血脂与增龄的关系及其临床意义

目的：探讨增龄与血脂的相互关系,为临床相关疾病的防治提供有力数据。方法：2010年4月本院对社区内35周岁以上6139例符合要求的新农合参保对象进行健康体检。结果：总胆固醇（TC）≥5.20mmol/L者745例,占12.14%;三酰甘油（TG）≥1.70mmol/L者831例,占13.54%;低密度脂蛋白胆固醇（LDL-C）≥3.4mmol/L者1107例,占18.03%;高密度脂蛋白胆固醇（HDL-C）≤1.04mmol/L者874例,占14.24%;三酰甘油（TG）≥1.7mmol/L者735例,占11.97%。各年龄组血脂随年龄增长而增高。结论：血脂增高是各种心脑血管疾病的诱因,血脂增高及血脂边缘增高的患者应积极治疗,定期复查。注意饮食结构的调整和机体锻炼。     

血脂检验对糖尿病患者的临床诊断价值

目的系统地探究在糖尿病患者中应用血脂检验的诊断意义。方法选取我院收治的75例糖尿病患者并将其列入观察组,选取同期来我院体检的75例血糖正常人员并将其列入对照组。对两组均行血脂检验,对比两组血脂指标。结果两组总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白等血脂指标比较,差异均有统计学意义(由于P均<0.05)。结论在糖尿病患者中应用血脂检验的诊断意义显著,能够为临床诊治提供参考信息。     

心力衰竭患者血脂与肌酐清除率的相关性研究

目的 探讨心力衰竭(心衰)患者血脂与肌酐清除率(Ccr)水平的相关性。方法 收集2010年1月—2013年6月天津医科大学第二医院心内科出院诊断为心衰(心功能分级NYHAⅡ~Ⅳ级)的955例患者作为心衰组,选择心功能正常且与心衰组情况大致匹配的200例查体者为对照组。将心衰组根据心功能分级分为Ⅱ、Ⅲ、Ⅳ级;根据Ccr水平分为正常组、肾功能轻度损伤组、肾功能中重度损伤组;并根据性别进行分组,比较各组血脂水平。采用二分类Logistic回归分析心衰患者肾功能的影响因素。结果 与对照组相比,心衰组三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、非高密度脂蛋白胆固醇(non-HDL-c)水平升高,Ccr、高密度脂蛋白胆固醇(HDL-c)水平降低。心衰组不同心功能分级间比较,心功能Ⅳ级的心衰患者Ccr及血脂各项指标降低。不同肾功能组间比较,肾功能中重度损害组TG、HDL-c水平降低。不同性别组间比较,女性组各项血脂水平均比男性组增高(P<0.05或P<0.01)。Logistic回归显示年龄高、冠心病、高血压是心衰患者肾功能损害的危险因素,体质量增加、HDL-c升高是保护因素。结论 心衰患者的血脂水平影响肾功能,在控制心衰患者血脂水平的同时要注意保护肾功能。     

成年人血脂异常状况研究

目的 探索成年人血脂水平与血脂异常状况及特点.方法 对2011年6月至2013年5月在我院体检健康的成人2368名,其中用酶法检测血清总胆固醇（TC）、甘油三酯（TG） 2368名,检测高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C） 1992名.结果 男女性TC随年龄增长而增高,TC老年前期组最高;男性组TG：青年组＜中年组,其余各组差异无统计学意义（P＞0.05）;女性组TG随年龄增长而增高;TC、TG水平男性女性组及各年龄组间均存在统计学差异（P＜0.05）,其中TC水平青年、中年组男性＞女性,老年前期、老年组女性＞男性;男性HDL-C随年龄增长呈增高趋势,女性随年龄增长呈递减趋势;男性LDL-C先是随年龄增长呈增高,至进入老年则有降低的现象,女性随年龄增长呈增高趋势明显,LDL-C水平男性女性全组及各年龄组比较均存在统计学差异（P＜0.05）.TC水平分层：合适范围、边缘升高、升高男性分别为55.13％、28.22％、16.64％,女性分别为63.31％、25.05％、11.65％;TG水平分层：合适范围、边缘升高、升高男性分别为59.33％、18.82％、21.85％,女性分别为82.90％、9.89％、7.21％; LDL-C水平分层：合适范围、边缘升高、升高男性分别为84.66％、11.65％、3.69％,女性分别为90.96％、6.86％、2.94％.血脂异常检出率男性组64.37％,女性组43.66％,血脂异常主要为TC及TG,且集中在中年和老年前期组.结论 顺德地区健康成人血脂总体水平高,血脂异常检出率高,提示对本地区健康成人血脂异常的预防和干预迫在眉睫.     

