北京地区13 336例成人空腹血脂水平分析

目的 通过检测健康查体者空腹血脂水平来了解北京地区人群血脂水平现状及其血脂异常患病率.方法 应用日立7 170全自动生化分析仪检测北京地区13 336例成人空腹血脂,血脂指标包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),比较不同性别和年龄组间血脂水平差别及血脂异常患病率的差异.结果 总体血脂异常患病率59.9%,男性71.6%,女性47.2%.男性TC平均(4.89±0.87)mmol/L、LDL-C平均(3.33±0.84)mmol/L、HDL-C平均(1.28±0.30)mmol/L、TG中位数1.32 mmol/L;女性TC平均(4.79±0.94)mmol/L、LDL-C平均(2.99±0.89)mmol/L、HDL-C平均(1.53±0.34)mmol/L、TG中位数0.9mmol/L.男性和女性4种血脂成分异常患病率均随年龄增加而增高(P＜0.01).TC、LDL-C、TG水平随年龄增加而增高(P＜0.01),HDL-C水平随年龄的增加有降低趋势(P＜0.01).TC在25～44岁间男性高于女性(P＜0.01),在55岁以上女性显著高于男性(P＜0.05).LDL-C在18～44岁间男性高于女性(P＜0.01),在45～74岁女性显著高于男性(P＜0.01).HDL-C水平各年龄组女性明显高于男性(P＜0.01).TG在18～54岁男性显著高于女性(P＜0.01),在55～64岁组两性间无差异,64岁以上女性高于男性(P＜0.05).结论 北京地区成人中血脂异常患病率较高,并且随年龄增大而增高,男女性别间血脂异常患病率差异有统计学意义.     

四川省凉山州公务员血脂水平调查分析

目的 评估凉山州公务员血清三酰甘油(TG)、血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,描述血脂谱的流行特征.方法 于2008年11月至2010年8月完成9 903名凉山州公务员的健康体检,其中男5 872名,女4 031名,按年龄段分为20～29、30～39、40～49、50～59、60～69、≥70岁,检测其血脂指标.结果 凉山州公务员TG、TC、HDL-C、LDL-C的标准化均数依次为(1.87±1.61)、(4.66±0.88)、(1.39±0.33)、(2.59±0.71)mmol/L,血脂异常及边缘异常患病率分别为34.6%、24.5%,其中HDL-C降低的百分比构成远低于其他三项,标准化患病率仅为12.2%.结论 凉山州公务员血脂异常和边缘异常的患病率均较高,人群血脂异常主要表现为高TG和高TC.     

2275例65岁以上老年居民血糖血脂相关性分析

目的探讨65岁以上老年居民血糖和血脂异常情况以及两者的相关性。方法对2275例65岁以上老年居民(1006例男性和1269例女性)的空腹血糖(GLU)、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)的检测结果进行分析和比较。结果 2275例老年居民中GLU升高的占25.3%,TG升高占52.6%,TC升高的占13.1%,LDL-C升高的占24.5%。男性平均血糖水平高于女性(P0.01),HDL-C、LDL-C、TC整体水平女性高于男性(P0.01)。TG水平随血糖升高而升高,HDL-C水平随血糖升高有所下降。结论老年居民的血糖血脂异常率相对较高,血糖和血脂水平有一定相关性,应加强对该人群健康教育和指导,并定期做健康体检。     

