26. Chinese

　　14. Causes of Zieve syndrome include

　　11. What complications can Zieve syndrome easily lead to

　　10. 1. Early-onset coronary heart disease is common in familial hypercholesterolemia, with an average onset age of 45 years for males and 55 years for females. The youngest child had a myocardial infarction at 18 months. Atherosclerosis can also occur in other parts of the arteries. For example, atherosclerosis of the carotid artery can cause carotid stenosis, and vascular murmurs can be heard in the carotid area during physical examination.

　　9. 2. Markedly elevated triglyceridemia can cause acute pancreatitis.

　　6. Common in patients with a long history of alcohol consumption and chronic alcoholism, often accompanied by nausea and vomiting, anorexia, and upper abdominal pain after excessive alcohol intake.

　　5. Liver enlargement with moderate texture and tenderness, rare splenomegaly, and liver cirrhosis manifestations in the late stage, such as ascites, palmar erythema, and spider angioma. Shaking and delirium may occur after stopping alcohol consumption. Scleral jaundice.

　　3. Hemoglobinuria and hemosiderinuria, and other hemolytic anemia manifestations.

　　The cause of the disease is liver cell damage due to alcohol intoxication and varying degrees of bile stasis, leading to jaundice. Alcohol can increase the level of free fatty acids in plasma and, due to the increased formation of intracellular lipids, cause an increase in serum triglycerides. Hyperlipidemia leads to changes in the lipid composition of the red blood cell membrane, impairing its function and increasing fragility, leading to hemolysis. In addition, pancreatitis caused by alcohol intoxication and vitamin E deficiency are also related to hemolysis. It is recommended to abstain from alcohol and reduce alcohol intake!

　　1. Blood count: hemoglobin levels decrease, reticulocyte counts increase, and red blood cell morphology changes, such as macrocytes, spherocytes, and target cells.

　　2. Red blood cell fragility increases.

　　3. Bone marrow examination shows active proliferation of the red blood cell system.

　　4. Blood lipid levels increase, with cholesterol, phospholipids, and triglycerides being particularly prominent.

　　5. Serum bilirubin levels increase, alkaline phosphatase levels increase, and liver function is abnormal.

　　6. Liver biopsy shows fat infiltration and liver cirrhosis changes.

　　Part One: Dietary Principles

　　1. Reduce total calorie intake and control body constitution; eat less and more frequently, and do not overeat.

　　2. Reduce fat intake, with no more than 40 grams per day. Control weight by not overeating.

　　3. Cholesterol intake should not exceed 200 milligrams per day.

　　4. Patients with high triglyceride levels should avoid or eat less refined sugar (sugar, glucose, honey, pastries, candies, etc.).

　　5. Protein intake should be 1 gram per kilogram of body weight per day.

　　6. Increase the intake of niacin (with lipid-lowering effects) and vitamin C (with blood cholesterol-lowering effects). When consuming more unsaturated fatty acids, the intake of vitamin E should also be increased.

　　7. Eat more foods rich in zinc and chromium, such as animal products and coarse grains.

　　8. Lignin in crude fiber has the effect of reducing cholesterol production, so it is advisable to eat more coarse grains, vegetables, fruits, and other fibrous foods rich in fiber. Many foods have been found to have a lowering blood lipid effect. Garlic, hawthorn, soybeans, milk, mung beans, mushrooms, peanuts, ginger, oatmeal, corn, tea, celery, onions, vegetable oils, fruit (orange, grapefruit, tangerine, etc.), and seafood (kelp, sea vegetables, etc.).

　　Part Two: Dietary Taboos

　　1. Absolute smoking and alcohol should be avoided.

　　2. Avoid overeating and drinking. Try to reduce the intake of animal fats. Control the intake of animal livers and other internal organs. Strict control should be exercised over animal brains, crab roe, fish eggs, egg yolks, salted eggs, etc.