原发性高血压患者血尿酸和血脂变化的临床观察

目的探讨原发性高血压患者血尿酸和血脂变化情况。方法采用回顾性分析的方法 ,分析潮州市潮安县庵埠华侨医院收治的120例原发性高血压患者和90例健康体检患者的血尿酸和血脂变化情况。结果原发性高血压组患者的UA、TC、TG、LDL-C均明显高于对照组,P<0.05;而HDL-C明显低于对照组,P<0.05,差异均有统计学意义。原发性高血压患者临床分级与UA、TG呈明显正相关(r=0.351,r=0.426,P<0.05),而临床分级与HDL-C呈明显负相关(r=-0.332,P<0.05),差异均有统计学意义。结论血尿酸、三酰甘油及HDL-C可以作为原发性高血压患者病情发生、发展的易感指标,值得临床推广应用。     

南宁市体检人群血红蛋白浓度与血脂异常的关系

目的 探讨南宁市体检人群血红蛋白（Hb）浓度与血脂异常的关系。方法 选取2018年1月至12月广西医科大学第一附属医院的4 305例体检者作为研究对象,检测其Hb浓度、三酰甘油（TG）、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）水平。根据Hb浓度将体检人群分为低Hb组、Hb正常组、高Hb组,比较三组的血脂水平和血脂异常发生率。结果 高Hb组的TG、TC水平高于Hb正常组及低Hb组,Hb正常组的TG、TC水平高于低Hb组,高Hb组、Hb正常组的LDL-C水平高于低Hb组,差异有统计学意义（P<0.05）,三组的HDL-C水平比较,差异无统计学意义（P>0.05）。Pearson相关分析显示,Hb浓度与TG、TC、LDL-C呈正相关,与HDL-C呈负相关（P<0.05）。高Hb组、Hb正常组、低Hb组血脂异常总发生率分别为46.0%、34.2%、28.4%,高Hb组血脂异常总发生率高于Hb正常组和低Hb组,差异有统计学意义（P<0.016 7）,其中高Hb组的TG异常发生率高于Hb正常组,高Hb组和Hb正常组的TC异常发生率...     

血脂化验的识别误区及思考

通过观察近 1个月我中心门诊情况 ,结合参看近期门诊患者在省城几所医院血脂化验报告 ,置疑很多 ,其“参考范围”见表 1。表 1　各医疗单位血脂参考范围医疗单位 TC TG LDL -c HDL -c山西省人民医院 3.5～ 6 .2 0 .4～ 1.6 2 .1～ 3.90 .8～ 1.8山西省第二人民医院 3.3～ 5 .7 0 .6～ 1.7 2 .3～ 3.90 .8～ 1.6山西医科大学第一医院 3.2 5～ 5 .5 5 0 .2 0～ 1.980～ 3.90 1.0～ 1.5山西医科大学第二医院 3.1～ 5 .7 0 .5 6～ 1.70 0～ 3.12 0 .93～ 1.93太原市中心医院内分泌科 3.1～ 5 .7 0 .5 7～ 1.70　 <3.5 0 .85～ 1.80太原市中…     

调血脂和抗动脉粥样硬化药物的应用现状和进展趋势

血脂异常主要表现为低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)及载脂蛋白B(apoB)升高,高密度脂蛋白胆固醇(HDL-C)及apoA1降低,是导致冠心病,脑卒中和外周血管疾病的最主要危险因子之一.血脂异常也可导致冠状动脉粥样硬化症.虽然目前治疗目标集中在降低LDL-C上,但未来若干年内其他脂肪/脂蛋白和非脂肪因素有可能成为特殊治疗靶向.现对调血脂和抗动脉粥样硬化药物的应用状况和进展趋势作一介绍.     

