血脂指南1.ppt

FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * 指导思想 指导思想 These are categories of risk factors. The major independent ones are cholesterol, blood pressure, smoking, and so on. These are addressed and are included in the Framingham risk calculation. Then there are life habit risk factors that are not actually in the Framingham calculation. These include obesity, physical inactivity, and an atherogenic diet. Also, there are merging risk factors that well come back to later on. Aside from the proinflammatory factors, there are others, such as lipoprotein(a), homocysteine, prothrombotic factors, impaired fasting glucose, and subclinical atherosclerosis such as you might detect and diagnose by carotid ultrasound or by rapid computed tomography (CT) scanning to demonstrate a high level of atherosclerotic burden by the calcium score in the vessels. FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * FUTURE RESEARCH * 胆酸螯合物 药物 剂量范围 考来烯胺 4-16g 考来替泊 5-20g Colesevelam 2.6-3.8g 烟酸的作用机制 肝脏 循环 HDL 血清VLDL分解为LDL减少 血清 LDL-C VLDL 肝脏产生VLDL 和apo B减少 VLDL 分泌 Apo B 肝细胞 全身循环 动员 FFA TG 合成 VLDL LDL 烟酸 主要作用 降低LDL-C 5-25% 降低TG 20-50% 升高HDL-C 15-35% 副作用：潮红、高血糖、高尿酸血症、上胃肠道不适、肝脏毒性 禁忌症：肝脏疾病、严重痛风、消化道溃疡 烟酸 药物 剂量范围 快效 1.5–3 g(结晶型) 长效 1–2 g 缓释 1–2 g 烟酸 明确的治疗益处 减少主要冠脉事件 可能减少总死亡率 维纤酸类或贝特类(fibrates) 主要作用 降低LDL-C 5-20% (伴正常TG) 可能升高 LDL-C (伴高TG 时) 降低TG 20-50% 升高HDL-C 10-20% 副作用: 便泌, 胆石, 肌病 禁忌症: 严重肾或肝病 贝特类药物对脂代谢相关基因的调节 Apo A-II 基因表达 LPL 基因表达 ABC-1 基因表达 SR-BI 表达 Apo A-I 基因表达 Apo A-I 产生 Apo A-II 产生 LPL 产生 ABC-1 产生 SR-BI 产生 活化的PPARa 贝特类 药物 剂量范围 吉非贝齐 600 mg BID 非诺贝特 200 mg QD 氯贝特 1000 mg BID 贝特类 明确的治疗益处 延缓冠脉损伤 减少冠脉事件 新型药物的应用 胆固醇吸收抑制剂 Ezetimibe HDL拟似物 ApoA-1米兰 CETP抑制剂 TC从HDL转至LDL减少 Rimonabant 减肥、调脂、戒烟 食物胆固醇 胆系排泄 INTESTINE 排泄 VLDL LDL LDL-R 胆固醇吸收抑制 —依折麦布 Synthesis IDL 吸收 胆固醇吸收抑制剂——依折麦布 --对胆固醇代谢的影响 19% 50% 50% 31% 50% 依折麦布（Ezetimibe) 唯一的胆固醇吸收抑制剂 单药治疗(10mg/d)LDL-C约降低18% 与