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] | เนื้อแดง
งานวิเคราะห์อภิมานปี 2012 พบว่า ความเสี่ยงมะเร็งกระเพาะอาหารสูงขึ้นเมื่อทานเนื้อแดงหรือเนื้อแปรรูปมากขึ้น
คือเนื้อแดงเองมีสารบางอย่างที่ในสถานการณ์โดยเฉพาะ ๆ จะเกิดสารก่อมะเร็งเช่นสารประกอบ N-nitroso (N-nitroso compound, NOC) |
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] | เนื้อแดง
ในปี 2015 สำนักงานวิจัยมะเร็งนานาชาติ () สรุปว่า เนื้อแดงน่าจะเป็นสารก่อมะเร็ง (กลุ่ม 2A) สำหรับมนุษย์
และรายงานว่า การได้เนื้อแดงมากขึ้นแต่ละ 100 กรัม (จนถึงประมาณ 140 ก.) ต่อวัน
เพิ่มความเสี่ยงมะเร็งลำไส้ใหญ่ 17%
และก็ดูเหมือนจะเสี่ยงมะเร็งตับอ่อนและมะเร็งต่อมลูกหมากเพิ่มขึ้นด้วย แม้ความสัมพันธ์จะไม่ชัดเจนเท่า
ให้มองเห็นง่ายขึ้นก็คือ ในสหราชอาณาจักร คน 56 คนจาก 1,000 คนที่ทานเนื้อแดงน้อยที่สุดจะเกิดมะเร็งลำไส้ใหญ่ (5.6%) เทียบกับ 66 คนจาก 1,000 คนที่ทานเนื้อแดงมากกว่า (6.6%) คือเสี่ยงมะเร็งมากกว่า 17% (1.17 x 5.6 = 6.6) |
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] | เนื้อแดง
งานทบทวนวรรณกรรมปี 2016 รายงานว่า การทานเนื้อแดงมากขึ้นทุก ๆ 100 ก. ต่อวัน จะเพิ่มความเสี่ยงโรคหลอดเลือดสมองและมะเร็งเต้านมแต่ละอย่างขึ้น 11%, ความเสี่ยงตายเพราะโรคหัวใจร่วมหลอดเลือด 15%, ความเสี่ยงมะเร็งลำไส้ใหญ่ 17% และความเสี่ยงมะเร็งต่อมลูกหมากระยะท้าย ๆ 19% |
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] | เนื้อแดง
งานศึกษาปี 2018 ยังพบการแพ้เนื้อแดงที่สูงขึ้นในสหรัฐเพราะถูกแมงปรสิต (tick) กัด |
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] | เนื้อแดง
เนื้อแปรรูปโดยมากมีเนื้อแดงอย่างน้อยก็เป็นบางส่วน
เพื่อเพิ่มรสชาติหรือเพื่อให้อยู่ได้นาน เนื้อจะหมักเกลือ หมักเกลือ+ไนเตรต (nitrate)+ไนไตรต์ (nitrite)/น้ำตาล ผ่านกระบวนการหมัก รมควัน หรือผ่านกระบวนการอื่น ๆ กลายเป็นเนื้อแปรรูป
แต่ไนเตรตและไนไตรต์ที่พบในเนื้อเช่นนี้ (เช่น เบคอน แฮม ไส้กรอกอิตาลี/ซาลามิ ไส้กรอกอเมริกัน/เป็บเปอโรนี ฮอตดอก) อาจเปลี่ยนในร่างกายมนุษย์เป็นไนโตรซามีน (nitrosamine) ที่เป็นสารก่อมะเร็ง ทำให้เซลล์ในลำไส้ใหญ่/ไส้ตรงกลายพันธุ์ โดยก่อเนื้องอกแล้วในที่สุดก็กลายเป็นมะเร็ง |
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] | เนื้อแดง
สำนักงานวิจัยมะเร็งนานาชาติ () ได้แถลงข่าวในปี 2015 อาศัยการทบทวนงานศึกษากว่า 800 งานที่ทำในช่วง 20 ปี แล้วสรุปว่า เนื้อแปรรูปเป็นสารก่อมะเร็ง (กลุ่ม 1) อย่างชัดเจน และพบว่า เนื้อแปรรูปที่ทานเพิ่มขึ้น 50 กรัมในแต่ละวัน จะเพิ่มความเสี่ยงมะเร็งลำไส้ใหญ่ขึ้น 18% (จนถึงขนาดมากสุดคือ 140 ก.)
องค์กรยังพบว่ามันเพิ่มความเสี่ยงมะเร็งกระเพาะอาหารอีกด้วยแต่ยังไม่ชัดเจนเท่า
งานทบทวนวรรณกรรมปี 2016 พบว่า การทานเนื้อแปรรูปเพิ่มขึ้น 50 กรัมแต่ละวัน (เช่น เบคอน แฮม ฮอตดอก และไส้กรอก) จะเพิ่มความเสี่ยงมะเร็งต่อมลูกหมาก 4%, ความเสี่ยงตายเพราะมะเร็ง 8%, มะเร็งเต้านม 9%, มะเร็งลำไส้ใหญ่ 18%, มะเร็งตับอ่อน 19%, โรคหลอดเลือดสมอง 13%, ความเสี่ยงตายเพราะโรคหัวใจร่วมหลอดเลือด 24% และเบาหวาน 32% |
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] | เนื้อแดง
การทำเนื้อด้วยความร้อนสูง หรือการรมควันเนื้อ จะสร้างสารประกอบ polycyclic aromatic hydrocarbon (PAH) และ heterocyclic amine (HCA) ที่ก่อมะเร็ง
กลุ่มย่อยของ HCA รวมทั้ง amino-dimethylimidazo-quinoxaline (MelQx), amino-dimethylimidazo-quinoxaline (DiMelQx) และ amino-methyl-phenylimidazo-pyridine (PhIP) ซึ่งเกิดโดยมากเพราะทำเนื้อด้วยความร้อนสูง
ยังพบสารประกอบ Benzo[a]pyrene (B[a]P) ในเนื้อที่ทำด้วยความร้อนสูงมากอีกด้วย
ดังนั้น การหมักเนื้อแดงสดมีไขมันน้อยในซอสแล้วหุงต้มที่ความร้อนต่ำ จึงน่าจะช่วยลดการสร้างสารประกอบซึ่งก่อมะเร็ง และลดความเสี่ยงมะเร็งลำไส้ใหญ่ |
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เวลานำ () หมายถึงช่วงเวลาระหว่างการตรวจพบโรค (ปกติโดยใช้กฎเกณฑ์ใหม่หรือทำทดลอง) กับการพบและวินิจฉัยอาการ (ตามเกณฑ์ปกติ)
เป็นระยะเวลาระหว่างการวินิจฉัยโรคที่อาศัยการการตรวจคัดโรค กับเวลาปกติที่จะวินิจฉัยโรคได้โดยไม่ได้ตรวจคัด
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จุดหมายของการตรวจคัดโรคก็เพื่อให้สามารถวินิจฉัยโรคได้เร็วกว่าเมื่อไม่ตรวจคัด
เพราะการตรวจพบโรควิธีหลังจะช้ากว่าคือพบเมื่ออาการปรากฏ |
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] | อคติเพราะเวลานำ
แต่การวินิจฉัยได้เร็วโดยตรวจคัดโรค เช่น การตรวจดีเอ็นเอ อาจไม่ทำให้รอดชีวิตได้นานขึ้น เพียงแต่ตรวจพบแนวโน้มที่บุคคลจะเกิดโรค
คนไข้อาจจะวิตกกังวลนานขึ้น เพราะรู้ตัวว่ามีโรคนานขึ้น
ยกตัวอย่างเช่น โรคพันธุกรรมคือโรคฮันติงตัน ปกติแพทย์จะวินิจฉัยได้เมื่ออายุประมาณ 50 ปีเพราะอาการปรากฏ และคนไข้จะเสียชีวิตราวอายุ 65 ปี
ดังนั้น คนไข้ทั่วไปจะมีชีวิตอยู่ได้ 15 ปีหลังจากวินิจฉัยโรค
แต่การทดสอบยีนเมื่อคลอดอาจทำให้วินิจฉัยโรคนี้ได้เร็วกว่า
ถ้าทารกเกิดใหม่จะเสียชีวิตราวอายุ 65 ปี ดังนั้น คนไข้ก็จะรอดชีวิต 65 ปีหลังวินิจฉัยโรค โดยไม่ได้รอดชีวิตได้นานกว่าผู้ที่วินิจฉัยโดยไม่ได้ตรวจยีน |
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] | อคติเพราะเวลานำ
ข้อมูลสถิติที่ไม่ได้กรองอาจทำให้การตรวจคัดโรคดูเหมือนจะเพิ่มเวลาที่รอดชีวิต (คือเพิ่มเวลานำ)
เพราะถ้าบุคคลยังเสียชีวิตในช่วงอายุปกติ จริง ๆ ชีวิตของบุคคลนั้นก็ไม่ได้ยืนขึ้นแม้ตรวจพบโรคเร็วกว่า
เพราะการตรวจพบโรคได้เร็ว ไม่ได้หมายความว่าจะรอดชีวิตได้นานขึ้น
ดังนั้น ความเอนเอียงเพราะเวลานำอาจทำให้แปลความหมายข้อมูลทางสถิติ เช่น อัตรารอดชีวิตอย่างน้อย 5 ปี (five-year survival rate) ผิด ๆ |
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] | อคติเข้าข้างเวลายาว
อคติเข้าข้างเวลายาว () เป็นรูปแบบหนึ่งของอคติที่เกิดจากการเลือกตัวอย่าง เป็นความบิดเบือนทางสถิติที่ทำให้สรุปข้อมูลอย่างผิด ๆ
เกิดเมื่อเลือกวิเคราะห์ช่วงเวลาหนึ่ง ๆ ที่มีผลต่อข้อสรุปเพราะสิ่งที่วิเคราะห์มีช่วงเวลาการเกิด/การปรากฏที่แตกต่างกัน
กระบวนการเช่นนี้เข้าข้างช่วงเวลาที่ยาวกว่าและดังนั้น จึงบิดเบือนข้อมูล
ประโยชน์ของการตรวจคัดกรองโรคมะเร็งมักกล่าวคู่กับอคตินี้ เป็นความเอนเอียงซึ่งทำให้รู้สึกว่า การตรวจคัดโรคทำให้ได้ผลที่ดีกว่าแม้จริง ๆ จะไม่มีผลอะไร
คือเนื้องอกที่โตอย่างรวดเร็วทั่วไปจะมีระยะที่ไม่แสดงอาการสั้นกว่าเนื้องอกที่โตอย่างช้า ๆ
