糖尿病脂代謝紊亂及其與冠心病的關(guān)系講義-展示頁(yè)
2024-09-11 13:11本頁(yè)面
【正文】 image from a 56yearold diabetic patient with extensive calcification of the left anterior descending artery (LAD) and diagonal branch. Am Heart J 141(4): 637644, 2020 WHY ? ? 糖尿病冠心病的危害性 糖尿病冠心病的臨床特點(diǎn) ? 脂代謝紊亂在糖尿病冠心病中的地位 ? 糖尿病患者調(diào)脂治療的益處 大血管病變，微血管病變，其它方面 WHY ? ? 糖尿病冠心病的危害性 糖尿病冠心病的臨床特點(diǎn) ? 脂代謝紊亂在糖尿病冠心病中的地位 ? 糖尿病患者調(diào)脂治療的益處 大血管病變，微血管病變，其它方面 1176。chap 11. 0 % of deaths Ischemic Other Strictly Cancer Stroke Infection Other heart heart diabetes disease disease related 50 40 30 20 10 Type 2 diabetes and CHD: 7year incidence of fatal/nonfatal MI (East West Study) MI = myocardial infarction. * These patients had no prior MI at baseline. Haffner SM, et al. N Engl J Med. 1998。糖尿病脂代謝紊亂及其與冠心病的關(guān)系 內(nèi)分泌科 糖尿病中心 XX醫(yī)科大學(xué)附屬第一醫(yī)院 糖尿病脂代謝紊亂及其與冠心病的關(guān)系 ?WHY ?WHO GOALS ?WHEN ?HOW 血脂、脂蛋白和載脂蛋白 ?血脂是血漿中的中性脂肪（甘油三酯和膽固醇）和類(lèi)脂（磷脂、糖脂、固醇、類(lèi)固醇）的總稱(chēng) ?脂蛋白是由蛋白質(zhì)、膽固醇、甘油三酯和磷脂組成的球形大分子復(fù)合體 ?載脂蛋白是脂蛋白的蛋白質(zhì)部分，它與脂質(zhì)結(jié)合，在血漿中運(yùn)轉(zhuǎn)脂質(zhì) Frederickson Classification of Dyslipidemias Typical Lipid Range, mg/dL Phenotype Lipoprotein in Excess Cholesterol Triglyceride I CM 300 to 500 5,000 to 6,000 IIA LDL 250 to 800 250 IIB LDL, VLDL 240 to 350 250 to 500 III bVLDL, IDL 300 to 450 300 to 1,000 IV VLDL 200 to 240 300 to 700 V CM, VLDL 200 to 1,000 500 to 6,000 表型分類(lèi)法有助于高脂血癥的診斷和治療，但是較繁瑣。 簡(jiǎn)易分型法將高脂血癥分為高膽固醇血癥、高甘油三酯血癥和混合型高脂血癥 Causes of Secondary Dyslipidemias Hypercholesterolemia Hypertriglyceridemia Combined Hyperlipidemia Common disorders Hypothyroidism Diabetes Hypothyroidism Nephrotic syndrome Obesity Nephrotic syndrome Obstructive liver disease Alcohol Chronic renal failure Chronic renal failure Unmon disorders Pregnancy Myocardial infarction Acromegaly Anorexia nervosa Acute infection Liver disease Connective tissue diseases Nephrotic syndrome Pregnancy Bulimia Medications Thiazide diuretics bblockers Thiazide diuretics Retinoids Retinoids Glucocorticoids Glucocorticoids Oral estrogens Retinoids Cyclosporine Progestins Androgens WHY ? ?糖尿病冠心病的危害性 糖尿病冠心病的臨床特點(diǎn) ? 脂代謝紊亂在糖尿病冠心病中的地位 ? 糖尿病患者調(diào)脂治療的益處 大血管病變，微血管病變，其它方面 Mortality in people with diabetes Causes of death Geiss LS, et al. In: Diabetes in America. 2nd ed. 1995。339:229–234. 0 5 10 15 20 25 30 35 40 45 50 7year incidence ra
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