　　Part One: Controlling Ideal Weight

　　Many epidemiological studies show that the average plasma cholesterol and triglyceride levels in obese individuals are significantly higher than those in non-obese peers of the same age. In addition to the obvious positive correlation between body mass index (BMI) and blood lipid levels, the distribution of body fat is also closely related to plasma lipoprotein levels. Generally, central obesity is more likely to lead to hyperlipidemia. After weight loss in obese individuals, blood lipid disorders can also return to normal.

　　Part Two: Exercise Training

　　Physical exercise not only enhances cardiovascular function and improves insulin resistance and glucose tolerance, but also helps reduce weight, lower plasma triglyceride and cholesterol levels, and increase HDL cholesterol levels.

　　To achieve the goal of safety and effectiveness, the following matters should be paid attention to when exercising:

　　1. Exercise intensity:If the amount of exercise is not appropriate, it may not achieve the expected effect, or it may easily lead to accidents. The intensity of exercise is usually measured by the heart rate after exercise, and the appropriate exercise intensity is generally to control the heart rate after exercise at about 80% of the maximum heart rate. The forms of exercise are recommended to be aerobic activities such as moderate walking, jogging, swimming, skipping rope, doing physical exercises, cycling, etc.

　　2. Exercise duration:Before each exercise session, a 5 to 10-minute warm-up activity should be performed first to gradually reach the above heart rate level, and then maintain it for 20 to 30 minutes. It is best to perform a 5 to 10-minute relaxation activity after exercise. At least 3 to 4 times of activity per week.

　　3. Pay attention to safety protection during exercise to avoid various accidents.

　　Three, quit smoking

　　Smoking can increase the levels of plasma cholesterol and triglycerides and decrease the level of HDL-cholesterol. After stopping smoking for 1 year, the level of plasma HDL-cholesterol can rise to the level of non-smokers, and the risk of coronary heart disease can be reduced by 50%, even approaching that of non-smokers.

　　Four, dietary treatment

　　Plasma lipids mainly come from food. By controlling the diet, the level of plasma cholesterol can be reduced by 5% to 10%, which also helps in weight loss. It also helps to maximize the effectiveness of lipid-lowering drugs. Most patients with Type III hyperlipoproteinemia can reduce their blood lipid levels to normal through dietary treatment, while correcting other coexisting metabolic disorders.

　　The timing of dietary treatment mainly depends on the degree of risk of coronary heart disease and the level of plasma LDL-cholesterol in the patient. Generally speaking, the higher the risk of coronary heart disease, the lower the level of plasma LDL-cholesterol at which dietary treatment should begin.

　　The dietary treatment of hyperlipidemia is achieved through dietary control methods, while maintaining an ideal weight, to reduce the level of LDL-cholesterol in the plasma. As shown in Table 10, dietary treatment is usually divided into two steps. If the level of plasma LDL-cholesterol fails to reach the control target after the first step of dietary treatment, which lasts for 3 months, a more stringent dietary control according to the second step plan is required. For patients with coronary heart disease, the second step dietary treatment plan should be adopted directly.

　　The dietary structure can directly affect the level of blood lipids. The level of plasma cholesterol is easily influenced by the intake of cholesterol in the diet, and consuming a large amount of saturated fatty acids can also increase the synthesis of cholesterol. Although monounsaturated fatty acids and polyunsaturated fatty acids have the effect of lowering the levels of plasma cholesterol, LDL-cholesterol, and increasing the level of HDL-cholesterol, both contain a high amount of calories. Excessive intake can also lead to overweight or obesity. Therefore, it is also not advisable to consume too much unsaturated fatty acids in the diet. Usually, foods such as meat, eggs, dairy products (especially yolks and animal internal organs) contain a high amount of cholesterol and saturated fatty acids, and should be consumed in limited quantities. Edible oils should mainly be plant oils, and the recommended daily intake for each person is 25 to 30 grams. Patients with familial hypercholesterolemia should strictly limit the intake of cholesterol and fatty acids in food.