ระยะที่คนไข้มีมะเร็ง (ที่อาจตรวจคัดกรองพบ) แต่ยังไม่ใหญ่พอให้เกิดอาการที่ทำให้คนไข้ปกติไปหาแพทย์แล้วตรวจพบ จึงสั้นกว่าในกรณีที่มีเนื้องอกแบบโตช้า
ดังนั้น ถ้ามีเนื้องอกที่โตเร็วและที่โตช้าเกิดขึ้นจำนวนเท่า ๆ กันในปีหนึ่ง การตรวจคัดโรคจะตรวจพบเนื้องอกที่โตช้าได้มากกว่า
ถ้าเนื้องอกที่โตช้ามีโอกาสทำให้เสียชีวิตได้น้อยกว่ามะเร็งที่โตเร็ว คนไข้มะเร็งที่ตรวจคัดโรคเจอก็จะเหมือนได้ผลที่ดีกว่าโดยเฉลี่ยเทียบกับคนไข้ที่ตรวจพบอาการตามปกติ (เช่น โดยตัดเนื้อออกตรวจ) แม้จะไม่มีประโยชน์จริง ๆ เพราะตรวจพบโรคได้ก่อน
ซึ่งทำให้รู้สึกว่า การตรวจคัดกรองมะเร็งลดอันตราย แม้จริง ๆ เป็นการตรวจพบมะเร็งที่อันตรายน้อยกว่าและตรวจพบได้ง่ายกว่าด้วยการตรวจคัดโรค |
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วิทยาการระบาดของมะเร็ง () เป็นการศึกษาปัจจัยที่มีผลต่อมะเร็ง เพื่ออนุมานทิศทาง/แนวโน้มและเหตุของโรค
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] | วิทยาการระบาดของมะเร็ง
การศึกษาในเรื่องนี้ต้องเผชิญกับปัญหาอคติเพราะเวลานำ (lead time bias) และอคติเข้าข้างเวลายาว (length time bias)
อคติเพราะเวลานำเป็นแนวคิดว่า การวินิจฉัยพบโรคได้เร็วอาจทำให้สถิติของเวลาที่รอดชีวิตจากมะเร็งเกินจริง โดยไม่ได้ปรับปรุงการดำเนินของโรคจริง ๆ
ส่วนอคติเข้าข้างเวลายาวเป็นแนวคิดว่า เนื้องอกที่โตช้ากว่ามีโอกาสวินิจฉัยพบมากกว่าด้วยการตรวจคัดกรองโรค แต่การปรับปรุงให้ตรวจพบมะเร็งที่โตช้าเป็นจำนวนมากกว่าอาจไม่ทำให้คนไข้ได้ผลดีจริง ๆ
ปัญหาที่เกี่ยวกันอีกอย่างหนึ่งก็คือการวินิจฉัยพบโรคเกินจริง คือการตรวจคัดโรคมีแนวโน้มในการวินิจฉัยพบโรคโดยไม่มีผลเพิ่มชีวิตคนไข้ได้จริง ๆ
ตัวอย่างเด่น คือมะเร็งต่อมลูกหมากกับการตรวจคัดโรคด้วยการเช็คค่าแอนติเจนเฉพาะต่อมลูกหมาก (Prostate-specific antigen, PSA) |
994747#2 | [
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] | วิทยาการระบาดของมะเร็ง
นักวิชาการทางมะเร็งบางท่านอ้างว่า การทดลองทางคลินิกของมะเร็งที่ได้ผลลบ/ผลว่าง ไม่มีกำลังทางสถิติเพื่อค้นพบประโยชน์ต่อการรักษาได้จริง ๆ
ซึ่งอาจเป็นเพราะมีคนไข้สมัครเข้าร่วมการทดลองเป็นจำนวนน้อยกว่าที่วางแผนไว้ดั้งเดิม |
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] | วิทยาการระบาดของมะเร็ง
สำนักงานทะเบียนมะเร็ง (cancer registry) ไม่ว่าจะในระดับประเทศหรือระดับภูมิภาค เป็นองค์กรที่สรุปข้อมูลมะเร็งจากทะเบียนคนไข้
เป็นองค์กรที่ให้ข้อมูลแก่รัฐและกลุ่มสาธารณสุขของประเทศต่าง ๆ เพื่อช่วยติตตามแนวโน้ม/ทิศทางของการวินิจฉัยและการรักษามะเร็ง
องค์กรที่ใหญ่สุดและอาจสำคัญสุดแห่งหนึ่งก็คือ Surveillance Epidemiology and End Results (SEER) ซึ่งรัฐบาลกลางสหรัฐเป็นผู้บริหาร |
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] | วิทยาการระบาดของมะเร็ง
อย่างไรก็ดี ความเป็นห่วงเรื่องความเป็นส่วนตัวของข้อมูลสุขภาพได้ทำให้จำกัดการแชร์ข้อมูลทะเบียนมะเร็ง เช่น กระทรวงทหารผ่านศึกสหรัฐ ()
และสถาบันอื่น ๆ |
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] | วิทยาการระบาดของมะเร็ง
สมาคมมะเร็งอเมริกัน () ได้พยากรณ์ว่า ในสหรัฐปี 2012 จะมีคนไข้มะเร็งใหม่ 1,690,000 ราย และผู้เสียชีวิตเพราะมะเร็ง 577,000 ราย (จากประชากรประมาณ 323 ล้านคน) |
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งานศึกษาวิทยาการระบาดแบบสังเกตที่แสดงความสัมพันธ์ระหว่างปัจจัยเสี่ยงมะเร็งกับมะเร็งโดยเฉพาะ ๆ โดยมากช่วยสร้างสมมติฐานเกี่ยวกับการรักษาที่อาจลดอุบัติการณ์หรือพยาธิภาวะของโรค
ต่อจากนั้น การทดลองแบบสุ่มและมีกลุ่มควบคุม () จึงตรวจสอบสมมติฐานที่ได้จากงานศึกษาเช่นนั้นและจากการวิจัยแบบทดลองว่า ช่วยลดอุบัติการณ์หรือพยาธิภาวะของโรคจริง ๆ หรือไม่
ในกรณีจำนวนมาก สิ่งที่ค้นพบจากงานศึกษาวิทยาการระบาดแบบสังเกตไม่สามารถยืนยันได้ด้วยงานทดลองแบบสุ่มและมีกลุ่มควบคุม |
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] | วิทยาการระบาดของมะเร็ง
ปัจจัยเสี่ยงสำคัญที่สุดก็คืออายุ
ตามนักวิจัยมะเร็งผู้หนึ่ง "ถ้าเรามีชีวิตนานพอ ไม่ช้าก็เร็วทุกคนก็จะเป็นมะเร็ง"
โดยพื้นฐานแล้ว ในประเทศอังกฤษ การเพิ่มอัตราการเกิดมะเร็งจากยุคก่อนประวัติศาสตร์จนถึงปี 1901-1905 มาจากช่วงอายุที่ยืนขึ้น
แม้การเพิ่มความเสี่ยงมะเร็งตามอายุจะมีหลักฐานที่ชัดเจน แต่รูปแบบตามอายุก็ค่อนข้างซับซ้อน
มะเร็งบางอย่าง เช่น มะเร็งอัณฑะ มีอุบัติการณ์สูงสุดในช่วงต้นของชีวิตโดยยังไม่ทราบสาเหตุ
อนึ่ง การเกิดมะเร็งต่าง ๆ จะเพิ่มตามอายุตามอัตราที่ต่าง ๆ กัน เช่น อุบัติการณ์ของมะเร็งต่อมลูกหมากจะเพิ่มเร็วมากกว่ามะเร็งสมอง |
994747#8 | [
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มะเร็งทั่วโลกประมาณ 1/3 (แต่ประมาณ 75-80% ในสหรัฐ)
เกิดจากปัจจัยเสี่ยงที่อาจเปลี่ยนได้
ปัจจัยระดับต้น ๆ ทั่วโลกรวมทั้ง |
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ชายที่เป็นมะเร็งมีโอกาสมีปัจจัยเสี่ยงที่เปลี่ยนได้เป็นสองเท่าของหญิงที่เป็นมะเร็ง |
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] | วิทยาการระบาดของมะเร็ง
พฤติกรรมและปัจจัยทางสิ่งแวดล้อมที่รู้ว่ามีผลต่อความเสี่ยงมะเร็ง ไม่ว่าจะเป็นผลบวกหรือลบ
รวมทั้งการใช้ฮอร์โมนสังเคราะห์ (เช่น การบำบัดด้วยการทดแทนฮอร์โมน คือ อันเป็นเหตุของมะเร็งเต้านม), การรับ/ถูกต้องกับรังสีแตกตัว (ionizing radiation) หรือรังสีอัลตราไวโอเลต และการรับปัจจัยเสี่ยงเช่นสารเคมีเนื่องกับอาชีพ |
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] | วิทยาการระบาดของมะเร็ง
ทุก ๆ ปี คนอย่างน้อย 200,000 คนเสียชีวิตทั่วโลกเพราะมะเร็งที่เกี่ยวกับอาชีพ
ผู้ประกอบอาชีพเป็นล้าน ๆ คนเสี่ยงเกิดมะเร็งเช่น pleural mesothelioma (มะเร็งเยื่อหุ้มปอด) และ peritoneal mesothelioma (มะเร็งเยื่อบุท้อง) เพราะสูดแร่ใยหินเข้าทางอากาศ หรือมะเร็งเม็ดเลือดขาวเพราะได้รับ/ถูกต้องน้ำมันเบนซีนในอาชีพ
ปัจจุบัน การตายเพราะมะเร็งเกี่ยวกับปัจจัยทางอาชีพเกิดโดยมากในประเทศพัฒนาแล้ว
ในสหรัฐ ประมาณว่า ผู้ตายเพราะมะเร็ง 20,000 รายและคนไข้มะเร็งใหม่ 40,000 รายในแต่ละปีเกี่ยวข้องกับอาชีพ (จากประชากรทั้งหมด 323 ล้านคน) |
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] | วิทยาการระบาดของมะเร็ง
ในสหรัฐ มะเร็งเป็นเหตุความตายเป็นอันดับสองรองจากโรคหัวใจร่วมหลอดเลือด () เท่านั้น
แต่ในสหราชอาณาจักร มันเป็นเหตุอันดับหนึ่ง
ในประเทศกำลังพัฒนาหลายประเทศ อุบัติการณ์ของมะเร็ง (ตามที่วัดได้) ดูเหมือนจะต่ำกว่ามาก โดยน่าจะเป็นเพราะอัตราความตายเนื่องกับโรคติดต่อหรือการบาดเจ็บที่สูงกว่า
