Baidu
map

赵水平解读ADA糖尿病指南:几乎所有糖尿病患者都需加用他汀

2016-07-21 卢芳 中国循环杂志

糖尿病患者多合并有血脂紊乱,如何更好管理糖尿病患者血脂?近期中南大学湘雅二院赵水平、赵旺等就此对近年来美国糖尿病学会(ADA)和美国内分泌医师协会(AACE)/美国内分泌学会(ACE)对糖尿病患者降脂的态度和推荐进行了对比和分析。   几乎所有糖尿病患者在生活方式干预基础上应加用他汀 ADA指南认为,他汀类药物治疗应基于患者的危险因素而非LDL-C检测结果,推荐几乎所有糖尿

糖尿病患者多合并有血脂紊乱,如何更好管理糖尿病患者血脂?近期中南大学湘雅二院赵水平、赵旺等就此对近年来美国糖尿病学会(ADA)和美国内分泌医师协会(AACE)/美国内分泌学会(ACE)对糖尿病患者降脂的态度和推荐进行了对比和分析。
 
几乎所有糖尿病患者在生活方式干预基础上应加用他汀

ADA指南认为,他汀类药物治疗应基于患者的危险因素而非LDL-C检测结果,推荐几乎所有糖尿病患者在生活方式干预基础上加用他汀类药物治疗。

对于合并ASCVD的所有年龄段糖尿病患者,一开始便予以高强度他汀类治疗。
 
AACE/ACE指南认为,当单纯生活方式干预无法达标时应首选他汀治疗,但对于高危患者,无论LDL-C基线水平如何,他汀类治疗应同生活方式干预一起开始。
 
值得注意的是,他汀类药物用于儿童的长期安全性和心血管获益不明确,对于10岁以下儿童不推荐使用他汀。由于他汀类药物致畸作用尚不明确,孕妇禁用。
 
此外,他汀类药物虽会导致新发糖尿病风险增加,但他汀减少心血管事件发生率的获益远超过新发糖尿病的风险。
 
血脂控制指标:ADA指南放弃,AACE/ACE指南坚持
 
ADA指南放弃血脂治疗目标,而AACE/ACE指南依据糖尿病患者是否并存动脉粥样硬化性心血管病(ASCVD)危险因素,分别制定了相应的血脂治疗目标(表1)。
 
表1  2015年AACE/ACE指南推荐的糖尿病患者血脂治疗目标


注:中危患者是指无显性ASCVD或主要ASCVD危险因素的糖尿病或糖尿病前期患者;高危患者是指伴有≥1项主要ASCVD危险因素(高血压、阳性家族史、HDL-C低下、吸烟等)的糖尿病患者;极高危患者指合并显性ASCVD的糖尿病患者。

赵水平等指出,AACE/ACE指南临床可操作性较强,更为实际,有目标且他汀类药物治疗强度更为稳妥。不过该指南同时把LDL-C和非HDL-C作为首要治疗目标,为使二者均达标,易造成过度医疗。建议把非HDL-C作为在特殊情况下可以考虑的替代治疗目标。
 
高甘油三酯血症:首选他汀,而非贝特

AACE/ACE指南推荐,空腹TG在2.26 mmol/L和5.7 mmol/L间,可使用最大耐受剂量的他汀类药物以使首要治疗目标(LDL-C和非HDL-C)和次要治疗目标(APOB或LDL颗粒)达标。
 
若TG仍>2.26 mmol/L,可以加用贝特类、大剂量鱼油制剂或烟酸等降TG药物。若空腹TG≥5.7 mmol/L,则应使用贝特类、大剂量鱼油制剂或烟酸,甚至联用这3种降TG药物。
 
联合用药
 
ADA指南并不推荐他汀类/贝特类和他汀类/烟酸联合治疗。不过如果HDL-C<1.0 mmol/L和LDL-C在2.6~3.4mmol/L,可使用贝特类或烟酸,尤其在患者不能他汀类药物时。
 
AACE/ACE指南认为单独使用他汀类药物不能达标时,可联用胆汁酸螯合剂、烟酸和/或依折麦布;当不宜使用他汀时,可考虑联用或用这些药物代替他汀。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=131797, encodeId=3b1b131e97fa, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:37:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125621, encodeId=3c9d125621d9, content=高血糖的患者常常出现大血管的损害,尽管血脂不高,加用他汀类药物有助于稳定斑块, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:42:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264602, encodeId=8d46126460244, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474021, encodeId=c2ae14e40213e, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=)]
    2016-09-20 1e10c84am36(暂无匿称)

    文章很好,非常有益

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=131797, encodeId=3b1b131e97fa, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:37:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125621, encodeId=3c9d125621d9, content=高血糖的患者常常出现大血管的损害,尽管血脂不高,加用他汀类药物有助于稳定斑块, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:42:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264602, encodeId=8d46126460244, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474021, encodeId=c2ae14e40213e, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=)]
    2016-09-13 舒心和人

    高血糖的患者常常出现大血管的损害,尽管血脂不高,加用他汀类药物有助于稳定斑块

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=131797, encodeId=3b1b131e97fa, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:37:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125621, encodeId=3c9d125621d9, content=高血糖的患者常常出现大血管的损害,尽管血脂不高,加用他汀类药物有助于稳定斑块, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:42:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264602, encodeId=8d46126460244, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474021, encodeId=c2ae14e40213e, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=)]
    2016-07-23 般若傻瓜
  4. [GetPortalCommentsPageByObjectIdResponse(id=131797, encodeId=3b1b131e97fa, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:37:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125621, encodeId=3c9d125621d9, content=高血糖的患者常常出现大血管的损害,尽管血脂不高,加用他汀类药物有助于稳定斑块, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:42:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264602, encodeId=8d46126460244, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474021, encodeId=c2ae14e40213e, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 23 05:54:00 CST 2016, time=2016-07-23, status=1, ipAttribution=)]
Baidu
map
Baidu
map
Baidu
map