糖尿病脂代谢紊乱

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1、糖尿病脂代谢紊乱及其与冠心病的关系内分泌科糖尿病中心中山医科大学附属第一医院廖志红黄知敏糖尿病脂代谢紊乱及其与冠心病的关系WHYWHO-----GOALSWHENHOW血脂、脂蛋白和载脂蛋白血脂是血浆中的中性脂肪（甘油三酯和胆固醇）和类脂（磷脂、糖脂、固醇、类固醇）的总称脂蛋白是由蛋白质、胆固醇、甘油三酯和磷脂组成的球形大分子复合体载脂蛋白是脂蛋白的蛋白质部分，它与脂质结合，在血浆中运转脂质FredericksonClassificationofDyslipidemiasTypicalLipidRange,mg/dLPhenotypeLipoproteininExcessCholestero

2、lTriglycerideICM300to5005,000to6,000IIALDL250to800<250IIBLDL,VLDL240to350250to500IIIb-VLDL,IDL300to450300to1,000IVVLDL200to240300to700VCM,VLDL200to1,000500to6,000表型分类法有助于高脂血症的诊断和治疗，但是较繁琐。简易分型法将高脂血症分为高胆固醇血症、高甘油三酯血症和混合型高脂血症CausesofSecondaryDyslipidemiasHypercholesterolemiaHypertriglyceridemiaCombined

3、HyperlipidemiaCommondisordersHypothyroidismDiabetesHypothyroidismNephroticsyndromeObesityNephroticsyndromeObstructiveliverdiseaseAlcoholChronicrenalfailureChronicrenalfailureUncommondisordersPregnancyMyocardialinfarctionAcromegalyAnorexianervosaAcuteinfectionLiverdiseaseConnectivetissuediseasesNeph

4、roticsyndromePregnancyBulimiaMedicationsThiazidediureticsb-blockersThiazidediureticsRetinoidsRetinoidsGlucocorticoidsGlucocorticoidsOralestrogensRetinoidsCyclosporineProgestinsAndrogensWHY?糖尿病冠心病的危害性糖尿病冠心病的临床特点脂代谢紊乱在糖尿病冠心病中的地位糖尿病患者调脂治疗的益处大血管病变，微血管病变，其它方面MortalityinpeoplewithdiabetesCausesofdeathGei

5、ssLS,etal.In:DiabetesinAmerica.2nded.1995;chap11.0%ofdeathsIschemicOtherStrictlyCancerStrokeInfectionOtherheartheartdiabetes-diseasediseaserelated5040302010Type2diabetesandCHD:7-yearincidenceoffatal/nonfatalMI(EastWestStudy)MI=myocardialinfarction.*ThesepatientshadnopriorMIatbaseline.HaffnerSM,etal

6、.NEnglJMed.1998;339:229–234.051015202530354045507-yearincidencerateofMINopriorMI*MINopriorMI*MINondiabeticDiabeticn=1373n=1059P<0.001P<0.0014%19%20%45%Type2diabetesandCHD:7-yearincidenceoffatal/nonfatalMI(EastWestStudy)糖尿病合并冠心病的临床特点较高的合并动脉粥样硬化的比例；发病率高且发病年龄提前，女性的保护作用消失；无痛性心梗发生率高；心梗并发症（心衰、心律失常、心源性休克

7、等）发生率高；更容易合并感染；住院时间长，住院病死率高。Across-sectionalaxialimagefroma56-year-olddiabeticpatientwithextensivecalcificationoftheleftanteriordescendingartery(LAD)anddiagonalbranch.AmHeartJ141(4):637-644,2001WHY?糖尿病冠心病的危