血脂异常与冠心病（上）

一、血脂和血脂异常的概念 血脂是血液中脂类物质的总称,其主要成分为总胆固醇（TC）、三酰甘油（TG）、磷脂及游离脂肪等,通常所说的血脂是指血浆中的三酰甘油和胆固醇。三酰甘油和胆固醇不能以游离的形式存在于血浆中,必须以脂蛋白的形式才能在血液中被转运。临床主要检测血浆脂蛋白中所含三酰甘油和胆固醇,各类脂蛋白中的胆固醇,如高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL-C）等（注：LDL—C是通过Friedwald公式计算而得）。     

南京地区616例体检人群血脂水平调查

笔者于2005年5月对南京地区616名不同职业人群的血脂水平进行了调查,结果报告如下。1材料与方法1.1标本来源近2年南京市机关,企、事业单位等干部和职工共616名。来我部进行健康体检,其中男性366名,女性250名,年龄23~74岁。1.2仪器和试剂酶标生化多功能分析仪(中国航天总公司第二研究院283厂产品),试剂由浙江东瓯生物工程有限公司提供。1.3方法按中华医学会检验学会1995年血脂推荐方法[1],总胆固醇(TC)测定采用酶法(CHOD-PAP法),三酰甘油(TG)测定采用酶法(GPO-PAP法)。数据处理用SPSS10.0软件,性别之间比较用成组设计t检验,不同年龄…     

Effects of ezetimibe,either alone or in combination with atorvastatin,on serum visfatin levels: a pilot study

Introduction: Ezetimibe inhibits intestinal absorption of cholesterol and lowers circulating low-density lipoprotein cholesterol levels. Visfatin is a novel adipokine, which may be implicated in the atherosclerotic process. Objective: The aim of this study was to explore the possible association between ezetimibe administration and serum visfatin concentrations. Methods: Patients (n = 30) with primary dyslipidemia and another 30 who failed to reach their assigned low-density lipoprotein cholesterol target on atorvastatin therapy (20 mg/day) were included in the study. All participants were given ezetimibe at 10 mg/day for 12 weeks. Results: At baseline the visfatin levels correlated significantly with the total cholesterol (r = 0.61 and p < 0.01) and low-density lipoprotein cholesterol (r = 0.51 and p < 0.01) levels in the statin pretreatment group. Furthermore, in the statin group the post-treatment levels of visfatin and low-density lipoprotein cholesterol were significantly correlated (r = 0.57 and p < 0.01). The serum visfatin concentrations did not change significantly in either the monotherapy or statin pretreatment groups or in subgroups divided according to the baseline lipid variables. In both the ezetimibe monotherapy and ezetimibe plus atorvastatin groups the effect of ezetimibe on the lipid variables depended on the baseline lipid values. The low-density lipoprotein cholesterol:high density lipoprotein cholesterol ratio was consistently improved by ezetimibe in all groups or subgroups. Conclusions: Ezetimibe did not alter serum visfatin concentrations, either when administered as monotherapy or combined with a statin. Future studies investigating the effect of ezetimibe on visfatin levels need to include groups of patients with distinct lipid characteristics.     

Effect of rimonabant,micronised fenofibrate and their combination on cardiometabolic risk factors in overweight/obese patients: a pilot study