แต่เมื่อควบคุมมาลาเรียและวัณโรคได้ดีขึ้น อุบัติการณ์ของมะเร็งเชื่อว่าจะสูงขึ้น
ยกตัวอย่างเช่น ในเขตทะเลเมดิเตอร์เรเนียนตะวันออก อุบัติการณ์ของมะเร็งเชื่อว่าจะเพิ่มขึ้น 100-180% ภายใน 15 ปีข้างหน้าเพราะการคาดหมายคงชีพที่สูงขึ้น จำนวนผู้ชราภาพในสัดส่วนที่สูงขึ้น และการควบคุมโรควัยเด็กได้
เป็นปรากฏการณ์ที่เรียกว่า epidemiological transition (การเปลี่ยนสถานะทางวิทยาการระบาด) |
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] | วิทยาการระบาดของมะเร็ง
การระบาดของมะเร็งเป็นกระจกส่องปัจจัยเสี่ยงที่มีอยู่ในประเทศต่าง ๆ
มะเร็งเซลล์ตับ () เกิดในประเทศตะวันตกน้อยแต่เป็นมะเร็งหลักในจีนและประเทศใกล้เคียง โดยน่าจะเป็นเพราะมีไวรัสตับอักเสบ บี และสารพิษอะฟลาทอกซิน เป็นของประจำถิ่น
เช่นเดียวกัน เพราะการสูบบุหรี่ได้กลายเป็นเรื่องสามัญในประเทศโลกที่สามต่าง ๆ อุบัติการณ์ของมะเร็งปอดจึงได้เพิ่มตาม |
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] | วิทยาการระบาดของมะเร็ง
ในประเทศไทย ชายมีอัตราอุบัติการณ์เฉลี่ยของโรคต่อปีปรับตามอายุ (age-standardized incidence rate, ASR) ต่อประชากร 100,000 คนระหว่างปี 2013-2015 ที่ 143.8 รายและหญิง 134.2 ราย
เมื่อแบ่งเป็นภาค ๆ อัตราจะสูงสุดในภาคตะวันออก คือ ชายมีอัตรา 164.5 ราย และหญิง 214.8 ราย
ดังนั้น เมื่อคำนวณกับจำนวนประชากรเฉลี่ยระหว่างปีเดียวกันเป็นชาย 31,540,076 ล้านคนและหญิง 33,325,926 คน
ชายอาจเกิดโรคทั้งหมดต่อปีประมาณ 45,350 คน และหญิง 44,720 คน |
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] | วิทยาการระบาดของมะเร็ง
มะเร็งที่เกิดในอัตราสูงสุดต่อประชากร 100,000 คนในชายตามลำดับคือ ตับและท่อน้ำดี (33.9 ราย) ท่อลม หลอดลม และปอด (23.0 ราย) ลำไส้ใหญ่และไส้ตรง (16.2 ราย) และต่อมลูกหมาก (7.5 ราย)
มะเร็งที่เกิดในในหญิงตามลำดับคือ เต้านม (31.4 ราย) ตับและท่อน้ำดี (12.9 ราย) ปากมดลูก (11.7 ราย) และลำไส้ใหญ่และไส้ตรง (11.1 ราย) |
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] | วิทยาการระบาดของมะเร็ง
ตามงานปี 2017 ภาระโรคมะเร็งในประเทศไทย 60% มาจากมะเร็ง 5 อย่าง คือมะเร็งเต้านม ปากมดลูก ลำไส้ใหญ่และไส้ตรง ตับ และปอดโดยมีอัตราอุบัติการณ์ที่ 59.2% อัตราตายที่ 63.1% และความชุกโรคภายใน 5 ปีที่ 54.3% |
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] | วิทยาการระบาดของมะเร็ง
ตามคณะกรรมการวิจัยการแพทย์แห่งอินเดีย (India Council of Medical Research, ICMR) คนอินเดียเกิน 1,300 คนเสียชีวิตทุกวันเพราะมะเร็ง (ปีละ 474,500 รายจากประชากร 1,327 ล้านคน)
ระหว่างปี 2012-2014 อัตราการตายเพราะมะเร็งได้เพิ่มประมาณ 6%
ในปี 2012 มีผู้เสียชีวิต 478,180 รายจากคนไข้ 2,934,314 คนที่รายงาน (16.29%)
ในปี 2013 มีผู้เสียชีวิต 465,169 รายจากคนไข้ 3,016,628 คน (15.4%)
ในปี 2014 มีผู้เสียชีวิต 491,598 รายจากคนไข้ 2,820,179 คน (17.4%) |
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0.004053812474012375
] | วิทยาการระบาดของมะเร็ง
ในแคนาดาปี 2007 มะเร็งเป็นเหตุให้เสียชีวิตอันดับหนึ่ง คือที่อัตราร้อยละ 29.6
เหตุอันดับสองคือโรคหัวใจร่วมหลอดเลือด (CVD)
ในปี 2011 มะเร็งต่อมลูกหมากเป็นมะเร็งสามัญที่สุดในชาย (คนไข้มะเร็งใหม่ 28%) และมะเร็งเต้านมสามัญที่สุดในหญิง (คนไข้มะเร็งใหม่ 28% เหมือนกัน) |
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] | วิทยาการระบาดของมะเร็ง
มะเร็งที่ทำให้เสียชีวิตมากที่สุดทั้งในชายหญิงคือมะเร็งปอด เป็นเหตุให้ตายเพราะมะเร็ง 26.8%
ข้อมูลสถิติชี้ว่า ระหว่างอายุ 20-50 ปี อัตราอุบัติการณ์ (incidence rate) ของมะเร็งสูงกว่าในหญิง เทียบกับหลังอายุ 50 ปีที่อัตราอุบัติการณ์ในชายจะสูงขึ้น
สมาคมมะเร็งแคนาเดียนพยากรณ์ว่า ในอนาคต อัตราอุบัติการณ์ของมะเร็งจะสูงขึ้นทั้งในชายหญิง
ดังนั้น ก็จะคงเป็นปัญหาเรื้อรังต่อไปในอนาคต |
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] | วิทยาการระบาดของมะเร็ง
ในสหรัฐ มะเร็งเป็นเหตุให้เสียชีวิต 25% โดย 30% จากนั้นมีเหตุจากมะเร็งปอด
มะเร็งต่อมลูกหมากสามัญที่สุดในชาย (คนไข้มะเร็งใหม่ 25%) และมะเร็งเต้านมในหญิง (คนไข้มะเร็งใหม่ 25% เช่นกัน)
เด็กและวัยรุ่นก็อาจเป็นมะเร็ง แต่ก็ไม่สามัญ (มีกรณี 150 รายต่อล้านคน) โดยมะเร็งเม็ดเลือดขาวสามัญที่สุด
แต่ในปีแรกของชีวิต อุบัติการณ์อยู่ที่ 230 กรณีต่อล้านคน โดยนิวโรบลาสโตมาสามัญที่สุด
ข้อมูลปี 2004-2008 บ่งว่า อุบัติการณ์การเกิดมะเร็งที่ปรับตามอายุ (age-adjusted) โดยทั่วไปอยู่ที่ประมาณ 460 รายต่อชายหญิง 100,000 คนต่อปี |
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] | วิทยาการระบาดของมะเร็ง
ในสหรัฐ มะเร็งเป็นเหตุให้เสียชีวิต 25% ส่วนในโลกหลาย ๆ แห่ง ก็เป็นปัญหาหลักทางสาธารณสุขอย่างหนึ่ง
ข้อมูลทางสถิติต่อไปเป็นค่าประเมินสำหรับสหรัฐในปี 2008, อาจต่างกับประเทศอื่น ๆ อย่างสำคัญ,
ยกเว้นมะเร็งผิวหนังแบบ basal cell และ squamous cell, และยกเว้น carcinoma in situ ในตำแหน่งต่าง ๆ นอกเหนือจากกระเพาะปัสสาวะ
ดังที่จะเห็น มะเร็งเต้านม/ต่อมลูกหมาก มะเร็งปอด และมะเร็งลำไส้ใหญ่เป็นเหตุของอุบัติการณ์โรคมะเร็งประมาณครึ่งหนึ่ง
ในเรื่องการเสียชีวิตเพราะมะเร็งก็เช่นกัน แต่มะเร็งปอดจะเป็นเหตุหลักแทนมะเร็งเต้านม/ต่อมลูกหมาก |
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] | วิทยาการระบาดของมะเร็ง
ในปี 2016 จะมีคนไข้ที่วินิจฉัยว่าเป็นมะเร็งใหม่ 1,685,210 ราย โดย 595,690 ราย (35.37%) จะเสียชีวิตเพราะโรค (จากประชากรประมาณ 324 ล้านคน) |
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ในประเทศพัฒนาแล้ว คน 1/3 จะเกิดมะเร็งในช่วงชีวิต
ถ้าคนไข้ทั้งหมดรอดชีวิตและมะเร็งเกิดโดยสุ่ม โอกาสการเกิดมะเร็งหลักอย่างที่สอง (ที่ไม่เกี่ยวกับมะเร็งที่เป็นอย่างแรก) ชั่วชีวิตปกติจะอยู่ที่ 1/9
แต่จริง ๆ แล้วคนไข้มีโอกาสเป็นมะเร็งหลักอย่างที่สอง 2/9 คือเสี่ยงเป็นมะเร็งอย่างที่สองมากขึ้น
คนไข้ประมาณครึ่งหนึ่งดังกล่าวจัดอยู่ในโอกาสเสี่ยง 1 ใน 9 ตามปกติดังที่ว่า |
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ความเสี่ยงเพิ่มเชื่อว่าเกิดจากปัจจัยเสี่ยงเดียวกันที่ก่อมะเร็งอย่างแรก เช่น กรรมพันธุ์ การสูบบุหรี่ทานแอลกอฮอล์ โรคอ้วน ปัจจัยทางสิ่งแวดล้อม และส่วนหนึ่งเกิดจากการรักษามะเร็งอย่างแรก ซึ่งอาจใช้ยาคีโมหรือการฉายรังสีซึ่งทำให้ยีนกลายพันธุ์ (mutagenic)
