贝特类药物在血脂治疗中的作用PPT课件.ppt

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1、COOCCH3COOCHCH3CH3ClCH3OCCH3COOC2H5CH3ClCH3CH3OCH2CH2CH2CH2CH3COOHCH3CFenofibrateClofibrateGemfibrozil%ReductionHMGCoARI20-50%Bileacidresins15-25%DosedependentNicotinicacid15-30%Gemfibrozil10-15%FixeddoseFenofibrate10-25%EffectofDrugsonLDL-CLevelsEffectofDru

2、gsonTriglycerideandHDL-CLevelsHDL-CTriglycerideNicotinicacid10-25%20-50%Fibrates10-25%20-50%HMGCoARI5-10%10-25%Bileacidresins3-5%0-20%FibricAcidDerivativesIndications:AdjunctivetherapytodietHypertriglyceridemia(TypeIVandV)Combinedhyperlipidemia(Ty

3、peIIb)withlowHDLwhodonotrespondtoNAMechanismofAction:IncreasesperipherallipolysisanddecreaseshepaticTGproductionEfficacy:DecreasesTG25-50%LDLdecreases,remainsthesameorincreasesIncreasesHDL15-25%inhypertriglyceridemiaSideEffects:GIupset(8%),cholelithiasis,m

4、yositis,abnLFTsContraindications:HepaticorrenaldysfunctionPre-existinggallbladderdiseaseInterventionTrials:HelsinkiHeartStudy,LOCAT,BECAIT,VA-HIT,BIPGoldbergAC,etal.ClinTher.1989;11:69-83.*Thesearemeanpercentagechanges,notpercentagechangesinmeans.NS=Notstat

5、isticallysignificantwhencomparedtoplacebo(12%increase).FenofibrateGroupA(350-499mg/dL)Before(mean±SE)After(mean±SE)PercentChange*PTotalcholesterol251.8±5.3227.4±6.7-9.1<0.001VLDL-cholesterol92.1±6.845.8±4.5-44.7<0.001LDL-cholesterol128.4±7.1136.7±5.3NS0.8570

6、HDL-cholesterol33.7±1.140.3±1.9+19.60.0014Totaltriglyceride432.0±19.1223.4±13.9-46.2<0.001VLDL-triglyceride349.8±34.3177.8±24.6-44.1<0.001FenofibratefortheTreatmentofTypeIVandVHyperlipoproteinemiasADouble-Blind,Placebo-ControlledMulticenterUSStudyFenofibrat

7、efortheTreatmentofTypeIVandVHyperlipoproteinemiasADouble-Blind,Placebo-ControlledMulticenterUSStudyGoldbergAC,etal.ClinTher.1989;11:69-83.*Thesearemeanpercentagechanges,notpercentagechangesinmeans.FenofibrateGroupB(500-1500mg/dL)Before(mean±SE)After(mean±SE

8、)PercentChanges*PTotalcholesterol261.0±6.7223.3±6.6-13.80.0001VLDL-cholesterol126.2±7.053.7±3.4-49.40.0001LDL-cholesterol103.1±6.8131.0±6.0+45.00.0002HDL-cholesterol29.6±1.336.0±1.8+22.90.0029To