浙江省奉化市18岁及以上人群血脂水平及其影响因素调查

目的 了解浙江省奉化市18岁及以上人群血脂水平及其影响因素,为心血管疾病预防提供依据。 方法 采用多阶段分层整群随机抽样方法调查奉化市18岁以上人群600人,采取问卷调查、体格检查和生化检测的方法,进行血脂水平及其影响因素的调查。计量资料用x s表示,组间比较用t检验,计数资料和率的比较用Pearson 2检验和趋势2检验,多因素分析采用非条件logistic回归分析方法。 结果 调查对象血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)平均水平分别为3.95 mmol/L、1.36 mmol/L、2.25 mmol/L和1.02 mmol/L。女性TC、LDL-C和HDL-C平均水平高于男性,差异有统计学意义(TC: t=-3.216,P=0.001;LDL-C: t=-2.396,P=0.017;HDL-C:t=2.498,P=0.013),男女间TG平均水平差异无统计学意义(t=-1.451,P=0.147)。血脂异常率为64.50%,标化异常率为45.47%,血脂边缘异常率为6.33%,标化边缘异常率为4.19%,血脂异常率随年龄增长而增加(趋势2=13.884,P=0.000)。TC、TG、LDL-C和HDL-C标化异常率分别为1.53%、6.78%、1.04%和42.92%,其中 HDL-C异常率男女间差异有统计学意义(2=7.181,P=0.007),且具有增龄趋势(趋势2=10.371,P=0.001)。logistic多因素分析显示,中心性肥胖、年龄、超重或肥胖是血脂异常的危险因素。 结论 奉化市18岁及以上人群血脂异常患病率较高,特别是HDL-C异常患病率较高。应针对血脂异常的危险因素开展社区血脂异常综合防治工作。     

南昌市四个辖区厨师血脂异常的现况分析

目的了解南昌市四个市辖区内厨师群体的血脂异常情况,为防控厨师群体血脂异常相关疾病提供科学依据。方法选取南昌市青山湖区、东湖区、西湖区、青云谱区内年龄≥18岁且完成健康知识问卷调查的1394例厨师作为研究对象,所有研究对象均接受血清甘油三酯(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)检测,现回顾分析其血脂检测结果。结果男性厨师组TG异常率、TC异常率、HDL-C异常率显著高于女性厨师组(P0.05),两种性别厨师LDL-C异常率比较差异无显著性(P0.05)。女性厨师≥40岁组TG异常率、TC异常率显著高于40岁组(P0.05),女性厨师≥40岁组与40岁组HDL-C异常率、LDL-C异常率相比差异无显著性(P0.05)。男性厨师≥40岁组TG异常率、TC异常率、HDL-C异常率显著高于40岁组(P0.05),男性厨师≥40岁组与40岁组LDL-C异常率相比差异无显著性(P0.05)。结论南昌市四个市辖区内厨师群体血脂异常与性别、年龄密切相关,男性≥40岁厨师群体更易发现血脂代谢紊乱。     

新疆牧区少数民族血脂水平调查

目的掌握新疆牧区少数民族血脂水平及血脂异常的患病现况,为今后血脂异常防治工作的开展筛选高危人群。方法采用整群随机抽样的方法对居住在新疆牧区和布克赛尔蒙古自治县和福海县两地的1084例哈萨克人和蒙古人进行现况调查;同时采集空腹静脉血,按照血脂测定的标准方法检测血浆总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C),采用计算法计算高密度脂蛋白胆固醇(HDL-C)的值。结果(1)高LDL-C、低HDL-C血症为该牧区人群血脂异常的主要类型,前者患病率男女性组分别为51.0%,32.1%(χ2=39.50,P<0.01);后者患病率分别为50.2%,29.8%(χ2=45.60,P<0.01),均接近全国最高水平。(2)血脂异常的患病率与年龄、性别有关。60岁年龄组以前男性组大于女性组,60岁年龄组以后则为女性组大于男性组);随年龄的增加男女患病率均成增加趋势。(3)HDL-C水平总趋势是女性组高于男性组,但差异无显著性意义。(4)与内地其他地区调查结果比较,本次调查人群的TC,LDL-C水平均处在较高水平,而TG,HDL-C处于较低水平。(5)与10年前该民族的血脂水平比较,TC,TG,LDL-C呈增加趋势,HDL-C呈递减趋势。结论新疆牧区哈萨克人和蒙古人为血脂异常的高发人群,其原因可能除与该民族的遗传易感性有关外,其特殊的饮食结构和习惯对血脂的影响也不容     