Objective: To assess the effect of rimonabant, micronised fenofibrate and their combination on anthropometric and metabolic parameters in overweight/obese patients with dyslipidaemia. Methods: All patients (n = 30) received a hypocaloric diet (～ 600 kcal/day deficit) and were randomly allocated to receive open-label rimonabant (R) 20 mg/day (n = 10), micronised fenofibrate (F) 200 mg/day (n = 10) or rimonabant 20 mg/day plus fenofibrate 200 mg/day (RF) (n = 10). Anthropometric and metabolic parameters were assessed at baseline and 3 months after treatment initiation. Results: Compared with baseline similar significant reductions in body weight, body mass index and waist circumference were observed in the R (–6, –5 and –5%, respectively; p < 0.01) and RF group (–5% for all, p < 0.05), while improvements in these parameters were smaller in the F group (–2, –2.5 and –2%, respectively; p < 0.05). Triglycerides were reduced by 18% in the R group (p = NS), by 39% in the F group (p < 0.001) and by 46% in the RF group (p < 0.05). Importantly, combination treatment resulted in a 42% increase in high-density lipoprotein cholesterol (HDL-C) levels (p < 0.05), while HDL-C was not significantly altered in the two monotherapy groups. Subsequently, a more pronounced increase in apolipoprotein A-I (ApoA-I) levels (+25%) was observed in the RF group compared with changes in both monotherapy groups (p < 0.0001 vs R and p < 0.005 vs F group). Low-density lipoprotein cholesterol (LDL-C) levels were not significantly altered in any group. Apolipoprotein B (apoB) levels were reduced in all groups and this reduction was significantly more pronounced in the RF group (p < 0.05 vs baseline as well as p < 0.005 and p < 0.01 for RF vs R and F groups, respectively). ApoB/apoA-I ratio decreased by 3% with R (p = NS), by 18% with F (p < 0.05) and by 40% with RF treatment (p < 0.01). Total cholesterol to HDL-C ratio decreased by 20% with F (p < 0.0001) and by 33% with RF therapy (p < 0.005), while it was not significantly altered in R group. Conclusion: The combination of rimonabant and fenofibrate may further improve metabolic parameters in overweight/obese patients with dyslipidaemia compared with each monotherapy. This improvement is particularly pronounced for HDL-C levels.     

Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension

Summary This is the first long-term study of pindolol in a population-based sample of men with newly diagnosed hypertension.Eighty-two patients, with a diastolic pressure of 100 mm Hg or more, were identified after screening 6000 men. Many patients were overweight. 82 population controls, matched by sex, age and body mass index, were also recruited. Fourty-eight per cent of the patients and 25% of the controls had a family history of hypertension.Serum triglyceride and urate values were higher in patients than controls at the baseline investigation. Seventy-four patients were followed for 1 year. The dose of pindolol averaged 7.7 mg once daily after 1 year.The diastolic blood pressure was reduced by 13.4 mm Hg. The target pressure of 95 mm Hg or less was achieved in 89% of the patients. The HDL-cholesterol concentration was normal and did not change, whereas the LDL-cholesterol concentration decreased by 0.15 mmol · l^–1 during treatment. The total triglyceride values increased transiently up to 6 months, but no significant increase was seen after one year.It is concluded that pindolol had no adverse effect on serum cholesterol and its HDL- and LDL-fractions during 1 year of treatment.     

The effects of ezetimibe and orlistat,alone or in combination,on high-density lipoprotein (HDL) subclasses and HDL-associated enzyme activities in overweight and obese patients with hyperlipidaemia

Background: High-density lipoprotein (HDL) includes discrete subfractions. HDL exhibits anti-atherogenic properties, which have been partly linked to the activity of HDL-associated enzymes, such as the lipoprotein associated phospholipase A₂ (HDL-LpPLA₂) and paraoxonase-1 (PON1). Objective: We assessed in an open-label randomised study the effect of orlistat and ezetimibe, alone or in combination, on plasma HDL subclasses and HDL-associated enzyme activities in overweight and obese subjects (body mass index > 28 kg/m²) with hypercholesterolemia [total cholesterol > 200 mg/100 ml (5.2 mmol/l)]. Methods: Eighty-six people were prescribed a low-fat low-calorie diet and were randomly allocated to receive orlistat 120 mg, three times daily (O group), ezetimibe 10 mg/day (E group) or both (OE group) for 6 months. HDL subfractions were determined using a polyacrylamide gel-tube electrophoresis method. Results: Levels of HDL cholesterol (HDL-C) and apolipoprotein AI did not change significantly in any group. In group O the cholesterol concentration of HDL-2 subclass increased significantly, while the cholesterol of HDL-3 subclass decreased significantly. In groups E and OE HDL-2 subclass did not significantly change, while the cholesterol concentration of HDL-3 subclass decreased significantly. We observed a non-significant decrease in the HDL-LpPLA₂ and PON1 activity in all groups. However, the ratios of both enzyme activities to low-density lipoprotein cholesterol (LDL-C) levels (an index of atherogenicity) significantly increased in all groups. Conclusion: Although HDL-C levels did not change after treatment with orlistat and ezetimibe, alone or in combination, there were alterations of the HDL-2 and HDL-3 subclasses. The activity of HDL-LpPLA₂ and PON1 per mg LDL-C increased significantly in all groups.     

