HDL-C-楂樺瘑搴﹁剛铔嬬櫧鑳嗗浐閱囨祴瀹氳瘯鍓傜洅(鐩存帴娉?杩囨哀鍖栨阿閰舵竻闄ゆ硶)
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鏍锋湰绫诲瀷锛氳娓呮垨鑲濈礌閿傛姉鍑濊娴咟/p>
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璇曞墏鐩掍紭鍔军/h4>
1.閲囩敤鐩存帴娉?杩囨哀鍖栨阿閰舵竻闄ゆ硶锛岀壒寮傛€ч珮锛屾姉骞叉壈鍔涘己
2.绮惧瘑搴﹂珮锛孋V≤4%
3.鏍″噯鍝佸畾鍊兼函婧愯嚦GBW09178
鎸囨爣绠€浠婞/h3>
鑴傝川瀵逛簬缁存寔鏈轰綋姝ｅ父鐢熺悊娲诲姩锛岀壒鍒槸鍦ㄨ兘閲忎唬璋㈠拰鑶滄瀯鎴愪腑鍏锋湁閲嶈鎰忎箟銆傝鑴傛槸琛€娑蹭腑鑴傜被鐗╄川鐨勬€荤О锛屽寘鎷儐鍥洪唶銆佺敇娌逛笁閰紙TG锛夊拰绫昏剛锛堝纾疯剛锛夌瓑銆傝鑴備笉婧朵簬姘达紝蹇呴』涓庣壒娈婄殑铔嬬櫧璐紝鍗宠浇鑴傝泲鐧斤紙apoprotein锛孉po锛夛紝缁撳悎褰㈡垚鑴傝泲鐧芥墠鑳芥憾浜庤娑诧紝琚繍杈撹嚦缁勭粐杩涜浠ｈ阿銆傛牴鎹矑寰勫ぇ灏忓拰姘村悎瀵嗗害涓嶅悓锛岃剛铔嬬櫧锛堢矑寰勯€愭笎鍙樺皬锛屾按鍚堝瘑搴﹂€愭笎鍙樺ぇ锛夊垎涓轰钩绯滃井绮掞紙CM锛夈€佹瀬浣庡瘑搴﹁剛铔嬬櫧锛圴LDL锛夈€佷腑闂村瘑搴﹁剛铔嬬櫧锛圛DL锛夈€佷綆瀵嗗害鑴傝泲鐧斤紙LDL 锛夊拰楂樺瘑搴﹁剛铔嬬櫧HDL銆傛澶栵紝杩樻湁涓€绉嶇壒娈婅剛铔嬬櫧绉颁负鑴傝泲鐧絘锛圠p(a)锛堻span style="color:hsl(212,80%,42%);">[1]銆 楂樺瘑搴﹁剛铔嬬櫧锛坔igh density lipoprotein锛孒DL)涓昏鐢辫倽鑴忓拰灏忚偁鍚堟垚锛屼负棰楃矑鏈€灏忕殑鑴傝泲鐧斤紝鍏朵腑鑴傝川鍜岃泲鐧借川閮ㄥ垎鍑犱箮鍚勫崰涓€鍗娿€侶DL鏄惈鏈堿poA I銆丄poA鈪°€佺７鑴傚拰鑳嗗浐閱囩殑灏忓瀷鑴傝泲鐧介绮掋€侶DL鐨勬姉鍔ㄨ剦绮ユ牱纭寲浣滅敤鍙兘鏄敱浜庡畠鑳藉皢鍛ㄥ洿缁勭粐鍖呮嫭鍔ㄨ剦澹佸唴鐨勮儐鍥洪唶杞繍鍒拌倽鑴忚繘琛屼唬璋紙鍗宠儐鍥洪唶閫嗚浆杩愶紝reverse cholesterol transport锛孯CT锛夛紝浠ュ強鍚湁ApoE鐨凥DL涓嶭DL绔炰簤LDL鎴朆/E鍙椾綋锛屽洜鑰屾姂鍒禠DL閫氳繃鍙椾綋杩涘叆缁嗚優鍐呫€傝€屼笖鏈夌爺绌跺彂鐜帮紝HDL杩樺叿鏈夋姉LDL姘у寲鐨勪綔鐢紝骞惰兘淇冭繘鎹熶激鍐呯毊缁嗚優鐨勪慨澶嶏紝杩樿兘绋冲畾鍓嶅垪鐜礌鐨勬椿鎬?span style="color:hsl(212,80%,42%);">[2]銆侶DL棰楃矑鐨凙po绾﹀崰50%锛屽叾涓瑼poA 