降脂治疗需转变观念

Harlan Krumholz和Rodney Hayward认为预防心脏病学应当尽可能地基于能够改善患者结局的策略,而非仅关注生化标志物。     

降脂药物用于冠心病的一级预防：随机试验的汇总分析

总结应用降脂药物对冠心病事件、冠心病病死率以及所有病因病死率的一级预防效果。     

降血脂的评价体系

本文将降血脂评价体系进行初步分类,主要分为动物模型评价体系和体外评价体系两大类.并分别对两个评价体系进行介绍和特点总结,以展示不同评价体系在降血脂评价过程中的建立方法、评价方式及其利弊.     

Effective lipid lowering diets including lean meat

The plasma lipid and lipoprotein responses to two modified isoenergetic diets including meat were studied in 15 free living men with hyperlipidaemia (mean plasma cholesterol and triglyceride concentrations 8.1 and 3.4 mmol/l). A reference diet (diet A, 42% energy from fat, ratio of polyunsaturated to saturated fatty acids (P:S ratio) 0.2) was compared with a fat reduced diet (diet B, 35% energy from fat, P:S ratio 0.5) and with a further fat modified diet supplemented with fibre (diet C, 27% energy from fat, P:S ratio 1.0). Daily intake of meat and meat products (180 g/day) was the same in each dietary period; that in diet A had a fat content typical of the average British diet, whereas that in diets B and C was based on very lean meat and meat products. During consumption of diet B the plasma cholesterol concentration fell by 8.6% and low density lipoprotein cholesterol by 11%. During consumption of diet C plasma cholesterol fell by 18.5% and low density lipoprotein cholesterol by 23.8%. Triglyceride and high density lipoprotein cholesterol concentrations and body weight did not change appreciably during the study. A modified diet including a moderate amount of lean meat and meat products is compatible with a reduced lipoprotein mediated risk of atherosclerotic heart disease.     

内科住院病人血脂控制状况分析

目的 观察院内高胆固醇血症患者的药物治疗血脂达标率及他汀类药物治疗的安全性和对病人的个体差异。方法 对177例院内诊断为高脂血症的病人，随机给予药物调脂治疗〉2个月，于门诊复查血脂，根据1997年我国的《血脂异常防治建议》了解血脂达标情况，同时观察不同他汀类药物和同一药物不同剂量的降脂幅度，以及对达标率的影响。结果 总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）总达标率分别为25％和40％，他汀类药物LDL-C的达标率为51．4％．明显高于贝特类及烟酸制剂及海鱼油（15．9％）。辛伐他汀大剂量比低剂量，具有更高的LDL-C达标率和降低幅度且安全性好。结论 他汀类药物适合作冠心病预防的一线用药，大剂量他汀更适合高脂血症病人的早期使用。     

强化降脂与心脑血管病

1994年以来具有里程碑意义的 5项大规模临床试验 [北欧辛伐他汀生存研究 (4S) [1] 、西苏格兰冠心病预防研究(WOSCOPS) [2 ] 、胆固醇和冠心病复发事件试验 (CARE) [3 ] 、普伐他汀对缺血性心脏病的长期干预 (LIPID) [4] 和空军 /得州冠状动脉粥样硬化预防研究 (AFCAPS/TEXCAPS) [5] ]充分证明降脂治疗具有能显著减少冠心病事件的巨大益处 ,奠定了他汀类药物在冠心病防治中的重要地位。随着循证医学的迅猛发展 ,调脂治疗的观念也在不断更新 ,认识不断深化。强化降脂是相对于一般降脂而言更为积极的降脂治疗 ,强调达到目标值或更…     

调脂药物对动物与临床试验疗效的比较

目的对调脂药物动物实验和临床试验治疗结果进行对比和评价。方法动物实验建立高脂血症大鼠模型,将大鼠分为对照组、模型组（造模成功后,分为药物治疗组和自然恢复组）,测各组血液生化指标并作比较。临床试验：选取高脂血症患者,排除糖尿病及其他心血管系统疾病等。服药前后测定多种血清生化指标与健康对照组进行比较。结果调脂药物对动物实验和临床试验均有很明显降血脂作用。临床试验结果显示差异有统计学意义（P〈0.05）,动物实验结果显示差异有统计学意义（P〈0.01）。结论调脂药物对高脂血症大鼠模型和高脂血症患者均有临床疗效。     

糖尿病动脉粥样硬化中抗栓联合降血脂的治疗作用

目的 探讨糖尿病动脉粥样硬化中抗栓联合降血脂的治疗效果.方法 选取本院2018年2月至2020年10月收治的94例糖尿病动脉粥样硬化患者作为研究对象,随机分为对照组和实验组,各47例.对照组实施抗栓治疗,实验组实施抗栓联合降血脂治疗,比较两组血糖水平(糖化血红蛋白、空腹血糖及餐后2h血糖)、血脂水平(血清总胆固醇、低密...     

