他汀类药物与肝脏的关系

3-羟基-3-甲基戊二酰-辅酶A(HMG-CoA)还原酶抑制剂是近年来开发的一大类降血脂药物,它可降低血脂异常病人的总胆固醇和低密度脂蛋白胆固醇。他汀类药物的动物及临床试验均表明有使肝脏酶轻微升高的作用,故美国食物与药品管理局(FDA)建议,监测药物可能引起的肝毒性。然而,随后的?..     

他汀类药物临床应用进展

他汀类药物是公认的高效降脂药，已广泛应用于临床，其降脂作用是通过抑制3-羟甲基戊二酸单酰辅酶A(HMG-CoA)还原酶(胆固醇合成途径的限速酶)，从而抑制胆固醇(TC)的合成，使血液中总胆固醇及低密度脂蛋白胆固醇(LDL-C)含量下降。目前国内外常用的他汀类药物有5种，在相同剂量下，其调脂强度依次为阿托伐他汀、辛伐他汀、洛伐他汀、普伐他汀和氟伐他汀。近年来从基础研究到临床研究，越来越多证据显示他汀类药物除了降脂作用外，可使血管松弛，     

他汀类药物与肌病

羟甲戊二酰辅酶A(HMG CoA)还原酶抑制剂 ,简称他汀类 ,其作用为抑制胆固醇的体内生成 ,临床主要用于降低血胆固醇与低密度脂蛋白水平。他汀类药物目前已用于临床的有 :洛伐他汀、辛伐他汀、普伐他汀、氟伐他汀、阿托伐汀、西立伐他汀等。此类药物的代谢需要细胞色素P4 5 0 3A4 (细胞色素P4 5 0 ,简称CYP4 5 0 ) ,与同样需要P4 5 0 3A4 代谢的吉非贝齐、非诺贝特、苯扎贝特等贝丁酸类降脂药同用可能发生肌病 ,特别是西立伐他汀与吉非贝齐伍用导致肌病 /横纹肌溶解的危险性更大 ;与环孢素、红霉素、烟酸、免疫抑制药同用增加肌溶解和急…     

他汀类药物抗高血压作用的研究进展

他汀类药物又名羟甲基戊二酸单酰辅酶A(HMG-CoA)还原酶抑制剂,由于HIMG-CoA还原酶是合成胆固醇的限速酶,HMG-CoA还原酶抑制剂通过对该酶的特异性竞争抑制,从而抑制胆固醇合成,增强细胞表面低密度脂蛋白(LDL)受体表达,加速血循环中LDL和极低密度脂蛋白(VLDL)残粒清除,是临床治疗高胆固醇血症和高低密度脂蛋白胆固醇血症的首选药物.     

他汀类药物治疗急性冠脉综合征的机制

羟甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂简称他汀类药物，他汀类药物的问世和在临床上广泛应用是对调脂治疗的一个重要贡献。该类药物具有调脂作用强、副作用小等优点。斯堪的纳维亚辛伐他汀生存研究(Scandinavian Simvastatin Simvastatin Survival Study，4S)、西苏格兰冠心病预防研究(WOSCOPS)、胆固醇和复发事件研究(CARE)以及普伐他汀     

胆石的体外背向散射积分测定

目的评价背向散射积分(IBS)可否体外预测胆石的化学性质。方法以红外光谱定量分析结石的化学性质,将结石分为纯胆固醇性和纯胆色素性两组(以胆固醇≥70%为胆固醇性结石;胆固醇≤30%为胆色素性结石),每组30例共60例,对结石及其声影进行体外IBS测定。结果胆固醇组和胆色素组结石的图像峰-峰值(PII)及图像强度标准差(SDI)之间无显著性差别,两组间的图像平均强度(AII)有显著性差别(P<0.05),胆色素类结石的AII大于胆固醇类结石的AII;胆固醇组和胆色素组声影的IBS值比较只有AII有显著性差别(P<0.001),胆色素类结石声影的AII小于胆固醇类结石的AII;两组间结石-声影AII差值之间有显著性差别(P<0.001),胆色素组大于胆固醇组。结论背向散射积分能体外区分纯胆固醇性和纯胆色素性结石。     

他汀类药物非降脂作用对慢性肾脏病的防治

他汀类药物是最为经典和有效的降脂药物,此类药物通过竞争性抑制内源性胆固醇合成限速酶羟甲基戊二酰辅酶A(HMG-CoA)还原酶,阻断细胞内甲羟戊酸代谢途径,使细胞内胆固醇合成减少,从而反馈性刺激细胞膜表面(主要为肝细胞)低密度脂蛋白(LDL)受体数量和活性增加,使血清胆固醇清除增加,水平降低.研究证实他汀类药物还具有不依赖于降脂的多效性作用,主要有抗细胞增殖、抗氧化清除自由基、抗炎等生物学活性作用.在慢性肾脏病(CKD)患者中应用他汀类药物,一方面可以改善脂质代谢紊乱,另一方面可延缓CKD的进展.本文就他汀类药物非降脂作用延缓CKD发展作一综述.     