อนึ่ง ผู้รอดชีวิตอาจทำตามคำแนะนำของแพทย์ให้ตรวจคัดโรคได้ดีกว่า จึงตรวจพบมะเร็งมากกว่าคนทั่วไป |
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] | วิทยาการระบาดของมะเร็ง
มะเร็งในเด็กและวัยรุ่นมีน้อย (ประมาณ 150 กรณีต่อ 1 ล้านคนต่อปีในสหรัฐ)
ในสหรัฐ มะเร็งเม็ดเลือดขาว (ปกติ acute lymphoblastic leukemia) เป็นมะเร็งสามัญที่สุดในเด็กวัยระหว่าง 1-14 ปี ตามด้วยมะเร็งในระบบประสาทกลาง (มะเร็งสมอง), นิวโรบลาสโตมา, Wilms' tumor และ non-Hodgkin's lymphoma
สถิติของ แสดงว่า มะเร็งวัยเด็กเพิ่มขึ้น 19% ระหว่างปี 1975-1990 เพราะ acute leukemia เป็นหลัก
แต่ตั้งแต่ปี 1990 อัตราก็ได้ลดลง |
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] | วิทยาการระบาดของมะเร็ง
การเกิดมะเร็งวัยเด็กสูงสุดในช่วงปีแรกของชีวิต
อุบัติการณ์ต่อปีเฉลี่ยในสหรัฐระหว่างปี 1975-1995 อยู่ที่ 233 รายต่อทารกล้านคน
มีค่าประเมินต่าง ๆ
ในสหรัฐตาม |
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] | วิทยาการระบาดของมะเร็ง
เนื้องอกวิรูป (teratoma เป็นเนื้องอกของเซลล์สืบพันธุ์) บางครั้งจัดว่าเป็นเนื้องอกสามัญที่สุดในเด็กวัยนี้
แต่เนื้องอกวิรูปโดยมากตัดออกเมื่อยังไม่ร้าย ดังนั้น อาจจะไม่จัดว่าเป็นมะเร็ง
ก่อนเริ่มตรวจทารกในครรภ์ด้วยคลื่นเสียงความถี่สูงอย่างกว้างขวาง อุบัติการณ์ของ sacrococcygeal teratoma เมื่อคลอดอยู่ที่ 25-29 รายต่อทารกล้านคน |
994747#29 | [
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] | วิทยาการระบาดของมะเร็ง
ทารกทั้งหญิงและชายมีอัตราอุบัติการณ์โรคมะเร็งทั่วไปเกือบเท่ากัน ซึ่งต่างกับเด็กที่สูงวัยกว่านี้
ทารกผิวขาวมีอัตราการเกิดมะเร็งสูงกว่าทารกผิวดำ
ความต่างที่มีเกิดจากมะเร็งเม็ดเลือดขาวเป็นส่วนสำคัญ อัตราเฉลี่ยต่อปีของทารกผิวขาว (ที่ 48.7 รายต่อล้านคน) สูงกว่าของทารกผิวดำ 66% (ที่ 29.4 รายต่อล้านคน)
การรอดชีวิตโดยสัมพัทธ์ของทารกดีมากสำหรับนิวโรบลาสโตมา, Wilms' tumor และ retinoblastoma และดี (80%) สำหรับมะเร็งเม็ดเลือดขาว แต่ไม่ดีสำหรับมะเร็งแบบอื่น ๆ |
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] | เซลล์เบ็ตซ์
เซลล์เบ็ตซ์ () เป็นเซลล์ประสาทพีระมิดขนาดยักษ์ในชั้นที่ 5 ของเนื้อเทาในเปลือกสมองสั่งการปฐมภูมิ (primary motor cortex)
มีชื่อตามนักวิทยาศาสตร์ชาวยูเครน วลาดิเมียร์ เบ็ตซ์ (Vladimir Betz) ผู้ระบุลักษณะของเซลล์ในงานที่ตีพิมพ์ปี 1874
เป็นเซลล์ประสาทที่ใหญ่สุดในระบบประสาทกลาง บางครั้งมีเส้นผ่าศูนย์กลางถึง 100 ไมโครเมตร (μm)
เซลล์เบ็ตซ์เป็นเซลล์ประสาทสั่งการบน (upper motor neuron, UMN) ที่ส่งแอกซอนลงไปยังไขสันหลังผ่านลำเส้นใยประสาทเปลือกสมอง-ไขสันหลัง (corticospinal tract) ในมนุษย์แอกซอนไปยุติที่ไซแนปส์กับเซลล์ประสาทในไขสันหลังปีกหน้า (anterior horn) ซึ่งก็ส่งแอกซอนไปยังกล้ามเนื้อที่เป็นเป้าหมาย
แม้เซลล์จะมีเดนไดรต์ที่เป็นยอดหนึ่งอันเหมือนกับเซลล์ประสาทพีระมิดทั่วไป แต่ก็มีก้านเดนไดรต์หลัก (primary dendritic shaft) หลายอัน ซึ่งสามารถงอกออกจากตัวเซลล์ (soma) เกือบได้ทุกจุด
เดนไดรต์รอบตัวเซลล์เช่นนี้บวกกับเดนไดรต์ที่ฐาน (basal dendrite) ส่งไปยังชั้นทุกชั้นในเปลือกสมอง แต่สาขาในแนวนอนจะส่งไปยังชั้นที่ 5 และ 6 โดยมีบางส่วนที่ส่งลงไปถึงเนื้อขาว
งานศึกษาหนึ่งแสดงว่า เปลือกสมองสั่งการปฐมภูมิของมนุษย์ชั้น 5b (Vb) เป็นเซลล์เบ็ตซ์ 10% ในบรรดาเซลล์พีระมิดทั้งหมด |
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] | อิโมโตะซาเอะอิเรบะอี
อิโมโตะซะเอะอิเระบะอี () เป็นซีรีส์ไลท์โนเวลของญี่ปุ่น เขียนโดย Yomi Hirasaka และภาพโดย Kantoku Shogakukan เผยแพร่นวนิยายรวมเก้าเล่มตั้งแต่เดือนมีนาคม 2015 ภายใต้สำนักพิมพ์ Gagaga Bunko ได้มีการดัดแปลงเป็นมังงะรวมสองเล่ม ได้รับการเผยแพร่โดย Shogakukan และSquare Enix การดัดแปลงเป็นซีรีส์อะนิเมะของ Silver Link เริ่มฉายเมื่อวันที่ 8 ตุลาคม 2017 |
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] | เซลล์พีระมิด
เซลล์พีระมิด หรือ เซลล์ประสาทพีระมิด หรือ นิวรอนพีระมิด () เป็นเซลล์ประสาทหลายขั้วที่พบในเขตต่าง ๆ ของสมองรวมทั้งเปลือกสมอง ฮิปโปแคมปัส และอะมิกดะลา
เป็นหน่วยส่งสัญญาณแบบเร้าหลักของ prefrontal cortex (คอร์เทกซ์กลีบหน้าผากส่วนหน้า) ในสัตว์เลี้ยงลูกด้วยนม และของลำเส้นใยประสาทเปลือกสมอง-ไขสันหลัง (corticospinal tract)
เป็นเซลล์อย่างหนึ่งในสองอย่างที่มีลักษณะเฉพาะ คือ Negri bodies เมื่อชันสูตรศพหลังติดเชื้อโรคพิษสุนัขบ้า
นักประสาทวิทยาศาสตร์ชาวสเปนซานเตียโก รามอน อี กาฮาล เป็นผู้ค้นพบและศึกษาเซลล์นี้เป็นบุคคลแรก
ตั้งแต่นั้นมา ได้มีการศึกษาเซลล์พีระมิดในประเด็นต่าง ๆ ตั้งแต่สภาพพลาสติกของระบบประสาท (neuroplasticity) จนถึงเรื่องประชาน |
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] | เซลล์พีระมิด
ลักษณะโครงสร้างหลักของเซลล์ประสาทพีระมิดก็คือตัวเซลล์ (soma) รูปกรวย ที่ตั้งชื่อให้แก่เซลล์
ลักษณะสำคัญอื่น ๆ รวมทั้ง แอกซอนเดี่ยว, เดนไดรต์ส่วนยอด (apical) ขนาดใหญ่เดี่ยว, เดนไดรต์ส่วนฐาน (basal) หลายอัน และเงี่ยงเดนไดรต์ (dendritic spine) |
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เดนไดรต์ส่วนยอด (apical dendrite) งอกออกจากยอดตัวเซลล์
เป็นเดนไดรต์อันเดียว ยาวและหนา ที่แตกออกเป็นหลายสาขาซึ่งยิ่งออกไกลจากตัวเซลล์ก็ยิ่งมาก โดยยื่นไปยังส่วนผิวของเปลือกสมอง |
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] | เซลล์พีระมิด
เดนไดรต์ส่วนฐาน (basal dendrites) งอกออกจากส่วนฐานของตัวเซลล์
"ต้นไม้เดนไดรต์ส่วนฐาน" (basal dendritic tree) มีเดนไดรต์หลัก ๆ 3-5 อัน
ยิ่งไกลออกจากตัวเซลล์เท่าไร เดนไดรต์ส่วนฐานก็จะแตกสาขาอย่างมากมายเท่านั้น |
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] | เซลล์พีระมิด
เซลล์พีระมิดเป็นเซลล์ประสาทขนาดใหญ่ที่สุดอย่างหนึ่งในสมอง
ทั้งในมนุษย์และสัตว์ฟันแทะ ตัวเซลล์จะยาวโดยเฉลี่ยราว ๆ 20 ไมโครเมตร (μm)
เดนไดรต์ปกติจะมีเส้นผ่านศูนย์กลางตั้งแต่ครึ่งไมโครเมตรจนถึงหลายไมโครเมตร
และปกติจะยาวเป็นร้อย ๆ ไมโครเมตร
เพราะมีสาขามากมาย เดนไดรต์อาจยาวรวม ๆ เป็นหลายเซนติเมตร
แอกซอนบ่อยครั้งยาวยิ่งกว่าและมีสาขามากกว่า และอาจยาวเป็นหลาย ๆ เซนติเมตรรวม ๆ กัน |
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] | เซลล์พีระมิด
เงี่ยงเดนไดรต์ (dendritic spine) เป็นตัวรับกระแสประสาทแบบเร้า (excitatory postsynaptic potential, EPSP) ที่ส่งมายังเซลล์