复方浒苔多糖降血脂及抗脂质过氧化作用研究

目的：研究复方浒苔多糖（浒苔多糖、山楂提取物、荷叶提取物及茶多酚各25％配制而成）的降血脂及抗脂质过氧化作用。方法根据TC水平将42只大鼠随机分为空白组,高脂模型组,浒苔多糖组,复方浒苔多糖低、中、高剂量组。浒苔多糖组及复方浒苔多糖组分别给予浒苔多糖及不同剂量的复方浒苔多糖灌胃干预45 d,测定各组大鼠血清中的总胆固醇（ 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）的含量及超氧化物歧化酶（ SOD）和谷胱甘肽过氧化物酶（ GSH－Px）的活性。结果与高脂模型组比较,各剂量复方浒苔多糖的TC水平下降、GSH－Px活性提高;复方中、高剂量组的TG水平降低、SOD活性提高,复方高剂量组的HDL－C水平提高,复方低、中剂量组的LDL－C水平降低（ P＜0．05）。各剂量复方浒苔多糖的TC、TG、HDL-C水平、GSH－Px活性及高剂量复方浒苔多糖的SOD活性与单一浒苔多糖比较差异无显著性意义（ P＞0．05）。结论复方浒苔多糖与单一浒苔多糖具有相似的降血脂及抗脂质过氧化作用效果。     

左旋肉碱对肥胖患者血脂水平影响的 meta分析

目的：采用meta分析明确左旋肉碱与肥胖患者血脂水平的关系。方法：按照系统评价的要求,检索左旋肉碱用于减肥的随机对照试验,对纳入的研究进行质量评价和meta分析。结果：试验组和对照组在 TG减少（WMD＝0．883,95％CI＝－0．230～1．980,Z＝1．560,P＝0．120）、 TC减少（WMD＝－0．060,95％CI＝－0．150～0．020,Z＝1．520,P＝0．130）、HDL减少（WMD＝0．040,95％CI＝－0．270～0．360,Z＝0．270,P＝0．790）方面差异均无统计学意义,在LDL减少（WMD＝1．080,95％CI＝－0．560～2．730,Z＝1．290,P＝0．020）方面差异有统计学意义。结论：左旋肉碱通过改善肥胖患者的LDL水平,调控肥胖患者脂肪代谢。     

降脂胶囊对高脂血症小鼠血脂及抗氧化系统的影响

目的观察降脂胶囊对实验性小鼠高脂血症的调节作用及抗氧化系统的影响。方法将72只雄性ICR小鼠随机分为正常对照组、模型组、胶囊低、中、高剂量组、脂必妥组,各组分别按剂量灌胃给予受试物。45d后取血测定血脂及肝脏SOD、GSH-PX、MAD含量。结果与正常对照组比较,模型组小鼠血脂及相关抗氧化指标有统计学差异(P<0.05);与模型组小鼠相比,降脂胶囊中、高剂量组和脂必妥组可降低模型小鼠血清TG、TC和LDL的含量,升高HDL,apoA水平;使肝组织SOD活性、GSH-Px活力上升,MDA含量降低(P<0.05)。结论降脂胶囊具有较好的血脂调节作用,可以有效提高肝组织抗氧化系统活性,其血脂调节作用可能和其抗氧化功能有关。     

Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight. A meta-analysis

Ninety-five studies conducted between September 1955 and October 1983 measuring changes in human serum lipid and lipoprotein levels in response to exercise training were analyzed using meta-analysis. Change in body weight during exercise training may confound observed serum lipid and lipoprotein level changes; thus, data from these studies were partitioned into those where subjects gained body weight, maintained body weight, or lost body weight. Results showed differential changes in cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol, and cholesterol/high-density lipoprotein-cholesterol levels in the three body-weight categories. Where body weight did not change, cholesterol and LDL-C levels decreased significantly (7.3 mg/dL and 3.3 mg/dL, respectively). Where body weight decreased, cholesterol and LDL-C levels also decreased significantly (13.2 mg/dL and 11.1 mg/dL, respectively). However, with body-weight increase, cholesterol and LDL-C levels increased by 2.9 mg/dL and 3.0 mg/dL, respectively. These results suggest that reductions in cholesterol and LDL-C levels were greatest when exercise training was combined with body-weight losses.     

