Kuze kube kutshanje, oogqirha abaninzi banikezele kwi-cholesterol-yokutya-CHD hypothesis. Okokuqala, amazinga aphakanyisiweyo we-cholesterol egazini okanye hypercholesterolemia enza i- coronary heart disease (CHD). Okwesibini, izidlo ezizityebi kwizilwanyana zezilwanyana kunye ne-cholesterol zandisa ama-cholesterol amanqanaba egazini. Okwesithathu, ukwehlisa izinga le-cholesterol egazini linciphisa umngcipheko wesifo senhliziyo.
Ubunzima bomntu, i-cholesterol-yokutya-CHD hypothesis ibonakala ingqiqo. Emva koko, "siyinto esiyidlayo," kwaye ukuba sidla ukutya okunotye kwi-cholesterol kunye nefuthe (iilwanyana), i-cholesterol yethu yegazi iya kuphakama. Ukongezelela, kuba iiplati-ziphi i-clog zamarridi kwaye zenza i-CHD kunye ne-stroke-ziyingxenye eyenziwe nge-cholesterol, amazinga okwanda kwe-cholesterol kwigazi lekondari ukuya kwondlo iya kwandisa umngcipheko we-CHD kunye ne-stroke. Kwaye, ukuba unokunciphisa amazinga e-cholesterol egazini lakho usebenzisa imithi, ngoko unciphisa umngcipheko we-CHD kunye nokushaywa kwesisu, kunene? Ewe, ngokubhekiselele kuzo zonke ezi ngcamango, akunakwenzeka.
Uninzi kunje, kukho utshintsho olwandle kwimigaqo elawula ulawulo lwe-CHD. Asiqinisekanga ukuba ukutya okunotye kwi-cholesterol kunye namafutha azaliswe ngokuthe ngqo kukunyuka kwamazinga e-cholesterol egazini. Ukongezelela, asiqinisekanga ukuba ukunciphisa amazinga e-cholesterol yegazi kulabo abasengozini yesifo senhliziyo kusiza ukukhusela isifo, ingozi engaqinisekanga, ukuhlasela kwentliziyo kunye nokunye.
Yonke into esiyaziyo kukuba ukuguqulwa kwendlela yokuphila (umzekelo, ukulahleka kwesisindo, ukusetyenziswa komzimba kunye nokuyeka ukutshaya) kunye nama-statins, okanye iziyobisi ezinjengeZocor kunye neCrestor, ezizinzisa iiplenti kwaye zenzeke ekunciphiseni i-lipoprotein cholesterol (LDL-C) okanye i-low-density of lipoprotein cholesterol. "i-cholesterol" engalunganga, mhlawumbi inokunceda ukukhusela ukufa kunye nezinye iziganeko ezibi zentliziyo,
U-Evolocumab ungowesigaba esitsha seziyobisi. Kwizilingo zekliniki kuboniswe ukuba kuphuculwe ngokukhawuleza amanqanaba e-LDL-C kubantu abahlukeneyo abathathi-nxaxheba-kakhulu kunabo kulabo abaneengxaki zomzimba ezibizwa ngokuba yi- familial hypercholesterolemia eyenza i-cyclopean (ngokwenene, ephezulu) ama-cholesterol egazini. Ngoku ke ingaba i-evolocumab iya kunika nayiphi na inzuzo kubantu abaninzi abasengozini yokufa kunye neziganeko ezimbi ezibangelwa zizifo zentliziyo ye-coronary ziyabonakala, kwaye ngokuqinisekileyo kuxhomekeka kwiziphumo zexesha elide okanye eziza kubafundi abathatha inxaxheba kwiminyaka ye-evolocumab (Repatha ) unyango. Ngamanye amazwi, kuphela ixesha eliza kuxela ukuba i-evolocumab isebenza.
Yintoni i-Evolocumab?
I-Evolocumab i-anti-monoclonal antibody epheleleyo yomntu ebopha kwaye iyanqanda iprotein ye-PCSK9. Le prothini iphazamisa i-receptor eyenza i-LDL-C ngokuchithwa kwesibindi kwaye iphazamise ukukwazi ukubuyisela kwakhona. (Okuthakazelisayo, uphando lubonisa ukuba i-statins ingayifumana i-PCSK9, kodwa, xa isetyenziselwa ndawonye, i-statins ne-evolocumab ayifani ngokuvisisana ngqo okanye inokubakho.)
Okwangoku, u-Amgen, umenzi we-evolocumab, uqhuba izilingo ezininzi zeekliniki ezinkulu kwiindawo ezahlukeneyo zesigulane emhlabeni wonke.
Iziphumo zezi zilingo zithembisa ngokubhekiselele kumandla evolocumab okunciphisa amanqanaba e-LDL-C. Ngokomzekelo, kwisilingo esisodwa seSigaba sesi-3, abathathi-nxaxheba abanesimo esibi kunazo zonke ze-hypercholesterolemia (iintsholongwane ze-hypercholesterolemia) ezinokwakheka kwezilwanyana (ezinye zezilwanyana ze-cholesterol ezithiwa yi-Zetia) zifumene i-31% ekhulwini kwi-LDL-C kuma-12 Iiveki ziqhathaniswa nabantu abangazange bamkele iziyobisi. (Abathathi-nxaxheba baye bafumana ukuhla kweepesenti ezingama-23 kwi-apolipoprothein B.) Kubaluleke kakhulu, i-evolocumab yasebenza ngokukhawuleza kunezinye izibilini ezimbini ezitsha eziza phantsi kwepayipi: i-omitapide kunye ne-mipomersen.