ซึ่งรามอน อี กาฮาลได้เห็นเป็นครั้งแรกในปี 1888 เมื่อแต้มสีด้วยเทคนิค Golgi
และยังเป็นคนแรกที่เสนอว่า เงี่ยงช่วยเพิ่มพื้นที่ผิวเพื่อรับกระแสประสาท
เพราะยิ่งมีพื้นที่ผิวมากเท่าไร เซลล์ก็จะสามารถแปลและรวบรวมข้อมูลได้มากยิ่งเท่านั้น |
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] | เซลล์พีระมิด
เงี่ยงเดนไดรต์ไม่มีที่ตัวเซลล์ โดยจำนวนจะเพิ่มขึ้นตามระยะห่างจากตัวเซลล์
เดนไดรต์ส่วนยอดในหนูมีเงี่ยงเดนไดรต์อย่างน้อย 3,000 อัน
เพราะเดนไดรต์ส่วนยอดของมนุษย์อาจยาวราว ๆ 2 เท่าของหนู จำนวนเงี่ยงเดนไดรต์จึงอาจมากถึง 6,000 อัน |
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] | เซลล์พีระมิด
การกำหนด (specification) เป็นเซลล์พีระมิด เกิดขึ้นในพัฒนาการระยะต้น ๆ ของสมองใหญ่
โดยเซลล์บรรพบุรุษ (progenitor cell) จะเปลี่ยนสถานะเป็น committed ว่าจะเป็นสายเซลล์ประสาทภายใน subcortical proliferative ventricular zone (VZ) และใน subventricular zone (SVZ)
เซลล์พีระมิดที่ยังไม่เจริญเต็มที่จะย้ายไปอยู่ที่แผ่นเปลือกสมอง (cortical plate) เป็นที่ที่จะเปลี่ยนสภาพให้แตกต่างมากขึ้น
โมเลกุลกลุ่มหนึ่งคือ endocannabinoid (eCB) มีผลโดยตรงต่อพัฒนาการของเซลล์พีระมิดและการวางทางดำเนินของแอกซอน
แฟ็กเตอร์ถอดรหัส (transcription factor) เช่น Ctip2 และ Sox5 พบว่ามีบทบาทกำหนดทิศทางแอกซอนของเซลล์พีระมิด |
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] | เซลล์พีระมิด
เซลล์พีระมิดในหนูพบว่า เปลี่ยนแปลงอย่างรวดเร็วในช่วงคลอดใหม่ ๆ
คือระหว่างวันที่ 3-21 เซลล์พีระมิดพบว่าเพิ่มขนาดตัวเซลล์เป็นทวีคูณ เพิ่มความยาวเดนไดรต์ส่วนยอด 5 เท่า และเพิ่มความยาวเดนไดรต์ส่วนฐาน 13 เท่า
ความเปลี่ยนแปลงอย่างอื่น ๆ รวมทั้ง ศักย์ช่วงพัก (resting potential) ของเยื่อหุ้มเซลล์ต่ำลง ความต้านทานของเยื่อหุ้มเซลล์ลดลง และค่าสูงสุดของศักยะงานสูงขึ้น |
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] | เซลล์พีระมิด
เหมือนกับนิวรอนอื่น ๆ นิวรอนพีระมิดมีช่องไอออนเปิดปิดด้วยความต่างศักย์ (voltage-gated ion channel) เป็นจำนวนมาก
เซลล์พีระมิดมีช่องไอออน Na, Ca และ K จำนวนมากในเดนไดรต์ และก็มีในตัวเซลล์บ้างด้วย
โดยช่องที่เดนไดรต์จะมีคุณสมบัติต่างกับช่องไอออนประเภทเดียวกันที่ตัวเซลล์
ช่อง Ca ที่เปิดปิดด้วยความต่างศักย์ (Voltage-gated Ca channel) ภายในเดนไดรต์ จะเริ่มทำงานด้วยศักย์แบบเร้าคือ excitatory postsynaptic potential (EPSP) ที่ต่ำกว่าขีด (subthreshold) และด้วยศักยะงานจากเซลล์เองแบบ back-propagating
ขอบเขตของ back-propagation ของศักยะงานภายในเดนไดรต์ของเซลล์พีระมิดจะขึ้นอยู่กับช่อง K ในเดนไดรต์
ช่องเป็นกลไกที่ใช้ควบคุมแอมพลิจูดของศักยะงาน |
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] | เซลล์พีระมิด
สมรรถภาพการรวบรวมข้อมูลของเซลล์พีระมิดจะขึ้นอยู่กับจำนวนและการกระจายตัวของไซแนปส์ขาเข้าที่มี
เซลล์หนึ่ง ๆ มีไซแนปส์ขาเข้าแบบเร้าประมาณ 30,000 อัน และแบบยับยั้ง (ด้วยสัญญาณ Inhibitory postsynaptic potential, IPSP) ประมาณ 1,700 อัน
สัญญาณแบบเร้า (EPSP) ส่งมาที่เงี่ยงเดนไดรต์เท่านั้น เทียบกับสัญญาณแบบยับยั้ง (IPSP) ที่ส่งมาที่ก้านเดนไดรต์ (dendritic shaft) ตัวเซลล์ และแม้แต่ที่แอกซอน
สารสื่อประสาทแบบเร้าที่เซลล์ได้รับคือ กลูตาเมต และแบบยับยั้งก็คือ กาบา |
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] | เซลล์พีระมิด
เซลล์พีระมิดสามารถจัดเป็นกลุ่ม ๆ ตามการตอบสนองเป็นกระแสประสาทต่อพัลส์ไฟฟ้า/พัลส์กระแสประสาทที่ได้ในช่วง
รวมทั้งเซลล์ประสาทแบบ RSad, RSna และ IB |
994758#13 | [
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] | เซลล์พีระมิด
เซลล์ประสาทพีระมิดแบบ RSad
หรือ adapting regular spiking neuron (นิวรอนที่ส่งสัญญาณยอดแหลมอย่างสม่ำเสมอและปรับตัวได้)
ปล่อยกระแสประสาทเป็นศักยะงานต่างหาก ๆ ตามด้วยศักย์ไฟฟ้าตามหลัง (hyperpolarizing afterpotential) ที่ต่ำกว่าศักย์ช่วงพัก
ศักย์ไฟฟ้าตามหลังอาจยาวขึ้น เป็นการปรับความถี่การส่งศักยะงาน (spike frequency adaptation, SFA) ภายในนิวรอน |
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] | เซลล์พีระมิด
เซลล์ประสาทพีระมิดแบบ RSad
หรือ non-adapting regular spiking neuron (นิวรอนที่ส่งสัญญาณยอดแหลมอย่างสม่ำเสมอและไม่ปรับตัว)
จะส่งศักยะงานเป็นขบวนหลังจากได้รับพัลส์ไฟฟ้าขาเข้า
แต่ไม่ปรากฏว่าปรับความถี่การส่งศักยะงาน |
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] | เซลล์พีระมิด
นิวรอนพีระมิดแบบ IB หรือ intrinsically bursting neuron (นิวรอนระเบิดส่งสัญญาณ) ตอบสนองต่อพัลส์สัญญาณที่ถึงขีดด้วยการระเบิดส่งศักยะงานอย่างถี่ ๆ 2-5 อัน
โดยไม่ปรากฏว่าปรับความถี่ศักยะงาน |
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] | เซลล์พีระมิด
นิวรอนพีระมิดเป็นนิวรอนหลักภายในลำเส้นใยประสาทเปลือกสมอง-ไขสันหลัง (corticospinal tract)
การทำงานของระบบสั่งการปกติจะต้องอาศัยพัฒนาการเป็นการเชื่อมต่อกันระหว่างแอกซอนภายในลำเส้นใยประสาทเปลือกสมอง-ไขสันหลังกับไขสันหลัง
โดยแอกซอนของนิวรอนจะยื่นไปเชื่อมต่อที่จุดต่าง ๆ ขึ้นอยู่กับ growth factor
เช่น เมื่อเชื่อมต่อกันอย่างถูกต้อง นิวรอนพีระมิดจะมีบทบาทในวงจรที่ทำให้เคลื่อนไหวอาศัยสายตาได้ |
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] | เซลล์พีระมิด
นิวรอนพีระมิดในคอร์เทกซ์กลีบหน้าผากส่วนหน้า (prefrontal cortex) มีหน้าที่ทางประชาน
ในสัตว์เลี้ยงลูกด้วยนม ความซับซ้อนของเซลล์พีระมิดจะเพิ่มขึ้นจากเขตสมองด้านหลัง (posterior) ไปยังเขตสมองด้านหน้า (anterior)
ระดับความซับซ้อนของเซลล์น่าจะสัมพันธ์กับสมรรถภาพทางประชานของลิงสปีชีส์ต่าง ๆ
เช่น มันอาจมีบทบาทที่ขาดไม่ได้ในการรู้จำวัตถุ (object recognition) ที่ซับซ้อนภายในเขตเปลือกสมองที่แปลผลทางตา |
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] | การกระตุ้นเนื้อเยื่อบุโพรง
การกระตุ้นเนื้อเยื่อบุโพรง หรือ การกระตุ้นเอนโดทีเลียม
เป็นภาวะสนับสนุนการอักเสบ (proinflammatory) ซึ่งโปรโหมตการจับเป็นก้อน/เป็นลิ่ม (procoagulant) ของเซลล์เนื้อเยื่อบุโพรง (endothelial cell) ที่บุช่องหลอดเลือด
ปรากฏโดยการมีปฏิสัมพันธ์กับเซลล์เม็ดเลือดขาวเพิ่ม และสัมพันธ์กับภาวะเริ่มต้นของโรคหลอดเลือดแดงแข็งและภาวะพิษเหตุติดเชื้อเป็นต้น
เป็นเหตุให้เกิดภาวะหลอดเลือดดำส่วนลึกมีลิ่มเลือด (deep vein thrombosis)
เพราะภาวะนี้ เยื่อก็จะหลั่ง Weibel-Palade body ออก |
