukutolika. Nangona i-scanning calcium scan yenza ingqiqo eninzi kubantu abasemngciphekweni wesifo se-coronary disease, ukuphindaphinda i-calcium scans emva kokuba unyango lwe-statin luqaliswe lungenza ixhala, ngaphandle kokongeza ulwazi oluncedo.
Imithombo:
UPuri R, uNicholl SJ, uShao M, et al. Impembelelo yeemimiselo kwi-serial coronary calcification ngexesha lokuqhubela phambili kwe-atheroma nokuguqulwa. J Am Coll Cardiol 2015; 65: 1273-1282.
Shaw LJ, Narula J, Chandrashekhar Y. Ibali elingapheliyo kwi-coronary calcium. J Am Coll Cardiol 2015; 65: 1273-1282