Ukuqalisa, ngokwemiphumo emibi, i-evolocumab ixhomekeke kangcono kune-omitapide kunye ne-mipomersen.
Kwisinye isilingo sesiGaba sesi-3, abathathi-nxaxheba ababengabandeleliyo ubuncinane ubuncinane bama-statins kwaye baphathwa nge-evolocumab ne-Zetia kuphela babone ukuhla kwe-53 ukuya kuma-56 kweepesenti kwi-LDL-C xa kuthelekiswa ne-37 ukuya kwe-39 kweepesenti ekunciphiseni kwabathathi-nxaxheba abafumana uZetia kuphela. Ukongezelela, i-evolocumab yenza imicimbi engaphantsi kweZetia.
Ekugqibeleni, kwizifundo zeSigaba sesi-2, kubafundi abathathi-nxaxheba kunye ne-hypercholesterolemia kwaye sele sele bekhulile kwi-stin therapy, i-evolocumab yanciphisa amazinga e-LDL-C ngama-66 ukuya kuma-75 ekhulwini xa ilawulwa kabini ngenyanga.
Ngaba Unokunceda Abagulane?
Kule ngongoma, i-jury isacacile ukuba ingaba i-evolocumab iya kuba neyiphi na inzuzo yezempilo kubantu abasengozini yokuhlaselwa isifo kunye nokuhlaselwa kwentliziyo. Ukunciphisa imilinganiselo ye-cholesterol mhlawumbi ithetha nje encinci kubantu abaninzi, iphuzu laqhutyelwa ekhaya yi-ACC / ezintsha i-AHA izikhokelo eziye zaphelisa ngokukhawuleza amanqanaba "okujoliswe kuwo" we-cholesterol ye-serum. Ukongezelela, ezi zikhokelo zibonisa ukuba i-statins, kuphela izidakamizwa ezibonisa ngokwenene nayiphi na inzuzo ekunciphiseni ukuxhatshazwa komzimba kunye nokufa, kufuneka zichazwe kubantu abanesifo senhliziyo (isifo okanye isifo senhliziyo), abantu abaneziLD-C ezingaphezu kwe-190 ( ii-cholesterol ezimbi kakhulu), abantu abaneminyaka engama-40 ukuya ku-75 abanesifo seswekile, kunye nabantu abaneminyaka engama-40 ukuya kuma-75 ubudala abanengxaki ye-7.5% yesifo senhliziyo kwiminyaka eyi-10 ezayo.
Ukuba ngexesha lexesha elide lonyango olulandelayo lithatha inxaxheba kwiminyaka, i-evolocumab ibonisa ngokuphumelelayo ukuphazamiseka kweziphumo zesifo senhliziyo njengesifo sokushaya nesifo senhliziyo, ngoko sibheke impumelelo yemveliso enokuthi ilinganiswa nemimiselo. Sijongene nokuqinisekiswa kwe-cholesterol-yokutya-i-CHD hypothesis ebonakala ingenakwenzeka ngokusekelwe kwiminyaka yesayensi. Ekugqibeleni, ikhono lika-evolocumab lokunciphisa amanqanaba e-LDL-C kwiindawo ezahlukeneyo ezithatha inxaxheba lukhumbuza i-blockbuster yezidakamizwa iZetia, eziye zabonakalisa zingasebenzi (okanye zitshatyalaliswa kancinci) ekukhuseleni i-plaque buildup kubathathi-nxaxheba. Ngamanye amazwi, uZetia wayeyi-epic fail and so-evolocumab
> Imithombo
> "I-anti-PCSK9 Anti-Anti-Effective iyanciphisa i-Cholesterol kwizigulane ezine-Statin Inxerance" ngo-Erik Stroes kunye noogxa abashicilelwe ngomhla we-11/23, 2014 (kwi-e-pub ngaphambi kokuprintwa) kwiNcwadi ye-American College of Cardiology.
> IBersot TP. Isahluko 31. Ulwaphulo lweMithi ye-Hypercholesterolemia kunye neDyslipidemia. Ku: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Basmacological Basis of Therapeutics, 12e . New York, NY: McGraw-Hill; 2011.
> "Impembelelo ye-evolocumab okanye i-ezetimibe ifakwe kwisifo esilinganiselweyo okanye esiphezulu sonyango lwe-LDL-C ehlaselwa kwizigulane ezine-hypercholesterolemia: ityala le-clinical rand-e-LAPLACE-2" likaJG Robinson kunye nabalingane abashicilelwe kwi-JAMA ngomhla we-5/14/2014.
> "Ukuvinjelwa kwe-PCSK9 kunye ne-evolocumab kwi-hypercholesterolemia yasekhaya ye-homozygous (TESLA Part B): inzululwazi elawulwa yi-FB Raal kunye nabalingane abapapashwe kwiLancet ngo-10/2/2014.