　　5. Drug treatment

　　1. Drug treatment for dyslipidemia:Currently, there are four types of lipid-lowering drugs commonly used outside of China with clear pharmacological mechanisms and definite efficacy. Among them, statins and resins are mainly used to reduce serum total cholesterol and LDL cholesterol, while drugs mainly for reducing serum triglycerides include bisphosphonates and niacin. The rational selection of treatment drugs should be based on the clinical classification of dyslipidemia.

　　(1) Statins: i.e., inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase, a class of lipid-lowering drugs with good efficacy, and also the most widely used class of lipid-lowering drugs in clinical use. Currently, commonly used statins include lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, and others.

　　Statins also have effects other than lowering lipids. Several large-scale, long-term follow-up studies on the primary and secondary prevention of coronary heart disease have confirmed that the treatment with statins can reduce coronary heart disease mortality by 20% to 43%; fatal or non-fatal myocardial infarction by 24% to 33%; cardiovascular disease mortality by 17% to 28%; stroke risk by 20% to 29%; and all-cause mortality by 12% to 31%.

　　(2) Bisphosphonates: i.e., derivatives of phenylphosphonic acid. Currently, the commonly used ones include fenofibrate, gemfibrozil, and bezafibrate. Based on the results of a series of large-scale, randomized, double-blind, controlled studies, bisphosphonate drugs can reduce serum triglyceride levels by 20% to 60%, total cholesterol levels by 10% to 20%, and LDL-C levels by 5% to 20%; HDL-C levels are increased by 5% to 20%. Bisphosphonate drugs also have a certain effect of reducing plasma fibrinogen.

　　Bisphosphonate drugs are indicated for patients with hypertriglyceridemia and mixed hyperlipidemia characterized by elevated triglycerides. Patients with simple low high-density lipoprotein cholesterolemia can also be treated with bisphosphonate drugs. Bisphosphonate drugs are contraindicated in patients with severe liver and kidney dysfunction, pregnant women, lactating women, and women with the potential for childbearing. For those using anticoagulant drugs concurrently, due to the potential enhancement of anticoagulant effects, attention should be paid to the adjustment of dosage.

　　Common adverse reactions include dry mouth, decreased appetite, and in some cases, an increase in transaminases, blood urea nitrogen, and creatinine. Occasional cases may exhibit decreased sexual function. Recovery to normal after discontinuation of the drug can be rapid. For patients taking the drug for a long time, regular monitoring of liver and kidney function, CK, and other indicators is recommended to prevent the occurrence of serious adverse reactions.

　　(3) Niacin derivatives: Niacin belongs to the B-group vitamins, but when used in doses exceeding the dosage of vitamin action, it has the effect of regulating blood lipids. Niacin derivatives can be used for any type of hyperlipidemia except pure hypocholesterolemia and type I hyperlipoproteinemia. Absolute contraindications include chronic liver disease and severe gout. Relative contraindications include diabetes, hyperuricemia, and peptic ulcer.

　　As lipid-lowering drugs, niacin derivatives have a large dosage, reaching 3 to 6g per day, so there are many adverse reactions. The main adverse reactions include facial flushing, skin vasodilation, gastrointestinal reactions including nausea, vomiting, dyspepsia, liver damage, and triggering ulcer disease. Niacin can also reduce glucose tolerance, worsen diabetes, increase blood uric acid, and exacerbate gouty arthritis. Therefore, the use of niacin usually starts with a low dose and gradually increases the dose.

　　(4) Resin drugs (bile acid sequestrants): This class of drugs includes colestyramine and colestipol, which are non-absorbable high-molecular-weight anion exchange resins not absorbed by the intestines. The common characteristics of this class of drugs are to prevent the absorption of bile acid or cholesterol from the intestines, promote the excretion of bile acid or cholesterol with feces, and promote the degradation of cholesterol. After taking resin drugs, total cholesterol can decrease by 10% to 20%, LDL-C can decrease by 15% to 25%, and triglycerides may remain unchanged or increase due to the increase of pre-existing VLDL levels, resulting in a higher level of serum triglycerides. Therefore, it may be necessary to add drugs that reduce VLDL. The efficacy of this class of drugs is related to the dose, usually starting from 20g per day and increasing to about 30g, taken 3 to 4 times a day.