青海省藏、汉族居民血脂异常特点分析

目的调查分析青海省藏、汉族成年居民血脂水平及其异常检出率的差异,为该地区血脂异常的防治提供依据。方法选取青海省藏(3 343例)、汉族(3 842例)体检者共7 185例为调查对象,测定血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)4项指标,分析藏、汉族血脂异常的特点,并比较两民族血脂异常检出率的差异。结果血脂异常总的患病率为49.1%,高于国内平原地区,藏族低于汉族(45.3%vs52.3%);两组人群中,血脂异常的发生率均随着年龄的增加而增高;55岁以前男性血脂异常的发生率高于女性(P0.05);藏族TC、LDL-C水平高于汉族(P0.05),而TG和HDL-C水平低于汉族(P0.05);藏族以高TC血症为主,汉族以高TG血症为主,两组中低HDL-C血症的发生率均为最低。结论青海省藏、汉族血脂异常的发生率高于平原地区,藏族呈"高TC、高LDL-C"、汉族呈"高TG"血脂分布特点,血脂异常的发生率在年龄、性别、民族间存在差异,应重视高原人群的血脂筛查及干预工作,降低血脂异常的患病率,预防心脑血管事件发生。     

血生化检验中血液胆固醇异常与ApoB代谢缺陷的关系研究

目的分析血生化检验中血液胆固醇异常与载脂蛋白B(ApoB)代谢缺陷的相关性。方法将2015年10月～2017年10月行体检的395例健康体检者(对照组)及181例血脂异常患者(观察组)纳入研究,对以上576名研究对象进行FBG、2hPBG、TG、TC、LDL﹣C、HDL﹣C、ApoB水平检测,比较两组各项血生化指标的差异,同时分析ApoB与其他血脂指标之间的相关性。结果继发性血脂水平异常比例(81.22%)明显高于原发性血脂水平异常(18.78%),差异具有统计学意义(P0.05)。观察组FBG、2hPBG、TG、TC、LDL-C、HDL-C、ApoB水平与对照组比较,有显著差异(P0.05)。多元分析结果显示,观察组ApoB与FBG、2hPBG、TG、TC、LDL-C、HDL-C等水平之间具有一定相关性,差异具有统计学意义(P0.05)。结论血脂异常以继发性为多见,血脂异常者FBG、2hPBG、TG、TC、LDL-C、HDL-C等水平有异于健康人群,ApoB的代谢缺陷与血胆固醇异常具有密切的关系。     

血液透析患者脂代谢现况调查及影响因素分析

目的:评估单中心血液透析患者脂代谢现况,并探讨相关危险因素。方法:以复旦大学附属中山医院血液净化中心维持性血液透析3个月以上的患者为研究对象进行横断面调查。所有患者均空腹检测三酰甘油(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)、糖化血红蛋白(HbA1c)、血清白蛋白等指标,并进行透析充分性评估。同时收集患者一般情况、病史资料。结果:203例患者平均TC为(4.45±1.16)mmol/L、TG(1.93±2.18)mmol/L、HDL-C(1.16±0.34)mmol/L、LDL-C(2.51±0.93)mmol/L。其中,132例患者(65%)存在至少1项血脂异常。女性患者血清高TC和高LDL-C比例高于男性,低HDL-C比例低于男性(P0.05)。年龄≥60岁组患者血清TG水平高于年龄45岁组和45~59岁组;年龄45岁组患者血脂异常比例最高(P0.05)。透析龄60个月组患者TG异常比例低于透析龄12个月组和透析龄12~60个月组;透析龄12个月组患者TG异常比例最高(P0.05)。HbA1c≤6%组TG水平低于HbA1c6%组;HbA1c≤6%组患者血脂异常比例低于HbA1c6%组(P0.05)。结论:维持性血液透析患者脂代谢紊乱发生率高;女性、年龄45岁、透析龄12个月、HbA1c6%是维持性血液透析患者脂代谢异常的危险因素。     