Anti-inflammatory and hypolipemic effects in vitro of simvastatin comparing to epicatechin in patients with type-2 hypercholesterolemia

Objective

The study involved 25 patients with type-2 hypercholesterolemia (mean age 49.3 ± 11.3). The control group consisted of 28 healthy individuals (mean age 50.7 ± 7.2).

Methods

The cholesterol concentrations in plasma membranes of erythrocytes were measured by means of Liebermann-Burchard reagent. The membrane lipid peroxidation in whole erythrocytes was determined. The membrane fluidity was estimated by spin labelled method.

Results

The in vitro study shows that the cholesterol concentration in membranes incubated with simvastatin and epicatechin decreases; in healthy donors there are no changes. Simvastatin does not lead to changes in the lipid peroxidation in the in vitro data. Epicatechin decreases the level of membrane lipid peroxidation in patients with hypercholesterolemia and in healthy donors. Simvastatin and epicatechin cause an increase in the fluidity of plasma membranes of erythrocytes.

Conclusions

Simvastatin causes the decrease in cholesterol concentration in erythrocytes membranes not only in the in vivo but also the in vitro experiments. Flavonoids have antioxidant properties in vitro. Simvastatin influences the lipid peroxidation only in vivo, not in vitro systems. This observation is an additional contribution to the statins’ pleiotropic effect.     

肝胆疾病中血脂水平检测的临床研究

目的 探讨血脂水平在肝胆疾病中变化规律及临床应用价值。方法 对162例住院肝胆病患者检测血脂6项为病例组,40例健康体检者作为对照组。结果 从单项血脂结果看,总胆固醇(TC)水平与肝细胞受损程度密切相关,肝功能受损越重,则11C降低越明显,甚至测不出,可反映肝脏病变程度和预后情况,以重型肝炎中表现最为突出,TC均值为0．61mmol/L,甘油三酯(TG)水平与胆石症明显呈正相关。而低密度脂蛋白胆固醇(LDL-C)整体水平与对照组差异有显著性,与肝损伤程度呈负相关,与TC平行。载脂蛋白(Apo)在重型乙型肝炎、慢性重度乙型肝炎皆明显降低。结论 血脂6项对判断急慢性肝损伤具有重要临床意义,应作为肝胆病常规检查项目。     

1 277例医院职工脂肪肝患病现状及其与高脂血症的关系

目的探讨健康体检的医院职工脂肪肝患病现状及其与高脂血症的关系。方法2006年7月～2006年8月在本院体检的具有高级职称或年龄≥40岁的医疗单位职工共1277例,进行肝脏超声检查和血清甘油三酯（TG）、总胆固醇（TC）检测。结果1277例受检者中,共检出脂肪肝453例,检出率为35.47%（453/1277）。男性脂肪肝的检出率44.36%（236/532）明显高于女性29.13%（217/745）（P〈0.01）。50～59岁组脂肪肝检出率最高,为42.55%;男性脂肪肝50～59岁组检出率最高,为55.34%;女性60～69岁组脂肪肝检出率最高为44.35%。在〈60岁人群中,男性脂肪肝的检出率显著高于女性（P〈0.01）,而在≥60岁人群中,男性和女性脂肪肝检出率无显著性差异。高脂血症的检出率46.67%（596/1277）。高TG血症组、高TC血症组和MHLP组脂肪肝的检出率分别为53.56%（188/351）、36.17%（34/94）和60.93%（92/151）,均显著高于血TG和TC正常组脂肪肝的检出率20.41%（139/681）（P〈0.01）。高TG血症组和MHLP组脂肪肝的检出率亦分别高于高TC血症组（P〈0.01）。结论具有高级职称或年龄≥40岁的医院职工脂肪肝和高血脂症患病率较高,脂肪肝与年龄、高脂血症尤其高TG血症关系密切。     