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] | ไลโพโปรตีนหนาแน่นสูง
ไลโพโปรตีนหนาแน่นสูง ( ตัวย่อ HDL) เป็นไลโพโปรตีนหลักชนิดหนึ่งใน 5 ชนิด
เป็นอนุภาคซับซ้อนประกอบด้วยโปรตีนหลายชนิด ซึ่งขนส่งโมเลกุลไขมันคือลิพิดไปยังส่วนต่าง ๆ ของร่างกายภายในน้ำนอกเซลล์
อนุภาคหนึ่ง ๆ ปกติจะมีโปรตีน 80-100 หน่วย
และขนส่งโมเลกุลไขมันได้เป็นร้อย ๆ โมเลกุลต่ออนุภาค |
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อนุภาค แบ่งออกเป็นกลุ่มย่อย ๆ 5 กลุ่มตามความหนาแน่นและขนาด (ซึ่งสัมพันธ์กันอย่างผกผัน) ซึ่งก็มีสหสัมพันธ์กับการเกิดปัญหาหัวใจด้วย
ไม่เหมือนกับไลโพโปรตีนที่ใหญ่กว่าอื่น ๆ ซึ่งส่งโมเลกุลไขมันไปให้เซลล์ อนุภาค HDL จะนำโมเลกุลไขมันออกจากเซลล์ที่ต้องขับโมเลกุลไขมันออก
ลิพิดที่ขนส่งรวมทั้งคอเลสเตอรอล ฟอสโฟลิพิด และไตรกลีเซอไรด์ โดยขนส่งแต่ละอย่างเป็นจำนวนต่าง ๆ กัน |
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] | ไลโพโปรตีนหนาแน่นสูง
การเพิ่มความเข้มข้นของอนุภาค HDL สัมพันธ์กับการลดสะสมคราบไขมัน (คราบไขมันบวกเซลล์เม็ดเลือดขาว คือ atherosclerosis) ที่ผนังภายในหลอดเลือดแดง
ซึ่งสำคัญเพราะคราบไขมันที่สะสมในที่สุดก็จะหลุดออก แล้วก่อโรคหัวใจร่วมหลอดเลือด โรคหลอดเลือดสมอง และโรคหลอดเลือด (vascular disease) อื่น ๆ
อนุภาค HDL บางครั้งเรียกว่า คอเลสเตอรอลแบบดี เพราะมันขนส่งโมเลกุลไขมันออกจากผนังหลอดเลือด ลดการสะสมแมคโครฟาจ (macrophage) และดังนั้นช่วยป้องกันหรือแม้แต่ทุเลาโรคหลอดเลือดแดงแข็ง
อย่างไรก็ดี งานศึกษาหลายงานได้แสดงว่า แม้หนูที่ไร้ HDL ก็ยังสามารถขนส่งคอเลสเตอรอลไปยังน้ำดี ซึ่งแสดงว่าต้องมีกลไกอื่นเพื่อกำจัดคอเลสเตอรอล |
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] | ไลโพโปรตีนหนาแน่นสูง
เพราะการวัดค่าอนุภาคโปรตีน HDL และ LDL (low-density lipoprotein) โดยตรงมีค่าใช้จ่ายสูง การตรวจ HDL ในเลือดมักจะวัดค่าทดแทน คือ HDL-C
ซึ่งเป็นคอเลสเตอรอลที่สัมพันธ์กับอนุภาค ApoA-1 (Apolipoprotein A1)/HDL
ในผู้สุขภาพดี HDL จะขนส่งคอเลสเตอรอลพร้อมกับไขมันชนิดอื่น ๆ ประมาณ 30% ในเลือด
นี่มักเทียบกับคอเลสเตอรอลที่สัมพันธ์กับอนุภาค คือ LDL-C ซึ่งเป็นค่าทดแทนค่า LDL ในเลือด
อนุภาค HDL กำจัดไขมันและคอเลสเตอรอลจากเซลล์ รวมทั้งตะกรันท่อเลือดแดง (atheroma) ที่ผนังหลอดเลือดแดง และขนส่งมันกลับไปยังตับเพื่อขับออกหรือนำไปใช้ใหม่
ดังนั้น คอเลสเตอรอลที่อนุภาค HDL ขนส่ง คือ HDL-C จึงเรียกว่า คอเลสเตอรอลแบบดี แม้จริง ๆ ก็เป็นคอเลสเตอรอลที่อนุภาค LDL ขนส่งเช่นกัน |
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] | ไลโพโปรตีนหนาแน่นสูง
ผู้ที่มีระดับ HDL-C สูงกว่ามักจะมีปัญหาโรคหัวใจร่วมหลอดเลือดน้อยกว่า และผู้ที่มีระดับต่ำกว่า (โดยเฉพาะต่ำกว่า 40 mg/dL หรือ 1 mmol/L) ก็มีโรคหัวใจในอัตราสูงกว่า
ระดับ HDL ที่สูงกว่าตามธรรมชาติยังมีสหสัมพันธ์กับสุขภาพหัวใจร่วมหลอดเลือดที่ดีกว่าด้วย
แต่ก็ไม่ปรากฏว่าการเพิ่ม HDL จะทำให้ได้ผลทางหัวใจร่วมหลอดเลือดที่ดีขึ้น |
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] | ไลโพโปรตีนหนาแน่นสูง
คอเลสเตอรอลในเลือดที่เหลือหลังจากนำ HDL ออกก็คือ คอเลสเตอรอลที่ไม่ใช่ HDL (non-HDL cholesterol)
ความเข้มข้นของส่วนนี้ ซึ่งอาจเป็นเหตุให้เกิด เรียกว่า non-HDL-C
ซึ่งปัจจุบันจัดเป็นตัวบ่งชี้ที่ดีกว่า LDL-C เพราะพยากรณ์โรคได้ดีกว่าและคำนวณได้ง่ายกว่า |
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] | ไลโพโปรตีนหนาแน่นสูง
HDL เป็นอนุภาคไลโพโปรตีนที่เล็กสุด
มันหนาแน่นสุดเพราะมีสัดส่วนโปรตีนสูงสุดเทียบกับลิพิด
apolipoprotein
ที่มันมีมากที่สุดคือ Apolipoprotein A1 (apo A-I) และ Apolipoprotein A2 (apo A-II)
ยีนต่างที่มีน้อยอย่างหนึ่งคือ ApoA-1 Milano ได้พบว่า มีประสิทธิภาพป้องกันและทุเลาโรคหลอดเลือดแดงแข็งดีกว่ามาก |
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] | ไลโพโปรตีนหนาแน่นสูง
ตับสังเคราะห์ไลโพโปรตีนเหล่านี้เป็นคอมเพล็กซ์ที่ประกอบด้วย apolipoprotein และฟอสโฟลิพิด ซึ่งคล้ายอนุภาคไลโพโปรตีนรูปทรงกลมที่ไร้คอเลสเตอรอลแต่ทำให้แบน โดยงานศึกษาปี 2017 ได้เผยแพร่โครงสร้างทางนิวเคลียร์แมกเนติกเรโซแนนซ์ () ของอนุภาค
คอมเพล็กซ์เช่นนี้สามารถเก็บคอเลสเตอรอลจากเซลล์แล้วพกไว้ในภายใน ผ่านปฏิกิริยากับโปรตีน ATP-binding cassette transporter A1 (ABCA1) |
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] | ไลโพโปรตีนหนาแน่นสูง
เอนไซม์ในน้ำเลือดคือ lecithin-cholesterol acyltransferase (LCAT) สามารถเปลี่ยนคอเลสเตอรอลอิสระให้เป็น cholesteryl ester (ซึ่งเป็นรูปแบบคอเลสเตอรอลที่ไม่ชอบน้ำยิ่งกว่า) แล้วแยกใส่เข้าในแกนกลางของอนุภาคไลโพโปรตีน ซึ่งในที่สุดก็จะทำให้ HDL ที่ได้สังเคราะห์ขึ้นใหม่นี้ให้มีรูปทรงกลม
อนุภาค HDL จะเพิ่มขนาดเมื่อไหลเวียนผ่านระบบเลือดแล้วรวมโมเลกุลคอเลสเตอรอลและฟอสโฟลิพิดจากเซลล์และจากไลโพโปรตีนอื่น ๆ เช่นผ่านปฏิกิริยากับโปรตีนขนส่ง ABCG1 (ATP-binding cassette sub-family G member 1) และโปรตีน PLTP (phospholipid transport protein) |
994772#9 | [
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] | ไลโพโปรตีนหนาแน่นสูง
HDL ขนคอเลสเตอรอลโดยมากไปยังตับ หรือไปยังอวัยวะสร้างสเตอรอยด์ เช่น ต่อมหมวกไต รังไข่ และอัณฑะ ทั้งโดยตรงและโดยอ้อม
โดยหน่วยรับ (receptor) HDL เช่น scavenger receptor BI (SR-BI/SCARB1) จะเป็นตัวจับ HDL แล้วอำนวยให้เนื้อเยื่อ/เซลล์ดูดซึม (selective uptake) คอเลสเตอรอลจาก HDL |
994772#10 | [
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] | ไลโพโปรตีนหนาแน่นสูง
ในมนุษย์ วิถีที่สำคัญที่สุดไม่ใช่แบบโดยตรง คือจะมีโปรตีน cholesteryl ester transfer protein (CETP) เป็นตัวอำนวย
โปรตีนจะแลกไตรกลีเซอไรด์ของไลโพโปรตีนหนาแน่นต่ำมาก () กับ cholesteryl ester ของ HDL
ผลก็คือ VLDL จะแปรเป็น ซึ่งหน่วยรับ LDL จะเป็นตัวเอามันออกจากระบบไหลเวียน
ส่วนไตรกลีเซอไรด์ภายใน HDL จะไม่เสถียร คือ เอนไซม์ hepatic lipase จะเป็นตัวทำให้เสื่อม ทำให้ในที่สุดเหลือแต่อนุภาค HDL เล็ก ๆ แล้วเริ่มต้นวัฏจักรการนำคอเลสเตอรอลออกจากเซลล์ใหม่ |
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] | ไลโพโปรตีนหนาแน่นสูง
ส่วนคอเลสเตอรอลที่ส่งไปยังตับจะขับออกในน้ำดี
ซึ่งก็ขับออกในลำไส้ไม่ว่าจะโดยตรงหรือโดยอ้อมหลังจากเปลี่ยนเป็นกรดน้ำดี (bile acid)
การส่งคอเลสเตอรอลกับ HDL ไปยังต่อมหมวกไต รังไข่ และอัณฑะ สำคัญในการสังเคราะห์ฮอร์โมนสเตอรอยด์