血清总胆固醇与高密度脂蛋白胆固醇比值作为冠心病危险标志的意义

目的分析冠心病(CHD)患者的血脂水平,探讨血清总胆固醇(TC)与高密度脂蛋白胆固醇(HDL-C)比值作为CHD危险标志的临床意义。方法测定295例CHD患者的血清TC、三酰甘油(TG)、HDL-C及低密度脂蛋白胆固醇(LDL-C)水平,并计算TC/HDL-C比值。结果依据《中国成人血脂异常防治指南》颁布的血脂水平合适范围,CHD患者血清TC、TG及LDLC高于合适范围百分率分别为32.20%、34.24%及37.63%,血清HDL-C低于合适范围百分率为39.32%。血清TC/HDL-C比值高于合适范围百分率为57.29%。血清TC/HDL-C比值异常率显著高于血清TC、TG、HDL-C及LDL-C(χ2=37.540、31.576、19.066、22.866,P0.01)。结论与任一单项血脂检测相比,血清TC/HDL-C比值作为CHD危险标志可能更有临床意义,临床血脂检测报告单应增加TC/HDL-C比值。     

Obesity and dyslipidemia

Dyslipidemia associated with obesity and the metabolic syndrome is one of the central features contributing to the increased CV risk in these patients. In view of the pandemic of the metabolic syndrome, it is imperative to fully understand the mechanisms leading to the metabolic lipid phenotype before embarking upon optimal treatment strategies. The traditional concept that insulin resistance causes increased FFA flux via increased TG hydrolysis in adipose tissue is still of a central theme in the general hypothesis. The combination of increased hepatic VLDL secretion with impaired LPL-mediated TG clearance explains the hypertriglyceridemia phenotype of the metabolic syndrome. Hence, central IR may be an important factor contributing to peripheral hypertriglyceridemia. Recently recognized regulatory systems include the profound impact of the hypothalamus on TG secretion and glucose control. In addition, dysfunctional (or inflamed) intra abdominal adipose tissue has emerged as a potent regulator of dyslipidemia and IR. It will be a challenge to design novel treatment modalities that target “dysfunctional” fat or central IR to attempt to prevent the epidemic of CV disease secondary to the metabolic syndrome.     

瑞舒伐他汀与考来烯胺治疗血脂异常的疗效观察

目的观察瑞舒伐他汀与考来烯胺治疗血脂异常的疗效及安全性。方法80例血脂异常患者随机分为瑞舒伐他汀组40例和考来烯胺组40例,治疗12周。分别测定治疗前后总胆固醇（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）等。结果治疗12周后瑞舒伐他汀组TC、LDL—C、TG水平与治疗前比较有明显降低,HDL—C升高,与治疗前比较差异有统计学意义（P〈0．05）。考来烯胺组TC、LDL—C下降,HDL—C增高,与治疗前比较差异有统计学意义（P〈0．05）,TG无明显变化。结论瑞舒伐他汀和考来烯胺均可有效调脂。     

血脂异常诊断与治疗进展

血脂异常是冠心病、心梗和缺血性脑卒中等心脑血管病的重要危险因素。据卫生部的权威报告显示,在我国18周岁以上的成年人血脂异常总患病人数已达1.6亿,在35岁以上的人群中,有2 500万人同时患有高血压和高脂血症。血脂异常对我国人民健康的危害上升到原来的3~5倍。     

Treatment of hypertension with dyslipidemia

Lifestyle modifications are the first approach to the treatment of dyslipidemia and hypertension, that is, control of overweight; reduced intake of saturated fat, cholesterol, sodium chloride, and alcohol; and increased physical activity. In high doses, thiazide diuretics and loop diuretics can induce at least short-term increases in levels of total plasma cholesterol, triglycerides, and low-density lipoprotein cholesterol. Low-dose thiazide diuretics do not produce these effects. beta-blockers may increase levels of plasma triglycerides transiently and reduce levels of high-density lipoprotein cholesterol. alpha-blockers may decrease serum cholesterol concentration to a modest degree and increase high-density lipoprotein cholesterol. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium antagonists, and central adrenergic agonists have clinically neutral effects on levels of serum lipids and lipoproteins.     

