诸骏仁教授-血脂异常指南解读(精)

中国成人血脂异常防治指南制订工作简介2006•8•18上海中山医院诸骏仁中华心血管病学会中华心血管病杂志编委会血脂异常防治对策专题组(按姓氏笔划排序)方圻王钟林宁田海邵耕陈在嘉陆宗良李健斋周北凡诸骏仁诸永康陶萍陶寿淇龚兰生顾复生游凯戴玉华血脂异常防治建议（1997）中华心血管病学会中华心血管病杂志编委会血脂异常防治对策专题组(按姓氏笔划排序)方圻宁田海叶平陈在嘉吴宁陆宗良李健斋周北凡赵冬赵水平武阳丰诸骏仁胡大一龚兰生高润霖徐成斌姜永茂游凯中国成人血脂异常防治指南（2006）中华医学会糖尿病学分会项坤三贾伟平潘长玉中国成人血脂异常防治指南李光伟曾正陪陈家伦中华医学会内分泌学分会中国成人血脂异常防治指南中华医学会医学检验学分会鄢盛恺陈文祥叶平中国成人血脂异常防治指南卫生部心血管病防治研究中心血脂异常防治委员会诸骏仁高润霖胡大一冯建章胡盛寿杨跃进葛均波霍勇马虹沈卫峰陈纪林吴宁曾定尹吴学思贾国良黄德嘉徐成斌陈再嘉陆宗良周北凡武阳丰陈保生叶平潘长玉陈文祥赵冬赵水平陆国平严晓伟游凯鄢盛恺李建军李小鹰李勇李莹杨晓光顼志敏中国成人血脂异常防治指南编写组诸骏仁周北凡武阳丰赵冬赵水平叶平陆宗良游凯陆国平项坤三贾伟平李光伟鄢盛恺陈文祥指南制订的背景近十年来•我国人民血脂异常显著增多,粥样硬化性疾病和糖尿病发病率日益增高•血脂异常的防治的概念、方法进展显著、迅速指南制订的条件近十年来•我国人群血脂异常的流行病学资料已有一定积累•血脂异常防治的国际经验进展显著,足为借鉴•专业人员和群众对血脂异常的认识有所提高指南制订的指导思想作为我国的当代指南,必须•结合中国人群血脂异常的特点,制定适合中国人的调脂策略•以循证医学的证据作为制订防治方案的依据•吸收国际上血脂异常防治的经验•原则上与国际指南一致,具体上有别于国际指南中国成人血脂异常防治指南背景及引言血脂与脂蛋白血脂检测及临床意义血脂异常分类血脂异常的检出与心血管病整体危险评估血脂异常的检出我国人群的血脂合适水平心血管病综合危险的评价降脂治疗在冠心病防治中的循证医学证据降脂治疗在冠心病一级预防中的临床证据降脂治疗在冠心病二级预防中的临床证据血脂异常的治疗血脂异常的治疗原则治疗性生活方式改变血脂异常的药物治疗血脂异常治疗的其他措施治疗过程的监测特殊人群的血脂异常治疗附录:临床血脂测定建议2002年全国营养与健康调查血脂人群水平及分布状况高脂血症的膳食治疗分类水合密度（g/mL）颗粒大小(nm)主要脂质主要载脂蛋白来源功能乳糜微粒（CM）0.9580-500甘油三酯B48、AI、AII小肠合成将食物中的甘油三酯和胆固醇从小肠转运至其他组织极低密度脂蛋白（VLDL）1.00630-80甘油三酯B100、E、Cs肝脏合成转运甘油三酯至外周组织，经脂酶水解后释放游离脂肪酸中间密度脂蛋白（IDL）1.006-1.01927-30甘油三酯、胆固醇B100、EVLDL中甘油三酯经脂酶水解后形成属LDL前体，部分经肝脏摄取低密度脂蛋白（LDL）1.019-1.06320-27胆固醇B100VLDL和IDL中甘油三酯经脂酶水解后形成胆固醇的主要载体，经LDL受体介导摄取而被外周组织利用，与冠心病直接相关高密度脂蛋白（HDL）1.063-1.215-17磷脂，胆固醇AI、AII、Cs肝脏和小肠合成，CM和VLDL脂解后表面物衍生促进胆固醇从外周组织移去、转运胆固醇至肝脏或其他组织再分布，HDL与冠心病负相关脂蛋白（a）[LP(a)]1.05-1.1226胆固醇B100、（a）肝脏合成后与LDL形成复合物可能与冠心病相关血脂与脂蛋白血脂检测和临床意义基本项目总胆固醇(TC)低密度脂蛋白胆固醇(LDL-C)高密度脂蛋白胆固醇(HDL-C)甘油三酯(TG)额外研究项目载脂蛋白A1(apoA1)载脂蛋白B(apoB)非高密度脂蛋白胆固醇小而密低密度脂蛋白脂蛋白(a)[Lp(a)]血脂异常分类起因分类•原发性高脂血症•继发性高脂血症表型分类•高胆固醇血症•高甘油三酯血症•混合型高脂血症•低高密度脂蛋白血症基因分类•家族性高胆固醇血症•家族性载脂蛋白B缺陷症•家族性混合型高脂血症•家族性异常ß脂蛋白血症•家族性高甘油三酯血症•多基因家族性高胆固醇血症•家族性脂蛋白(a)过多血症2002年全国营养与健康调查血清总胆固醇(TC,mmol/L)人群水平及分布状况调查样本数平均数百分位数51015255075859095城市77363.962.722.993.183.484.054.674.995.265.6818-4432383.892.582.843.033.293.834.424.795.015.3945-5924464.212.803.063.283.584.134.735.095.375.8060-7417784.322.893.233.443.744.274.865.205.465.8875+2744.382.993.283.563.854.364.915.175.415.90农村153893.752.572.802.973.223.734.314.664.915.3318-4477643.712.502.712.873.113.614.174.524.795.1945-5950583.962.702.923.083.333.874.454.775.045.4360-7422763.962.692.933.133.373.894.464.795.065.5075+2913.862.602.953.063.373.784.284.624.935.34城市91263.962.763.023.203.494.094.765.175.475.9218-4439763.752.572.842.983.223.704.234.544.765.1545-5930904.352.943.213.423.734.304.935.335.556.0160-7417944.713.183.463.694.024.685