甜荞麦叶总黄酮降糖、降脂作用及机制

目的 :研究荞麦叶总黄酮 (TFBL)对实验性糖尿病高脂血症大鼠的降血糖、血脂作用及其机制 .方法 :用链脲佐菌素和高脂饲料诱发大鼠糖尿病和高脂血症 ,以TFBL口服治疗 12wk ,剂量分别为 0 .2 ,0 .4和 0 .8g·kg-1.实验结束时检测空腹血糖 (FBG)、糖耐量 (OGTT) ,TC ,TG ,LDL C ,HDL C ,胰岛素 (INS)、血清和肝组织脂质过氧化产物丙二醛(MDA)、超氧化物歧化酶 (SOD)及肝细胞膜胰岛素受体结合力 .结果 :TFBL能降低血中FBG ,TG ,LDL C(P <0 .0 1) ,升高HDL C(P <0 .0 1) ,改善OGTT ,增加胰岛素敏感指数(ISI)和胰岛素与受体的结合力 ,存在剂量依赖性 .同时TF BL能降低血清和肝组织中MDA含量 (P <0 .0 1) ,增加血清SOD活力 .结论 :TFBL具有良好的降血糖、调血脂、增加胰岛素与受体结合力和敏感性及抗脂质过氧化作用     

降脂合剂对实验性高脂血症大鼠血脂代谢、LDL氧化易感性及血液黏浓聚凝状态的影响

目的:探讨降脂合剂对实验性高脂血症大鼠血脂代谢、LDL氧化易感性及血液黏浓聚凝状态的影响。方法:选取60只雄性Wistar大鼠并随机分为6组,每组10只,分别记为降脂合剂低、中、高剂量组和辛伐他汀组、模型组以及对照组。其中对照组采用基础饲料进行喂养,其他各组大鼠均采用高脂饲料进行喂养建立高脂血症大鼠模型,在进行的建模的过程中同时进行预防给药,测定各组大鼠10个星期后的血脂代谢、LDL氧化易感性及血液黏浓聚凝状态。结果:模型组大鼠的血清LDL-C抗氧化能力明显降低,而辛伐他汀组和三组降脂合剂组大鼠的血清LDL抗氧化能力均明显增强;并且降脂合剂高、中剂量组大鼠的LDL抗氧化能力均明显高于降脂合剂低剂量组大鼠(均P<0.05)。降脂合剂高、中剂量组大鼠对EET和ηp、ηb(高、中、低切)、IED、HCT、IEA的作用均显著强于降脂合剂低剂量组大鼠(P<0.01或P<0.05)。结论:降脂合剂对于实验性高脂血症大鼠的血脂代谢以及血液黏浓聚凝状态具有较好的调节作用,同时降脂合剂在血脂和血流异常方面降脂合剂还能够起到不错的调节和治疗效果。     

强化降脂治疗对急性心肌梗死患者预后的影响

目的 探讨强化降脂对急性心肌梗死患者预后的影响.方法 118例急性心肌梗死患者随机给予辛伐他汀20mg/d(传统降脂组)及40mg/d(强化降脂组)治疗,观察1、3、6、12个月后低密度脂蛋白胆固醇(LDL-C)的变化、一年后心脏事件发生的情况及不良反应发生的情况.结果 强化降脂组LDL-C下降明显(P＜0.05),心脏事件减少明显(P＜0.05),两组不良反应发生无差异(P＞0.05).结论 辛伐他汀40mg/d可改善急性心肌梗死患者的预后.     

Molecular basis for the effect of lipid lowering drugs on growth factors after de-endothelialization

Objective To study the mechanism and effect of lipid lowering drugs in arresting the development of arterial restenosis after angioplasty.Methods De-endothelialization injury of rabbit aortae, common iliac and femoral arteries using balloon angioplasty and the expression of growth factors such as platelet derived growth factor-B (PDGF-B), transforming growth factor β-1 (TGFβ-1), and fibroblast growth factos (bFGF) were investigated. Total serum cholesterol (TC) and triglycerides (TG) were analyzed during and after the treatment using either simvastatin combined with gemfibrozil or simvastatin alone for 6 weeks. Results Serum total cholesterol and triglycerides were only slightly to moderately increased after high cholesterol ration intake lasting for 6 weeks in rabbits of two therapeutic groups (simvastatin plus gemfibrozil or only simvastatin). A positive correlation was found between TC and intimal/medial ratio (r=0.5873, P&lt;0.05). PDGF-B detected by immuno-histochemistry and RT-PCR analysis showed that the release of PDGF-B was inhibited by simvastatin and gemfibrozil after de-endothelialization. RT-PCR analysis showed that TGFβ-1 was increased in the neointima in two treatment groups but no definite change was seen in the mRNA of bFGF in the smooth muscle cell (SMC) of the balloon-injured arteries even under lipid lowering drug treatment. Conclusion In addition to the lipid lowering effect, both simvastatin and gemfibrozil also influence the release of PDGF-Band TGF-1 in the neointima after de-endothelialization.