1绾﹀崰铔嬬櫧璐ㄧ殑65%~75%锛岃€屽叾浠栬剛铔嬬櫧涓瑼poA 1鏋佸皯銆侶DL棰楃矑涓殑鍏朵粬铔嬬櫧鎴愬垎濡傝娓呮穩绮夋牱铔嬬櫧A (serum amyloid A锛孲AA)銆佸嵉纾疯剛鑳嗗浐閱囬叞鍩鸿浆绉婚叾锛坙ecithin cholesterol acyltransferase锛孡CAT)銆佸姘х７閰秎 (paraoxonase-1锛孭ON-1)銆佽儐鍥洪唶閰浆绉昏泲鐧斤紙cholesteryl ester transfer protein锛孋ETP) 绛夛紝鍏卞悓鍙備笌HDL鐨勪唬璋㈣繃绋嬨€侶DL鐨勪唬璋㈠紓甯稿彲鑳戒笌澶氱鐤剧梾鐩稿叧锛屽寘鎷姩鑴夌播鏍风‖鍖栥€佸啝蹇冪梾绛夈€傚洜姝わ紝缁存寔姝ｅ父鐨凥DL姘村钩瀵逛簬蹇冭绠″仴搴疯嚦鍏抽噸瑕併€備复搴婁笂锛岄€氳繃娴嬪畾琛€娓呬腑鐨凥DL-C锛堥珮瀵嗗害鑴傝泲鐧借儐鍥洪唶锛夋按骞筹紝鍙互璇勪及涓綋鐨勫績琛€绠￠闄┿€傝娴嗚剛铔嬬櫧涓€鑸憟鐞冪姸锛屼笉鏄撶洿鎺ユ祴瀹氥€傜敱浜嶭DL銆丠DL涓儐鍥洪唶鍚噺姣旇緝绋冲畾锛屼复搴婁笂甯搁€氳繃妫€娴嬩綆瀵嗗害鑴傝泲鐧借儐鍥洪唶锛圠DL cholesterol锛孡DL-C)銆侀珮瀵嗗害鑴傝泲鐧借儐鍥洪唶锛圚DL cholesterol锛孒DL-C)鍚噺闂存帴浜嗚В琛€娴哃DL銆丠DL鍚噺[1, 3]銆侟/p>
妫€娴嬪師鐞咟/h3>
鍙嶅簲鍒嗕袱姝ヨ繘琛岋細
绗竴姝ワ細璇曞墏1涓儐鍥洪唶閰叾锛圕EH锛夛紝鑳嗗浐閱囨哀鍖栭叾(CHOD)鍜岃繃姘у寲姘㈤叾锛圕atalase锛夊幓闄や钩绯滈绮掞紙CM锛夈€佷綆瀵嗗害鑴傝泲鐧借儐鍥洪唶锛圠DL-C锛夊拰鏋佷綆瀵嗗害鑴傝泲鐧借儐鍥洪唶锛圴LDL-C锛夛紝鍏跺弽搴斾笉鏄捐壊銆侟br />
绗簩姝ワ細璇曞墏2涓殑琛ㄩ潰娲绘€у墏閲婃斁楂樺瘑搴﹁剛铔嬬櫧鑳嗗浐閱囷紙HDL-C锛夛紝骞跺湪鑳嗗浐閱囬叝閰躲€佽儐鍥洪唶姘у寲閰躲€佽繃姘у寲鐗╅叾浣滅敤涓嬪彂鐢熸樉鑹插弽搴斻€侟/p>
涓村簥搴旂敤
- 琛€娓匟DL-C姘村钩閫氬父涓嶢SCVD鍙戠梾鍗遍櫓鍛堣礋鐩稿叧銆?977骞达紝Castelli绛夐鍏堟彁鍑洪珮瀵嗗害鑴傝泲鐧借儐鍥洪唶 (HDL-C) 姘村钩涓庡績琛€绠＄柧鐥呴闄╁憟璐熺浉鍏炽€備經鏄庢眽濮嗗績鑴忕爺绌?Framingham Heart Study) 鏍规嵁鍓嶇灮鎬ч槦鍒楃爺绌惰瘉瀹炰簡杩欎竴瑙傜偣锛屽苟涓斿彂鐜癏DL-C姘村钩姣忛檷浣?0mg/dl锛屽績琛€绠￠闄╁皢澧炲姞50%銆備竴椤筂eta鍒嗘瀽鏄剧ず锛孒DL-C姘村钩姣忓鍔?mg/dl锛岀敺鎬у彂鐢熷啝蹇冪梾鐨勯闄╁皢涓嬮檷2%锛屽コ鎬у垯涓嬮檷3%銆傝繖浜涜瘉鎹潎鎻愮ず锛屽崌楂楬DL-C姘村钩鍙兘鏄檷浣庡績琛€绠￠闄╃殑鏈夋晥閫斿緞[4]銆侟/li>