　　Resin drugs are ineffective for any type of hypertriglyceridemia. For mixed dyslipidemia with elevated cholesterol and triglycerides, they need to be used in combination with other types of lipid-lowering drugs. The common adverse reactions of resin drugs are gastrointestinal reactions, such as nausea, bloating, constipation, and poor taste. Poor taste can be corrected with flavoring agents, and constipation should be addressed by eating more fibrous foods. Since resin drugs may interfere with the absorption of folic acid and other fat-soluble vitamins, long-term users should supplement vitamins A, D, K, calcium, and folic acid appropriately, and pregnant women should pay more attention to supplementation during the growth period.

　　(5) Probucol: During the period of taking the drug, the regression of xanthoma in patients can be observed. In addition, probucol is also a strong oxidant that can prevent the mutation of LDL and is beneficial for inhibiting the formation and development of atherosclerosis.

　　Common adverse reactions include nausea and abdominal pain, while less common adverse reactions include sweating, angioneurotic edema, headache, dizziness, and sensory abnormalities. Occasionally, there may be an increase in serum transaminases and alkaline phosphatase. Long-term use can lead to an extension of the Q-T interval and ventricular arrhythmias on the electrocardiogram, so probucol should not be used in patients with a history of Q-T prolongation. The drug is not recommended for pregnant women, lactating mothers, and children. It is also not advisable to become pregnant within 6 months after discontinuation of the drug.

　　(6) Fish Oil - Omega 3 Fatty Acids: The mechanism by which fish oil regulates blood lipids is not yet fully clear, and it may be that it inhibits the synthesis of intracellular lipids and lipoproteins, and promotes the excretion of cholesterol from feces. In addition, it can dilate coronary arteries, reduce thrombosis, and delay the progression of atherosclerosis. It is also likely to be related to the metabolism of prostaglandins, the improvement of platelet and white blood cell function. Common side effects are nausea caused by fishy taste. Patients with a history of gastrointestinal bleeding should not use fish oil preparations for a long time. The efficacy and safety of this type of preparation still need to be confirmed by long-term use.

　　2. Selection of Lipid-Lowering Drugs:In clinical practice, the selection of lipid-lowering drugs is often based on the etiology and type of dyslipidemia, as well as the mechanism of action and adverse reactions of lipid-lowering drugs. In addition to these simple principles, specific considerations should also be given to many specific situations of the patients, such as the patient's age, accompanying diseases, work and lifestyle, and economic bearing capacity.

　　For some patients with dyslipidemia, even with the adjustment of diet and lifestyle, the use of a lipid-lowering drug still cannot achieve ideal efficacy, and it may be necessary to use a combination of drugs. When choosing combination therapy, one should be cautious, especially paying attention to adverse reactions. For example, when statins and bile acid sequestrants are used together, especially at higher doses, the risk of liver dysfunction and rhabdomyolysis increases significantly, and close attention should be paid. In general, it is best to avoid combination therapy. If it is necessary, it should be used in small doses and closely monitored for symptoms of adverse reactions, and regular monitoring of liver function, CK, and other main indicators should be carried out.

　　Six, Non-drug Treatment for Severe Dyslipidemia

　　For some patients with partial dyslipidemia, adjusting diet and improving lifestyle can achieve relatively ideal blood lipid regulation effects. However, a very small number of patients have very high blood lipid levels, which are more common in patients with genetic hereditary abnormalities. These patients can be treated with methods such as plasma purification therapy, surgical treatment (such as partial resection of the ileocecal junction, portocaval shunt), and so on. Gene therapy may be able to overcome refractory hereditary dyslipidemia in the future.