血脂基础与临床热点问题.ppt

血脂基础与临床热点问题 什么叫血脂？ 血浆（清）中的脂质(脂肪+类脂）=血脂 主要是指胆固醇和甘油三酯 必须与蛋白质（载脂蛋白）和磷脂一起组织脂蛋白，才溶于血，被运送到各组织 血脂代谢=血浆脂蛋白代谢 高脂血症=高脂蛋白血症（血脂异常） 脂蛋白的结构 血脂代谢 纤维帽基质的合成 动脉粥样硬化真正的危害是斑块的不定时破裂 纤维帽基质的降解 早期安慰剂对照研究均显示：他汀对稳定性冠心病患者获益确切 将LDL-C降至远低于100mg/dL(2.6mmol/L)，仍可显著获益 纵观NCEP ATP演变：CHD患者的LDL-C达标值lower and lower JACC 2008;51(15):1512-1524ACC/ADA共同指出：血脂控制力度还需加大 2008年ACC/ADA共识：为防治动脉粥样硬化，CVD患者应控制LDL-C在50mg/dL 2009 ATPⅣ值得期待…… 降LDL-C新药 依折麦布联合辛伐他汀：降低LDL-C疗效优于他汀剂量加倍 2007年《WHO心血管病预防指南》明确要求：他汀治疗要长期坚持，坚持终生 冠心病死亡率 与 血总胆固醇 (61 studies, 892,337 pts, 11,600,000 pt-yr) 高胆固醇饮食12天后 Electron microscopic examination of leukocyte interactions with the artery wall in hypercholesterolemic nonhuman primates. A and B, Scanning electron micrographs that demonstrate the adhesion of mononuclear phagocytes to the intact endothelium 12 days after initiating a hypercholesterolemic diet. C and D, Transmission electron micrographs. Note the abundant interdigitations and intimate association of the monocyte with the endothelium in part C. In part D, a monocyte appears to diapedese between two endothelial cells to enter the intima. (From Faggiotto A, Ross R, Harker L: Studies of hypercholesterolemia in the nonhuman primate. I. Changes that lead to fatty streak formation. Arteriosclerosis 4:323, 1984 Figure 35-4 Schematic of the evolution of the atherosclerotic plaque. 1: Accumulation of lipoprotein particles in the intima. The modification of these lipoproteins is depicted by the darker color. Modifications include oxidation and glycation. 2: Oxidative stress, including products found in modified lipoproteins, can induce local cytokine elaboration. 3: The cytokines thus induced increase expression of adhesion molecules for leukocytes that cause their attachment and chemoattractant molecules that direct their migration into the intima. 4: Blood monocytes, upon entering the artery wall in response to chemoattractant cytokines such as monocyte chemoattractant protein 1 (MCP-1), encounter stimuli such as macrophage colony stimu