他汀类药物与骨质疏松症研究进展

他汀类药物，即羟甲基戊二酰辅酶A(HMGCoA)还原酶的抑制剂，已被临床广泛应用于降低血胆固醇和低密度脂蛋白(LDL)，可预防动脉粥样硬化，降低心血管事件的发生率。该类药物的主要作用是抑制胆固醇的生物合成，但既往的研究…也发现，他汀类药物尚有抑制平滑肌细胞增殖与迁移、     

他汀类药物治疗与缺血和非缺血性心力衰竭者存活率改善间关系

55 1例收缩功能不全性心力衰竭患者 ,平均年龄 (5 2± 13)岁 ,左心室射血分数人均 (0 2 5± 0 0 7)。其中冠状动脉病 (coronaryarterydisease ,CAD )所致心力衰竭4 5 % ,非CAD所致心力衰竭 5 5 %。研究中接受他汀类药物者占 4 5 % ,包括CAD所致心力衰竭 73%和非CAD所致心力衰竭 2 2 %。观察他汀类用药与心力衰竭者远期存活率间关系。结果 ,他汀类用药者较未用药者 ,年龄较大、男性、高血压、糖尿病及吸烟者均多 ,而左心室射血分数及总胆固醇无异。随访 1年发现 ,与未用药者相比 ,他汀类用药与非缺血性心力衰竭或缺血性心力衰竭者无需…     

辛伐他汀调血脂作用和不良反应的临床研究

动脉粥样硬化与低密度脂蛋白(LDL)发生氧化修饰形成氧化LDL密切相关。高胆固醇血症是早已确定的冠心病(CHD)独立危险因素。辛伐他汀为新型他汀类降血脂药，其作用机制为竞争性抑制3-羟-3-甲戊二酰辅酶A(HMG-CoA)还原酶，阻断甲羟戊酸代谢的中间产物及最终产物——胆固醇的合成。可降低血浆总胆固醇(TC)、低密度脂蛋白胆固     

艾塞那肽联合二甲双胍治疗口服降糖药控制不佳的2型糖尿病疗效观察

目的观察艾塞那肽联合二甲双胍治疗对口服降糖药(OAD)控制不佳的2型糖尿病(T2DM)患者的临床疗效。方法 31例既往使用OAD控制不佳的T2DM患者,改用艾塞那肽联合二甲双胍治疗3个月,观察治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、体重、体质指数(BMI)、C-肽(空腹及餐后2h)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的变化。结果治疗后FPG、2hPG、HbA1c、体重、BMI、TC、TG、LDL-C均有明显下降(P均<0.01)。C-肽(空腹及餐后2h)未发现明显变化(P>0.05)。低血糖发生率为3.23%。结论艾塞那肽联合二甲双胍能有效地控制T2DM患者的血糖,减轻体重,且发生低血糖的风险低。     

Serum lipids in hyper- and hypothyroidism before and after treatment

Total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), triglycerides (TG) and apoprotein A (Apo A) were determined in serum from 21 hyperthyroid patients and 11 hypothyroid patients before and after treatment to euthyroid state. The above-mentioned components were also determined in a reference population. In the hyperthyroid group the concentration of total cholesterol and low density lipoprotein-cholesterol increased significantly upon treatment. High density lipoprotein also increased except for 9 patients also receiving propranolol. The ratio between high density lipoprotein-cholesterol and total cholesterol decreased in the patients receiving propranolol. In the hypothyroid group the values after treatment decreased significantly for cholesterol, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol. The ratio between high density lipoprotein-cholesterol and total cholesterol was unchanged.     