ขั้นตอนต่าง ๆ ในเมแทบอลิซึมของ HDL มีบทบาทขนส่งคอเลสเตอรอลจากแมคโครฟาจอิ่มลิพิดของหลอดเลือดแดงที่สั่งสมคราบไขมัน (คือจากหลอดเลือดแดงที่แข็ง) ซึ่งบางครั้งเรียกว่า เซลล์โฟม (foam cell) ไปยังตับเพื่อขับออกในน้ำดี
เป็นวิถีที่เรียกว่า "reverse cholesterol transport" (การขนส่งคอเลสเตอรอลย้อนกลับ) และพิจารณาว่า เป็นหน้าที่ป้องกันหลอดเลือดแดงแข็งของ HDL แบบคลาสสิก |
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] | ไลโพโปรตีนหนาแน่นสูง
HDL ขนส่งลิพิดและโปรตีนหลายชนิด บางอย่างแม้เข้มข้นน้อยมากแต่ก็มีฤทธิ์ทางชีวภาพมาก
ยกตัวอย่างเช่น HDL พร้อมกับโปรตีนและลิพิดที่มันขนส่งช่วยยับยั้งกระบวนการออกซิเดชัน การอักเสบ การก่อกัมมันต์ของเนื้อเยื่อบุโพรง การจับเป็นก้อน/การจับเป็นลิ่ม (coagulation) และการรวมกลุ่มของเกล็ดเลือด
คุณสมบัติเหล่านี้อาจทำให้ HDL สามารถป้องกันโรคหลอดเลือดแดงแข็งได้ แม้จะยังไม่รู้ว่าคุณสมบัติอะไรสำคัญที่สุด
อนึ่ง HDL รูปแบบย่อย (subfraction) ขนาดเล็กอย่างหนึ่งซึ่งเรียกว่า trypanosome lytic factor (TLF) ยังช่วยป้องกันโพรโทซัวที่เป็นปรสิตคือ "Trypanosoma brucei brucei" ได้ |
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] | ไลโพโปรตีนหนาแน่นสูง
ในปฏิกิริยาที่ทำให้เครียด acute-phase protein และ apolipoprotein คือ serum amyloid A จะได้การกระตุ้นจาก cytokine คือ interleukin 1 และ interleukin 6 และจาก cortisol ที่เปลือกต่อมหมวกไต (adrenal cortex) ผลิต แล้วส่งรวมกับอนุภาค HDL ไปยังเนื้อเยื่อที่เสียหาย
เมื่อถึงที่อักเสบแล้ว มันก็จะเรียกและก่อกัมมันต์ต่อเม็ดเลือดขาว
ถ้าอักเสบแบบเรื้อรัง การสะสมมันที่เนื้อเยื่อจะปรากฏเป็นแอมีลอยด์ (amyloidosis) |
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มีการเสนอว่า ความเข้มข้นของอนุภาค HDL ขนาดใหญ่ในเลือด เป็นตัวบ่งชี้ฤทธิ์ป้องกันโรคหลอดเลือดแดงแข็งที่แม่นยำกว่า เทียบกับความเข้มข้นของอนุภาค HDL ทั้งหมด
อัตราส่วนของ HDL อนุภาคใหญ่และ HDL โดยรวมจะต่างกันมากระหว่างบุคคล และวัดได้ด้วยการสอบปริมาณไลโพโปรตีน (lipoprotein assay) ที่ซับซ้อนไม่ว่าจะด้วย electrophoresis (การเคลื่อนสู่ขั้วไฟฟ้า) ซึ่งพัฒนาขึ้นดั้งเดิมในคริสต์ทศวรรษ 1970 หรือด้วย NMR spectroscopy ซึ่งพัฒนาขึ้นในคริสต์ทศวรรษ 1990
HDL ได้แบ่งเป็นรูปแบบย่อย (subfraction) 5 อย่าง
ตั้งแต่ใหญ่สุด (และมีประสิทธิภาพกำจัดคอเลสเตอรอลมากสุด) จนถึงเล็กสุด (มีประสิทธิภาพน้อยสุด) คือ 2a, 2b, 3a, 3b และ 3c |
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] | ไลโพโปรตีนหนาแน่นสูง
ลิพิดเป็นกลุ่มสารประกอบที่หลายหลาก ละลายน้ำไม่ค่อยได้ แต่ละลายในตัวทำละลายที่ไม่แบ่งขั้วได้
ไตรกลีเซอไรด์ (TG) คอเลสเตอรอล และฟอสโฟลิพิด เป็นลิพิดหลัก ๆ ในร่างกาย
ซึ่งขนส่งเป็นคอมเพล็กซ์ประกอบด้วยลิพิดและโปรตีนที่เรียกว่า ไลโพโปรตีน |
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ไตรกลีเซอไรด์ (TG) สร้างขึ้นโดยรวมกรีเซอรีนกับกรดไขมัน 3 โมเลกุล
TG เป็นองค์ประกอบหลักของ และไคโลไมครอน (chylomicron) จึงมีบทบาทสำคัญในกระบวนการเมแทบอลิซึม
คือเมื่อร่างกายต้องการกรดไขมันเป็นแหล่งพลังงาน ฮอร์โมนกลูคากอนก็จะส่งสัญญาณให้ไลเพส (lipase) แตก TG เพื่อปล่อยกรดไขมันอิสระ ()
TG ละลายน้ำไม่ได้ เป็นไขมันไม่แบ่งขั้ว (non-polar)
ไม่ใช่องค์ประกอบของเยื่อหุ้มเซลล์ การสังเคราะห์และการเก็บโดยมากเกิดในตับและเนื้อเยื่อไขมัน (adipose tissue)
FFA และกลีเซอรีนต้องเปลี่ยนเป็นสภาพกัมมันต์ก่อนสังเคราะห์ TG เป็น Acyl-CoA และ glycerol-3-phosphate ตามลำดับ |
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ชื่อว่า คอเลสเตอรอล มาจากคำกรีกว่า "chole-" (น้ำดี), "stereos" (ของแข็ง) และปัจจัยเติมหลังทางเคมีสำหรับแอลกอฮอล์คือ "ol"
เป็นองค์ประกอบทางโครงสร้างของเยื่อหุ้มเซลล์ที่จำเป็นเพื่อให้ได้สภาพซึมผ่านได้ (permeability) และความยืดหยุ่นได้/ไหลได้ (fluidity)
นอกจากนั้น ยังเป็นองค์ประกอบสำคัญเพื่อผลิตกรดน้ำดี, ฮอร์โมนสเตอรอยด์, และวิตามินดี
แม้คอเลสเตอรอลจะสำคัญและจำเป็น แต่การมีในเลือดสูงก็เป็นตัวบ่งชี้โรคต่าง ๆ เช่น โรคหัวใจ
ตับผลิตประมาณ 20-25% ของคอเลสเตอรอลในแต่ละวัน |
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] | ไลโพโปรตีนหนาแน่นสูง
ฟอสโฟลิพิดเป็น TG ที่มีพันธะโคเวเลนต์กับหมู่ฟอสเฟต (phosphate group) ผ่านเอสเทอร์
มีหน้าที่สำคัญต่าง ๆ รวมทั้ง |
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] | ไลโพโปรตีนหนาแน่นสูง
ไลโพโปรตีนประกอบด้วยแกนกลางที่เป็นลิพิดไม่ชอบน้ำ (รวมทั้ง TG และ cholesteryl ester) หุ้มด้วยเปลือกฟอสโฟลิพิดที่แบ่งขั้ว ด้วยคอเลสเตอรอลอิสระ และด้วย apolipoprotein ที่ชอบน้ำ มี 6 ประเภท ต่างกันโดยสัดส่วนของแกนที่เป็นลิพิดและโดยประเภทของ apoprotein คือ |
994772#20 | [
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] | ไลโพโปรตีนหนาแน่นสูง
ชายมักจะมีระดับ HDL ที่ต่ำกว่าอย่างสังเกตได้เมื่อเทียบกับหญิง โดยมีขนาดเล็กกว่าและบรรจุคอเลสเตอรอลได้น้อยกว่า
ชายยังมีอุบัติการณ์ของโรคหัวใจเนื่องกับโรคหลอดเลือดแดงแข็งที่สูงกว่า
การดื่มแอลกอฮอล์มักเพิ่มระดับ HDL
แต่การดื่มแอลกฮอล์พอประมาณก็สัมพันธ์กับอัตราการตายที่ต่ำกว่าเพราะโรคหัวใจและหลอดเลือดและเพราะโรคทั้งหมด |
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] | ไลโพโปรตีนหนาแน่นสูง
งานศึกษาปี 2012 ยืนยันว่า HDL มีคุณสมบัติเป็นบัฟเฟอร์เพื่อลดสภาวะการจับเป็นลิ่ม/เป็นก้อนเกินของคนไข้เบาหวานชนิดที่ 2 และลดความเสี่ยงสูงของภาวะแทรกซ้อนเพราะโรคหัวใจร่วมหลอดเลือดในคนไข้เหล่านี้
งานยังแสดงด้วยว่า HDL มีสหสัมพันธ์ในเชิงลบที่สำคัญกับเวลาการจับลิ่มของเลือด (activated partial thromboplastin time, APTT) |
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] | ไลโพโปรตีนหนาแน่นสูง
งานศึกษาทางวิทยาการระบาดยังแสดงว่า ระดับ HDL ที่สูง (เกิน 60 mg/dL) ช่วยป้องกันโรคหัวใจร่วมหลอดเลือด เช่น โรคลมเหตุเลือดถูกอุดกั้น (ischemic stroke) และกล้ามเนื้อหัวใจตายเหตุขาดเลือด
ส่วน HDL ที่ต่ำ (น้อยกว่า 40 mg/dL ในชาย และน้อยกว่า 50 mg/dL ในหญิง) เพิ่มความเสี่ยงโรคหลอดเลือดแดงแข็ง |
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ข้อมูลจากงานศึกษาเด่น คือ Framingham Heart Study แสดงว่า ถ้าค่า LDL อยู่นิ่ง อัตราความเสี่ยงโรคหัวใจจะเพิ่มขึ้น 10 เท่า ถ้า HDL เปลี่ยนจากสูงไปเป็นต่ำ
แต่ในนัยกลับกัน เมื่อค่า HDL นิ่ง อัตราความเสี่ยงจะเพิ่ม 3 เท่า เมื่อ LDL เปลี่ยนจากต่ำไปสูง