- TG鍗囬珮甯镐即闅忕潃HDL-C鐨勯檷浣庯紝涓ラ噸钀ュ吇涓嶈壇鑰呬即闅忚娓匱C鏄庢樉闄嶄綆锛孒DL-C涔熶綆涓嬨€侶DL-C闄嶄綆杩樺彲瑙佷簬鎬ユ€ф劅鏌撱€佺硸灏跨梾銆佽偉鑳栥€佸惛鐑熴€佹參鎬ц偩鍔熻兘琛扮銆佽倽鐐庡拰鑲濈‖鍖栫瓑鐤剧梾銆侟/li>
- 鏈€杩戠殑鐮旂┒瀵逛紶缁熺悊瑙ｇ殑HDL-C涓庡績琛€绠＄柧鐥呴闄╀箣闂村崟涓€鍙嶆瘮鍏崇郴鎻愬嚭浜嗚川鐤戙€傚湪涓€椤归拡瀵瑰啝鐘跺姩鑴夌柧鐥?CAD)鎮ｈ€呯殑鍓嶇灮鎬с€佸涓績鐨勮嫳鍥介槦鍒楃爺绌朵腑锛岃瀵熷埌HDL-C姘村钩涓庡叏鍥犳浜＄巼銆佸績琛€绠＄柧鐥呮浜＄巼绛夌粓鐐逛簨浠朵箣闂村憟"U"鍨嬪叧绯伙紝骞堕潪瓒婇珮瓒婂ソ銆傚悓鏍风殑鐜拌薄鍦ㄤ腹楹﹀拰鏃ユ湰鐨勯槦鍒楃爺绌朵腑涔熸湁鍙戠幇[5]銆傚洜姝わ紝HDL鈥慍娴撳害骞朵笉鏄秺楂樿秺濂姐€傛祿搴︿笉鑳藉弽鏄 HDL鈥慍 棰楃矑鐨勫姛鑳斤紝姝ゅ锛屾煇浜涘洜绱犲彲灏咹DL鈥慍鐨勬姉鐐庣棁鐘舵€佽浆鎹负鑷寸値鐥囩姸鎬?span style="color:hsl(212,80%,42%);">[6]銆侟/li>
- 鍙︽湁鐮旂┒鍙戠幇锛屼笌HDL-C鐩告瘮锛孒DL棰楃矑鐨勬祿搴﹀浜庤瘎浼癆SCVD椋庨櫓鍜屼粬姹€绫昏嵂鐗╂不鐤楀悗鐨勬畫鐣欓闄╂洿鍏蜂复搴婁环鍊笺€傚鍔燞DL棰楃矑娴撳害鐨勬不鐤楃瓥鐣ユ湁鏈涢檷浣庢畫浣欓闄┿€傚洜姝わ紝妫€娴婬DL鐨勪簹缁勪唤鎴栭绮掓祿搴﹀凡鎴愪负鐮旂┒HDL涓嶢SCVD鍗遍櫓鎬у叧绯荤殑鐑偣[7]銆傛浘璁や负鍦ㄤ复搴婁笂娴嬪畾HDL2浜氱粍鍒嗘祿搴﹀棰勬祴鍐犲績鐥呯殑浠峰€艰緝澶э紝鍏舵晱鎰熸€х害姣旀€籋DL-C楂?.5鍊嶃€備絾鏂拌繎鐨勭爺绌惰〃鏄庯紝娴嬪畾HDL3浜氱粍鍒嗘祿搴﹀棰勬祴鍐犲績鐥呭叿鏈夊悓鏍风殑浠峰€硷紝骞跺彲鑳借緝HDL2浜氱粍鍒嗘祿搴︾殑娴嬪畾浠峰€兼洿澶?span style="color:hsl(212,80%,42%);">[2]銆侟/li>
- 闈濰DL-C(non-HDL-C)锛氶潪HDL-C(non-HDL-C)鏄寚琛€娑蹭腑闄DL浠ュ鍏朵粬鑴傝泲鐧芥墍鍚儐鍥洪唶鐨勬€诲拰锛屽寘鎷琕LDL銆両DL銆丩DL鍜孡p(a)涓殑鑳嗗浐閱囥€傝绠楀叕寮忓涓嬶細闈濰DL-C=TC-HDL-C銆傝秺鏉ヨ秺澶氱殑璇佹嵁琛ㄦ槑锛岄潪HDL-C鍙兘鏄瘮LDL-C鏇村ソ鐨勮瘎浼板啝鐘跺姩鑴夌梾鍙樹弗閲嶇▼搴︺€侀娴嬪績琛€绠′簨浠堕闄╃殑鏈夋晥鎸囨爣銆備粬姹€娌荤枟鍚庡績琛€绠＄梾浜嬩欢鐨勪笅闄嶄笌LDL-C鍙婇潪HDL-C鐨勫叧绯绘樉绀猴紝闈濰DLC涓庡績琛€绠′簨浠跺悓鏍峰瓨鍦ㄦ槑鏄剧殑姝ｇ浉鍏虫€э紝涓旀瘮LDL-C鐨勭浉鍏虫€ф洿鍔犳槑鏄俱€傚浗鍐呭琛€鑴傚紓甯搁槻娌绘寚鍗楁帹鑽愬叾浣滀负璋冭剛娌荤枟鐨勬瑕佸共棰勯澏鐐?