Serum lipoprotein profile in patients with cancer. A comparison with non-cancer subjects

The association of cancer with low serum total cholesterol is well established. Less clear is the relationship of cancer with the cholesterol distribution among the different lipoprotein classes. Conflicting results have been reported on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and serum triglyceride levels in different types of tumor. Total serum cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and serum triglycerides were analyzed in 530 patients with newly diagnosed cancer (97 with hematological malignancies, 92 with tumor of the lung, 108 of the upper digestive system, 103 of colon, 32 of breast, and 98 of the genitourinary system) and in 415 non-cancer subjects. Anthropometric (body mass index) and biochemical (serum albumin) indices of nutritional status were also determined in all subjects. Total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, serum albumin, and body mass index were significantly lower in cancer than in non cancer-subjects. The lowest values of total cholesterol, low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol were recorded in patients with hematological malignancies and the highest in patients with breast tumor. All the cancer groups, with the exception of women with breast cancer, showed significantly lower total cholesterol, low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol than age- and sex-matched non-cancer subjects. Multiple regression analysis with low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides as dependent variables and sex, age, body mass index, albumin, and cancer (dummy variable) as independent variables, showed that cancer was independently associated with low levels of low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol and with high values of serum triglycerides. Total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, serum triglycerides, body mass index and serum albumin were significantly lower in patients with metastatic than in patients with non-metastatic solid tumor. The significant difference in low-density lipoprotein-cholesterol and serum triglycerides between patients with metastatic and non-metastatic cancer was lost when lipoprotein cholesterol and serum triglyceride levels were adjusted for nutritional variables. The lipid profile in cancer patients is characterized by low low-density lipoprotein-cholesterol, low high-density lipoprotein-cholesterol and relatively high serum triglycerides. The abnormality is a common feature of both hematological and solid tumors and is not entirely explained by poor nutrition.     

Estimation of cardiovascular risk: total cholesterol versus lipoprotein profile

Summary The complete lipoprotein profile is thought to give more information about the individual risk of coronary heart disease than total cholesterol alone. Although total cholesterol has a low sensitivity in the correct assessment of the risk of coronary heart disease, it may be of value in screening programs because of its low cost. In this study of 5,335 subjects, total cholesterol gave a different assessment of coronary heart disease risk (United States National Cholesterol Education Program guidelines) in 25% of subjects than the complete lipoprotein profile. Differences in risk assignment were mainly accounted for by high- and low-density lipoprotein-cholesterol (Friedewald equation). The calculated low-density lipoprotein-cholesterol was highly correlated with the value measured with a mixed ultracentrifugation and precipitation procedure. However, calculated values gave estimates of coronary heart disease risk which were 20% different from those from measure values. In 200 subjects in whom the lipoprotein profile was assessed three times in 1 year, the total cholesterol low-density lipoprotein-cholesterol varied by more than 30 mg/dl (0.78 mmol/l) in 52% and 50%, respectively, triglycerides by more than 30 mg/dl (0.34 mmol/l) in 75%, and high-density lipoprotein-cholesterol by more than 15 mg/dl (0.39 mmol/l) in 34%. Compared with the mean of the measurements, the single measurement of total cholesterol misclassified 48% of subjects, low-density lipoprotein-cholesterol 60%, high-density lipoprotein-cholesterol 12%, and 28%. We conclude that total cholesterol alone may be misleading in the assignment of coronary heart disease risk. Calculation of low-density lipoprotein-cholesterol, although less accurate than desirable, is the only way of evaluating this in clinical practice. Finally, repeated lipid measurements are required to assess coronary heart disease risk accurately.     

湖北十堰市部分人群血压水平及其影响因素分析

目的观察分析十堰市部分人群血压水平及其相关因素。方法以该地区参加体检的7955人为研究对象,测量其血压、血脂、血糖,对血压水平的多个影响因素进行多元线性回归分析。结果高血压患病率为27.67%,其中男性30.97%,女性15.82%,男女性别之间差异显著(P<0.01)。多元线性回归分析显示血压水平与年龄、甘油三酯、低密度脂蛋白胆固醇、血糖呈正相关,而与高密度脂蛋白胆固醇呈负相关。结论人群血压水平与性别、年龄、甘油三酯、血糖、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等有关。     

Variations in apolipoproteins B and A, during the course of myocardial infarction

The plasma apolipoproteins B and A1, and plasma lipids and lipoproteins, were studied in fifteen patients with acute myocardial infarction. In the days immediately after acute infarction there was a decrease in total cholesterol, low density lipoprotein-cholesterol, total apolipoprotein-B, low density lipoprotein apolipoprotein-B and high density lipoprotein apolipoprotein A1. High density lipoprotein-cholesterol remained unchanged. In the same period the total triglycerides, very low density lipoprotein-protein, very low density lipoprotein-cholesterol, very low density lipoprotein apolipoprotein-B and very low density lipoprotein apolipoprotein A1 were increased. A reduction of the apolipoprotein ratio CII/CIII occurred after the acute phase. After 25--30 days all these values regained their baseline values.     

Aortic compliance in young patients with heterozygous familial hypercholesterolaemia.