.365.725.956.4075+2664.723.143.433.614.074.615.355.896.096.60农村168873.762.552.802.973.223.754.354.724.975.4018-4488983.592.452.662.823.063.524.024.344.574.9145-5954724.072.783.023.193.443.984.584.945.205.6560-7422104.232.803.103.313.584.174.815.165.425.8575+3074.273.123.203.343.624.174.865.255.545.77男性女性2002年全国营养与健康调查血清LDL-C(mmol/L)人群水平及分布状况调查样本数平均数百分位数51015255075859095男性城市76512.281.101.351.511.752.232.743.023.253.6118-4431952.091.001.221.371.602.042.522.812.993.3345-5924122.341.151.401.561.822.322.793.103.303.6860-7417712.501.351.561.741.962.442.953.243.463.7875+2732.561.451.711.892.092.542.963.263.533.86农村152482.021.021.211.341.541.952.432.722.923.2718-4476811.920.961.141.261.461.852.302.602.813.1345-5950072.111.091.281.421.632.042.532.793.003.3560-7422692.151.121.321.461.672.082.572.863.063.4275+2912.121.171.331.461.692.112.502.782.933.31女性城市90882.301.151.371.511.732.222.773.113.373.7818-4439731.981.051.231.351.531.912.352.602.793.1145-5930772.451.261.501.661.922.382.893.213.483.8660-7417752.711.471.701.862.122.663.233.543.804.1275+2632.731.511.741.842.142.663.253.684.054.27农村167952.021.021.211.331.531.942.432.732.933.2918-4488681.830.961.131.231.411.772.182.422.632.9145-5954212.191.141.341.481.682.122.612.903.123.5060-7421992.351.201.441.601.842.282.803.093.333.6975+3072.321.271.501.621.782.242.793.053.303.602002年全国营养与健康调查血清HDL-C(mmol/L)人群水平及分布状况调查样本数平均数百分位数51015255075859095男性城市77361.230.830.910.961.041.211.401.521.621.7818-4432381.220.830.900.961.031.191.381.481.571.7245-5924461.250.820.890.951.031.211.411.541.651.8060-7417781.270.840.920.971.051.231.431.561.681.8575+2741.290.870.940.981.061.261.461.591.681.79农村153891.280.840.920.971.061.241.461.591.701.8618-4477641.260.830.910.961.041.211.411.541.641.7745-5950581.340.850.920.981.071.261.511.651.771.9560-7422761.320.840.920.981.091.291.501.631.741.9175+2911.310.830.930.991.111.281.491.641.731.92女性城市91261.360.921.001.061.151.331.541.661.741.8818-4439761.350.931.011.061.151.341.531.651.731.8745-5930901.350.910.991.051.151.321.541.661.751.8960-7417941.360.910.991.061.161.331.531.651.761.9175+2661.400.940.991.041.131.371.611.761.842.07农村168871.310.880.971.021.111.281.481.601.681.8218-4488981.330.880.961.021.101.271.471.581.661.7945-5954721.330.890.971.031.121.291.491.621.701.8460-7422101.310.870.961.011.101.281.491.621.711.8675+3071.390.931.001.051.171.371.611.701.781.942002年全国营养与健康调查血清甘油三酯(mmol/L)人群水平及分布状况调查样本数平均数百分位数51015255075859095男性城市77361.180.550.630.690.801.081.551.902.222.8118-4432381.300.530.600.660.761