Management of dyslipidemia in NIDDM

Coronary heart disease is the leading cause of death among patients with non-insulin-dependent diabetes mellitus (NIDDM). NIDDM patients have a high frequency of dyslipidemia, which along with obesity, hypertension, and hyperglycemia may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for coronary heart disease are additive and perhaps multiplicative, even mild degrees of dyslipidemia may enhance coronary heart disease risk. Therefore, therapeutic strategies for management of NIDDM should give equal emphasis to controlling hyperglycemia and dyslipidemia. The National Cholesterol Education Program recently issued guidelines for treatment of hyperlipidemia in adults including diabetic patients. Because of the unique features of diabetic dyslipidemia, however, we suggest that certain modifications in these guidelines be made to meet specific needs of diabetic patients. For example, therapeutic goals for serum cholesterol reduction should be lower in diabetic patients than in nondiabetic subjects. Particular emphasis should be given to weight reduction in NIDDM patients. In some diabetic patients, monounsaturated fatty acids may be a better replacement for saturated fatty acids than carbohydrates. The target for cholesterol lowering should include both very-low-density lipoprotein and low-density lipoprotein (LDL) (non-high-density lipoprotein) rather than LDL alone. To obtain a substantial reduction of cholesterol levels, drug therapy may be required in many patients. However, first-line drugs for nondiabetic patients (nicotinic acid and bile acid sequestrants) may be less desirable in NIDDM patients than hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors and even fibric acids. In fact, HMG CoA reductase inhibitors may be the drugs of choice for NIDDM patients with elevated LDL cholesterol and borderline hypertriglyceridemia, whereas gemfibrozil appears preferable for NIDDM patients with severe hypertriglyceridemia.     

血脂异常的药物治疗

血脂异常可作为代谢综合征的组分之一,与多种疾病如肥胖症、2型糖尿病、高血压、冠心病、脑卒中等密切相关。长期血脂异常可导致动脉粥样硬化、增加心脑血管病的发病率和死亡率。随着生活水平提高和生活方式改变,我国血脂异常的患病率已明显升高。据《中国居民营养与健康现状（2004年）》报道,我国成人血脂异常患病率为18．60％,估计患病人数1．6亿。防治血脂异常对延长寿命、提高生活质量具有重要意义。     

肾小球病患者血脂异常特点及相关因素分析

目的：探讨肾小球病患者血脂异常特点、患病率和影响因素。方法横断面单中心分析我院经肾活检组织检查和临床确诊的3984例肾小球病患者的临床和化验资料并进行统计学分析和比较。结果依据尿蛋白>3.5 g/L 和血清白蛋白<30 g/L 者为肾病综合征(肾病)组1918例,其余为非肾病综合征(非肾病)组2066例。①肾病组血脂异常患病率(83.4%)明显高于非肾病组(41.2%)(P <0.05)。肾病组以高胆固醇和混合型高脂血症为主(37.0%,33.8%);非肾病组以高甘油三酯血症为多(14.6%),超过半数(52.3%)的小血管炎患者为低高密度脂蛋白血症。随着增龄高胆固醇血症占比进行性升高。②相关分析示：年龄和体质量指数对脂质各组份均产生不利的影响;胆固醇、甘油三酯和低密度脂蛋白胆固醇与尿蛋白正相关、血白蛋白负相关;血尿酸和血糖与高密度脂蛋白负相关(P均<0.01)。结论肾病患者血脂异常患病率高、以高胆固醇血症和混合高脂血症为主;非肾病患者以高甘油三酯血症为主;尿蛋白、年龄、体质量指数、血白蛋白和血糖均是影响血脂代谢异常的相关因素。     