เช่น ถ้า HDL อยู่นิ่งที่ 85 mg/dl ความเสี่ยงโรคหลอดเลือดแดงเลี้ยงหัวใจอุดตัน (coronary artery disease, CAD) จะอยู่ที่ 1/10 ของค่าปกติเมื่อ LDL ต่ำ (100 mg/dl) และยังคงอยู่ที่ 3/10 ของค่าปกติเมื่อ LDL สูง (220 mg/dl)
กล่าวอีกอย่างก็คือ ข้อมูลแสดงนัยว่า HDL เป็นปัจจัยเสี่ยงที่มีกำลังกว่า LDL
เพราะถ้า HDL สูง (85 mg/dl) ความเสี่ยง CAD ก็ยังต่ำกว่าค่าเฉลี่ยแม้เมื่อ LDL สูง
ดังนั้น การลดระดับ LDL ในบุคคลที่มี HDL สูง แม้จะมีประโยชน์บ้าง แต่ก็เพียงลดความเสี่ยงที่ต่ำอยู่แล้วให้ต่ำมาก
และบุคคลที่แม้มี LDL ต่ำมากก็ยังเสี่ยงสูงกว่าถ้าค่า HDL ไม่สูงพอ |
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] | ไลโพโปรตีนหนาแน่นสูง
ห้องปฏิบัติการดั้งเดิมวัดค่า HDL โดยแยกไลโพโปรตีนชนิดอื่น ๆ ออกไม่ว่าจะด้วยการหมุนเหวี่ยงเร็วยิ่งยวด (ultracentrifugation) หรือการทำให้ตกตะกอนด้วยไอออนมีเวเลนซีคู่เช่น Mg แล้วใส่ผลปฏิกิริยาของ cholesterol oxidase เข้ากับปฏิกิริยาของตัวบ่งชี้/ตัววัด
วิธีการที่เป็นมาตรฐานก็ยังใช้เทคนิคเหล่านี้
แต่ห้องปฏิบัติการปัจจุบันโดยมากใช้วิธีการวิเคราะห์อัตโนมัติที่ระงับฤทธิ์ของไลโพโปรตีนที่มี apolipoprotein B (apo B) ด้วยสารภูมิต้านทานของ apo B แล้ววัดค่าคอเลสเตอรอลในอนุภาค HDL ที่ไม่ได้ระงับผ่านปฏิกิริยาอาศัยเอนไซม์เพื่อวัดสี (colorimetric enzyme reaction)
เทคนิคโครมาโทกราฟีแบบ high-performance liquid chromatography (HPLC) ก็สามารถใช้วัดค่า HDL ได้เช่นกัน |
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] | ไลโพโปรตีนหนาแน่นสูง
แม้รูปแบบย่อย (subfractions) ของ HDL คือแบบ HDL-2C และ HDL-3C ก็วัดได้ด้วย
แต่ความสำคัญทางคลินิกของรูปแบบย่อยเหล่านี้ยังไม่ได้ระบุ
และการวัดสมรรถภาพการทำปฏิกิริยาของ apo-A แม้จะใช้วัดค่า HDL ได้ แต่ก็เชื่อว่าไม่แม่นยำเท่าวิธีที่กล่าวมาแล้ว |
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สมาคมหัวใจอเมริกัน (), สถาบันสุขภาพแห่งชาติ (สหรัฐอเมริกา) และโปรแกรมให้การศึกษาเรื่องคอเลสเตอรอลแห่งชาติอเมริกัน () มีคำแนะนำเกี่ยวกับค่า HDL เมื่ออดอาหารกับความเสี่ยงโรคหัวใจ
LDL ในระดับสูงพร้อมกับ HDL ในระดับต่ำ เป็นปัจจัยเสี่ยงอีกอย่างสำหรับโรคหัวใจร่วมหลอดเลือด |
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] | ไลโพโปรตีนหนาแน่นสูง
เพราะเทคโนโลยีมีค่าใช้จ่ายน้อยลงในขณะที่การทดลองทางคลินิกก็ยังแสดงความสำคัญของ HDL อย่างต่อเนื่อง
วิธีการวัดความเข้มข้นและขนาดของ HDL โดยตรงซึ่งมีค่าใช้จ่ายลดลงก็ได้มีเพิ่มมากขึ้น และพิจารณว่า เป็นเรื่องสำคัญเพื่อประเมินความเสี่ยงของบุคคลเนื่องกับโรคหลอดเลือดแดงแข็งที่แย่ลงเรื่อย ๆ และเพื่อชี้แนวการรักษา |
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] | ไลโพโปรตีนหนาแน่นสูง
เพราะอนุภาค HDL มีประจุไฟฟ้าสุทธิเป็นลบโดยมีความหนาแน่นและขนาดต่าง ๆ การวัดด้วยการหมุนเหวี่ยงเร็วยิ่งยวด (ultracentrifugation) ตามด้วย electrophoresis (การเคลื่อนสู่ขั้วไฟฟ้า) ได้ใช้ตั้งแต่ก่อนคริสต์ทศวรรษ 1950 เพื่อแยกแยะความเข้มข้นของอนุภาค HDL แล้วแยกลุ่มตามขนาดเทียบกับปริมาตรเฉพาะ (specific volume) ของน้ำเลือด
อนุภาค HDL ที่ใหญ่กว่าสามารถขนส่งคอเลสเตอรอลได้มากกว่า |
994772#29 | [
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ความเข้มข้นและขนาดของอนุภาคไลโพโปรตีนสามารถประมาณได้ด้วยลักษณะเฉพาะทางนิวเคลียร์แมกเนติกเรโซแนนซ์ (nuclear magnetic resonance) |
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] | ไลโพโปรตีนหนาแน่นสูง
งานศึกษาทางการแพทย์ MESA ที่ได้ทุนจากสถาบันหัวใจ ปอด และเลือดแห่งชาติสหรัฐ () ซึ่งเป็นส่วนหนึ่งของสถาบันสุขภาพแห่งชาติสหรัฐ () ได้จัดอัตราการเกิดโรคเป็นเปอร์เซ็นไทล์เทียบกับระดับ HDL รวมในเลือดและกับระดับ HDL ขนาดใหญ่ที่สุดในเลือด |
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] | ไลโพโปรตีนหนาแน่นสูง
อุบัติการณ์การเกิดเหตุการณ์หลอดเลือดแดงแข็งตามเวลา จะต่ำสุดสำหรับผู้ที่มีทั้งความเข้มข้นของอนุภาค HDL รวมสูงสุด (คือ เปอร์เซ็นไทล์ >75%) และความเข้มข้นของอนุภาค HDL ขนาดใหญ่สูงสุด
ในประเทศบางประเทศ การตรวจเลือดทั่วไปในคลินิกจะให้ค่าวัดหลายอย่างอื่น ๆ รวมทั้งความเข้มข้นของอนุภาค HDL, ความเข้มข้นของอนุภาค LDL ขนาดเล็ก, ความเข้มข้นของไลโพโปรตีนหนาแน่นต่ำมาก (), ค่าประมาณการดื้ออินซูลิน (insulin resistance) และค่าวัดคอเลสเตอรอลทั่วไป |
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] | ไลโพโปรตีนหนาแน่นสูง
มีการสัมพันธ์ความจำทางภาษา (verbal memory) กับระดับลิพิดในเลือดเมื่ออดอาหาร
ในงานศึกษาที่มีตัวอย่างผู้เข้าร่วมวัยกลางคนจำนวนมาก ระดับคอเลสเตอรอลแบบ HDL ต่ำสัมพันธ์กับความจำไม่ดี และการมีระดับลดลงภายใน 5 ปีที่ติดตาม สัมพันธ์กับความจำที่แย่ลง |
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] | ไลโพโปรตีนหนาแน่นสูง
แม้ระดับ HDL ในเลือดจะมีสหสัมพันธ์กับสุขภาพหัวใจร่วมหลอดเลือด แต่การใช้ยาเพื่อเพิ่มระดับในเลือดก็ไม่ปรากฏกว่าทำให้สุขภาพดีขึ้น
กล่าวอีกอย่างก็คือ การเพิ่มระดับ HDL อาจจะไม่ทำให้สุขภาพหัวใจร่วมหลอดเลือดดีขึ้น
เพราะฉะนั้น อาจเป็นไปได้ว่า สุขภาพหัวใจร่วมหลอดเลือดที่ดีทำให้ระดับ HDL สูง หรือมีปัจจัยที่สามอย่างอื่นที่ทำให้ทั้งสุขภาพดีและระดับ HDL สูง หรือนี่เป็นเรื่องบังเอิญโดยไม่เป็นเหตุผล |
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] | ไลโพโปรตีนหนาแน่นสูง
อนุภาคไลโพโปรตีนแบบ HDL ที่มี apolipoprotein C3 สัมพันธ์กับความเสี่ยงโรคหลอดเลือดแดงเลี้ยงหัวใจเพิ่มขึ้น ไม่ใช่ลดลง |
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] | ไลโพโปรตีนหนาแน่นสูง
การเปลี่ยนอาหารและการออกกำลังกายอาจมีผลเพิ่มระดับ HDL คือ |
994772#36 | [
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] | ไลโพโปรตีนหนาแน่นสูง
ไขมันอิ่มตัวโดยมากเพิ่มคอเลสเตอรอลแบบ HDL ในระดับต่าง ๆ แต่ก็เพิ่มระดับคอเลสเตอรอลรวมและแบบ LDL ด้วย
อาหารไขมันสูง, โปรตีนพอควร, และคาร์โบไฮเดรตต่ำ (เช่น ketogenic diet) อาจทำให้ร่างกายตอบสนองเหมือนกับทานวิตามินบี3 คือลดระดับ LDL และเพิ่ม HDL ดังจะกล่าวต่อไปผ่านการจับคู่ของสารประกอบอินทรีย์ beta-hydroxybutyrate กับหน่วยรับคือ Niacin receptor 1 |
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] | ไลโพโปรตีนหนาแน่นสูง
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