同型半胱氨酸水平与年龄因素在高血压合并焦虑状态中的作用探讨

目的 研究血清同型半胱氨酸(Hcy)水平及年龄因素在高血压患者合并焦虑状态之间的关系.方法 对164例近1周常规治疗血压仍不稳定的原发性高血压患者进行患者健康问卷抑郁量表(PHQ-9)和广泛性焦虑量表(GAD-7)抑郁焦虑状态测评,根据合并焦虑状态情况分为无焦虑组(28例)、轻中度焦虑组(81例)和重度焦虑组(55例).分析患者的GAD-7水平,同时检测患者Hcy、LDL-C、HDL-C、高敏C反应蛋白(hs-CRP)和纤维蛋白原(FIB),比较3组间的差别及与高血压合并焦虑状态程度的相关性.结果 无焦虑组、轻中度焦虑组、重度焦虑组的年龄分别为(58.1±2.4)、(58.2±2.0)、(60.6±2.3)岁,Hcy分别为(12.8±0.8)、(16.4±0.7)、(17.4±1.1) μmol/L,3组年龄及Hcy比较差异均有统计学意义(P＜0.05).相关分析显示GAD-7评分与PHQ-9评分相关,相关系数为0.581 (P ＜0.01)；GAD-7评分与Hcy及年龄相关；与其他检验指标未显示相关性.多元回归分析显示PHQ-9、Hcy及年龄是影响高血压合并焦虑状态评分的重要因素.结论 Hcy水平和年龄因素与高血压合并焦虑状态程度具有相关性.     

江西省2013年男男性行为人群艾滋病感染率及相关高危行为现况分析

目的：了解江西省目前男男性行为人群行为学特征及艾滋病病毒感染率现状。方法回顾分析2013年江西省男男性行为人群艾滋病监测哨点资料。结果对纳入7个哨点的1542例进行分析,最近6个月肛交安全套坚持使用率仅为63.1%,接受同伴教育比例为49.7%;参与检测的1534例中,HIV检测阳性49例,阳性率3.2%,梅毒ELISA/TRUST双阳性24例,阳性率1.6%。结论江西省MSM人群安全套持续使用率较低,HIV和梅毒感染率相对较高,MSM人群利用艾滋病防治服务不足,我省应在男男性行为人群配偶及性伴检测、促进安全套使用、开展同伴教育以及发展网络干预方面加强工作力度。     

Real-world treatment patterns of PCSK9 inhibitors among patients with dyslipidemia in Germany,Spain, and the United Kingdom

Objective: Proprotein convertase subtilisin/kexin type 9 antibody inhibitors (PCSK9i) are approved as adjuncts to maximal tolerated statin therapy to lower low-density lipoprotein cholesterol (LDL-C). This study describes real-world use, characteristics of PCSK9i users and non-users, and factors influencing treatment choice.

Methods: A physician and patient survey was conducted in Germany, Spain, and the UK from December 2016 to April 2017 through the Adelphi Dyslipidemia Disease Specific Program. Physicians reported patients’ lipid-lowering therapy (LLT) history and characteristics. PCSK9i users were systematically over-sampled. Results were summarized using frequencies and proportions.

Results: The study included 110, 123, and 117 physicians from Germany, Spain, and the UK, respectively, providing data on 3,073 patients (mean age?=?62 years; 60% male). Most patients (63–73%) had prior statin and/or ezetimibe use. Compared to patients receiving other LLT (n?=?2686), PCSK9i users (222 in Germany, 97 in Spain, 68 in the UK) were, on average, 5–7.5 years younger and had LDL-C at diagnosis averaging 23–53?mg/dl higher. Familial hypercholesterolemia (FH), coronary heart/artery disease, myocardial infarction, and acute coronary syndrome were more common among PCSK9i users than non-users. PCSK9i users were also more likely to use high-intensity statins in their current LLT regimen (64–89% vs 28–50%). Physicians commonly reported PCSK9i benefits on LDL-C and total cholesterol as reasons for initiating these agents, and PCSK9i users reported good knowledge of cardiovascular disease and treatment options.

Conclusions: Results indicate that physicians are prescribing PCSK9i to patients with high cardiovascular risk in accordance with European guidelines and reimbursement requirements.