鈪绫绘帹鑽愶紝B绾ц瘉鎹?[8]銆傚熀浜庡皢鏉ユ洿澶氫复搴婅瘉鎹紝闈濰DL-C鏈夋湜鍙栦唬LDL-C鎴愪负涓昏鐨勬不鐤楃洰鏍嘃span style="color:hsl(212,80%,42%);">[9]銆傛澶栵紝闈濰DL-C璁＄畻绠€鍗曪紝涓旂粨鏋滅ǔ瀹氾紝鍙桾G娉㈠姩鍜岃繘椁愬悗褰卞搷杈冨皬銆傞潪HDL-C閫傚悎浣滀负TG杞绘垨涓害鍗囬珮(2.26~5.65mmol/L)銆佺硸灏跨梾銆佷唬璋㈢患鍚堝緛銆佽偉鑳栧拰鏋佷綆LDL-C绛夌壒娈婁汉缇ょ殑闄嶈剛鐩爣銆傚€煎緱娉ㄦ剰鐨勬槸锛岄潪HDL-C鐨勫弬鑰冨€间负1.97锝?.63 mmol/L锛屼絾杩欎釜鏁板€煎彲鑳藉洜骞撮緞銆佹€у埆銆佺鏃忕瓑鍥犵礌鑰屾湁鎵€涓嶅悓銆傚湪瀹為檯涓村簥搴旂敤涓紝鍖荤敓搴旀牴鎹偅鑰呯殑鍏蜂綋鎯呭喌鏉ヨ瘎浼伴潪HDL-C鐨勬按骞筹紝骞跺埗瀹氱浉搴旂殑娌荤枟鍜岀鐞嗙瓥鐣ャ€傞€氬父鏉ヨ锛岄潪HDL-C娌荤枟鐩爣鍊兼瘮LDL-C楂樼害0.78mmol/L[1, 3]銆傞潪HDL鈥慍鐩爣鍊间笌LDL鈥慍鐩爣鍊间箣闂寸殑宸€奸殢LDL鈥慍鍊奸檷浣庤€岀缉灏廃span style="color:hsl(212,80%,42%);">[9]銆侟/li>
閫傜敤绉戝
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閫傜敤绉戝 |
閫傛浜虹兢 |
|
鍐呯/蹇冨唴绉慄/strong> |
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鑲剧梾绉?鑲惧唴绉慄/strong> |
鎱㈡€ц偩鍔熻兘涓嶅叏銆佸悇绉嶆€ユ參鎬ц偩鑴忕梾 |
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鐨偆绉慄/strong> |
鐨偆鎴栬倢鑵遍粍鑹茬槫鍙婅窡鑵卞鍘氳€匋/p> |
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娑堝寲绉?鑲濊儐鍐呯 |
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濡囦骇绉慄/strong> |
瀛曞 |
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鑲跨槫绉慄/strong> |