Niacin-ER and lovastatin treatment of hypercholesterolemia and mixed dyslipidemia

OBJECTIVE: To review the currently available information on the once-daily combination of niacin extended-release (ER)/lovastatin in the treatment of patients with hypercholesterolemia and mixed dyslipidemia at high risk for cardiovascular events. DATA SOURCES: MEDLINE (1966-July 2002) was searched for primary and review articles. Data from the manufacturer were also included. STUDY SELECTION/DATA EXTRACTION: All articles and product labeling deemed relevant to the combination of niacin and statins (i.e., lovastatin) were included for review. English-language studies selected for inclusion were limited to those with human subjects. DATA SYNTHESIS: The Food and Drug Administration approved a new fixed-dose combination of niacin-ER/lovastatin, which is administered once daily. The efficacy and safety of the combined agent have been proven to be similar to either component used alone or in combination for management of hyperlipidemia and mixed dyslipidemia. CONCLUSIONS: Elevated low-density lipoprotein cholesterol (LDL-C) is independently associated with a higher risk for cardiovascular events. Lowering of elevated LDL-C concentrations with statin monotherapy may be insufficient in patients at high risk for cardiovascular events. In fact, consideration of elevated triglycerides (TGs) and/or low concentrations of high-density lipoprotein cholesterol (HDL-C) in patients with elevated LDL-C places them at greater risk. The addition of niacin may enhance or improve the lipid profile of those who require a further decrease of TGs and/or increase of HDL-C even after stable statin therapy. Niacin-ER offers efficacy similar to that of immediate-release niacin, but minimal myopathy and hepatotoxicity (compared with sustained-release niacin). Although no clinical outcomes are available, current evidence shows that the combination product offers adequate lowering of LDL-C and TGs and increasing HDL-C. The data suggest that therapy with the niacin-ER and lovastatin combination product is safe and does not increase the incidence of adverse effects.     

The metabolic basis of atherogenic dyslipidemia

Atherogenic dyslipidemia is one of the major components of the metabolic syndrome, a complex cluster of several risk factors within a single patient that according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III includes at least 3 of the following: large waist circumference, elevated triglyceride levels, low levels of high-density lipoprotein cholesterol (HDL-C), hypertension, and elevated fasting glucose levels, which are directly related to the incidence of coronary heart disease. Atherogenic dyslipidemia clinically presents as elevated serum triglyceride levels, increased levels of small dense low-density lipoprotein (sdLDL) particles, and decreased levels of HDL-C. An important component of atherogenic dyslipidemia is central obesity, which is defined as increased waist circumference and has recently been identified as a chief predictor of the metabolic syndrome in certain patients. Another recent study found that both body mass index and waist circumference were highly predictive of eventual development of the metabolic syndrome. Because atherogenic dyslipidemia usually precedes the clinical manifestation of the metabolic syndrome, strategies to treat it are the focus of pharmacologic intervention. For example, the 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors, commonly known as statins, benefit hypercholesterolemic patients who have atherogenic dyslipidemia that is associated with the metabolic syndrome. Pioglitazone, an antidiabetic agent that acts primarily by decreasing insulin resistance, improves sensitivity to insulin in muscle and adipose tissue and inhibits hepatic gluconeogenesis. Pioglitazone improves glycemic control while reducing circulating insulin levels. The investigational agent, rimonabant--a centrally and peripherally acting, selective cannabinoid type-1 receptor blocker--is the first therapy developed for managing several cardiovascular risk factors at one time. Rimonabant has shown promise in attacking atherogenic dyslipidemia from several vantage points by affecting glucose, HDL-C, triglycerides, and waist circumference in patients who are prone to atherogenic dyslipidemia.