1. Aortic compliance and plasma lipid and lipoprotein levels were measured in 20 young patients with heterozygous familial hypercholesterolaemia and in 20 age- and sex-matched control subjects. 2. Patients with familial hypercholesterolaemia had significantly higher plasma cholesterol, low-density lipoprotein-cholesterol and triacylglycerol levels than control subjects (P < 0.001, P < 0.001 and P < 0.005, respectively). The patients with familial hypercholesterolemia also had significantly more compliant (distensible) aortas than the control subjects (P < 0.001), a significant inverse correlation being observed between compliance and age (r = 0.73, P < 0.001) and between compliance and mean blood pressure (r = -0.60, P < 0.005). 3. When the effects of age and sex on aortic compliance were corrected for, the blood pressure effect disappeared, significant correlations being observed between normalized compliance and cholesterol (r = 0.50, P < 0.03), low-density lipoprotein-cholesterol (r = 0.54, P < 0.01), high-density lipoprotein-cholesterol (r = -0.44, P < 0.05), low-density lipoprotein-/high-density lipoprotein-cholesterol ratio (r = 0.60, P < 0.0006) and duration of disease (r = 0.67, P < 0.002). Multivariate regression analysis showed that the low-density lipoprotein-/high-density lipoprotein-cholesterol ratio (P < 0.03) and duration of disease (P < 0.04) were the best predictors of normalized compliance. 4. We suggest that the measurement of aortic compliance in young patients with familial hypercholesterolaemia may potentially be a useful, non-invasive, research tool for assessing their susceptibility to atheroma.     

毛细管等速电泳法分析肾病综合征患者的脂质代谢

目的探讨肾病综合征(NS)患者脂蛋白组成、含量和脂质代谢酶的活性。方法用毛细管等速电泳法(cITP)将血清脂蛋白分成9种成分,结合总胆固醇(TC)浓度定量分析高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),并根据代谢酶催化的底物/产物比值反映卵磷脂胆固醇酰基转移酶(LCAT)、脂蛋白脂肪酶(LPL)和三酰甘油酶(HL)活性。慢高密度脂蛋白(sHDL)和快高密度脂蛋白(fHDL)相对峰面积的比值可反映LCAT活性;乳糜微粒(CM)/中间密度脂蛋白(IDL)和IDL/低密度脂蛋白(LDL)比值分别反映LPL和HL活性。底物/产物比值越大,酶活性越低。结果cITP定量测定HDL-C、LDL-C与常规方法呈正相关[相关系数(r)分别为0.86、0.83,P<0.001]。NS组sHDL/fHDL、CM/IDL、IDL/LDL比值均明显高于对照组,LCAT、LPL和HL活性均低于对照组。结论cITP可作为分析脂蛋白组成、含量和反映脂质代谢酶活性的新方法。     

老年退行性心瓣膜病合并冠心病的临床研究

目的探讨老年退行性心瓣膜病(SDHVD)合并冠心病(CHD)患者的临床特点。方法经冠状动脉造影和超声心动图检查,选择SDHVD+CHD患者53例为观察组,CHD患者54例为对照组。比较组间年龄、冠脉血管病变、心功能、心律失常、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),纤维蛋白原(FIB)。结果两组年龄、TC、LDL-C、FIB心功能、心律失常在组间的分布差异有统计学意义(P<0.01,P<0.05)。结论SDHVD+CHD组的患者年龄偏大,TC、LDL-C、FIB明显增高,冠脉病变总支数、钙化或弥漫性病变明显增多,易导致心律失常和心力衰竭。     

血脂与脑梗死患者颈动脉粥样硬化的关系

目的了解血脂与脑梗死患者颈动脉粥样硬化的关系。方法对344例脑梗死疑似患者进行三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A-I(apo A-I)、载脂蛋白B(apo B)、脂蛋白(a)[Lp(a)]检测,同时用计算机断层扫描(CT)、B超检测颈动脉病变。结果344例脑梗死疑似患者中有303例经临床及CT检查诊断为脑梗死,其余41例作为对照组。303例确诊患者中颈动脉管壁内膜-中层厚度(IMT)>0.9 mm或有斑块者206例,占68.0%;其余97例无病变,占32.0%。脑梗死患者LDL-C水平无论有无颈动脉病变均高于对照组(P<0.05)。无脑梗死的颈动脉粥样硬化患者apoA-I水平低于对照组(P<0.05)。结论LDL-C、apo A-I是发生脑梗死和颈动脉硬化病变重要的危险因素和诊疗的观察指标,B超检测颈动脉粥样硬化再结合血脂检查,对于脑血管疾病的预防、早期诊断、指导治疗以及观察疗效具有一定的临床价值。