澶氬彂鎬ч楂撶槫銆佹穻宸寸槫銆佷钩鑵虹檶绛堻/p> |
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钀ュ吇绉慄/strong> |
钀ュ吇涓嶈壇 |
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鎬ヨ瘖绉?鎰熸煋绉?ICU |
鎬ユ€ф劅鏌撱€佽創姣掔棁锛堣触琛€鐥囷級 |
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椋庢箍鍏嶇柅绉慄/strong> |
绯荤粺鎬х孩鏂戠嫾鐤?/p> |
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浣撴绉?浣撴涓績 |
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[2] 涓崕鍖诲浼?涓崕鍖诲浼氭潅蹇楃ぞ,涓崕鍖诲浼氬叏绉戝尰瀛﹀垎浼?绛? 琛€鑴傚紓甯稿熀灞傝瘖鐤楁寚鍗?2019骞?[J]. 涓崕鍏ㄧ鍖诲笀鏉傚織,2019,18(5):406-416.
[3] 涓崕鍖诲浼氭楠屽尰瀛﹀垎浼?涓浗鍖诲笀鍗忎細妫€楠屽尰甯堝垎浼?涓浗鐢熺墿鍖栧涓庡垎瀛愮敓鐗╁浼氳剛璐ㄤ笌鑴傝泲鐧戒笓涓氬鍛樹細,绛? 涓浗涓村簥琛€鑴傛娴嬫寚鍗梉J]. 涓崕妫€楠屽尰瀛︽潅蹇?2022,45(10):1017-1033.
[4] 鏈辨弧,鏅紵,娑傚缓鎴? 楂樺瘑搴﹁剛铔嬬櫧鎶楀姩鑴夌播鏍风‖鍖栫殑鐮旂┒杩涘睍[J]. 涓崕妫€楠屽尰瀛︽潅蹇?2016,39(4):315-318.
[5] 鏉庢睙,鍛ㄥ厑,鏇规案褰? 楂樺瘑搴﹁剛铔嬬櫧閲忓拰璐ㄥ湪鍔ㄨ剦绮ユ牱纭寲涓殑涓村簥搴旂敤[J]. 涓崕妫€楠屽尰瀛︽潅蹇?2023,46(7):667-671.
[6] 鏉ㄤ簹鏌?闄堢孩,瀛欒壓绾? 楂樺瘑搴﹁剛铔嬬櫧鑳嗗浐閱囷細"濂?quot;鑳嗗浐閱?[J]. 涓崕蹇冭绠＄梾鏉傚織,2023,51(7):693-695.
[7] 瀹嬩匠甯?姹繆鍐? 鍏虫敞闈炰紶缁熷嵄闄╁洜瀛愬湪蹇冭绠＄柧鐥呮畫浣欓闄╄瘎浼颁腑鐨勪綔鐢╗J]. 涓崕妫€楠屽尰瀛︽潅蹇?2019,42(8):595-601.
[8] 鍒樻収鎱?鏉庡缓鍐? 闈炰紶缁熻鑴傛寚鏍囩殑涓村簥鎰忎箟搴斿彈鍒板叧娉╗J]. 涓崕鍖诲鏉傚織,2021,101(39):3190-3194.
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