目标值与调脂策略杨国君课件.ppt

《规范》及指导原则适用于食品药品监管部门对第三类医疗器械批发/零售经营企业经营许可（含变更和延续）的现场核查，第二类医疗器械批发/零售经营企业经营备案后的现场核查，以及医疗器械经营企业的各类监督检查 LDL-C目标值与调脂策略 宁波大学医学院附属医院 杨国君 LDL-C致病假说 Adapted from Fan J, Watanabe T. J Atheroscler Thromb. 2003;10:63–71. Monocyte Induction of adhesionmolecules and chemotaxis AdhesionVCAM-1ICAM-1 P-selectin E-selectin MigrationMCP-1CCR-2 oxLDL oxidation CytokinesMMPsEndothelin-1 Endothelialcells Smooth muscle cells Intima Internal elastic lamina Lumen CD36SR-A Differentiation(GM-CSF) Macrophage Foam cell T lymphocyte CD40 IFN-gamma LDL, β-VLDL, Lp(a) ATP III LDL-C目标值与药物治疗切点 危险分层 LDL-C目标值 启用 TLC 考虑药物治疗 高度危险 100mg/dL ≥100mg/dL 100mg/dL# 冠心病或其等危症 可选:70mg/dL (100mg/dL: (10年危险20%) 考虑药物选用) 中度高危 130mg/dL ≥ 130mg/dL ≥ 130mg/dL 2+ 危险因子 可选:100mg/dL (100-129mg/dL: (10年危险10-20%) 考虑药物选用) 中度危险 130mg/dL ≥ 130mg/dL ≥160mg/dL 2+ 危险因子 (10年危险 10%) 低度危险 160mg/dL ≥160mg/dL ≥190mg/dL 0-1 risk factor (160-189mg/dL: 考虑药物选用) # 基线LDL-C100mg/dL,药物治疗可选 Circulation 2004;110;227-239 ATPIII明确指出高危患者LDL-C的治疗目标值依据来源于多项流行病学研究 Keys A, Arvanis C, Blackburn H. Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge, MA: Harvard University Press, 1980; 381. Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ 1994;308:367-72. Law MR. Lowering heart disease risk with cholesterol red