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1、NCEPATP-IICutpointsforTGandHDL-CParametermg/dLNormalTG<200Borderline-highTG200–400HighTG400–1,000VeryhighTG>1,000LowHDL-C<35High(protective)HDL-C?60ExpertPanelonDetection,Evaluation,andTreatmentofHigh BloodCholesterolinAdults.JAMA1993;269:3015–3023EffectsofLipid-ModifyingDrugs onHDL-
2、CLevelsNiacin?15–35%Fibrates?10–15%Estrogens?10–15%Statins?5–10%BelalcazarLMetal.ProgrCardiovascDis1998;41:151–174DrugEffectsonHDL:NiacinLiverBBTGCMR/IDLC-IICM/VLDLLPLA-ICECEFCFCLCATA-IABC1MacrophageMatureHDLNascent HDLLDLRHLIntestineNIACINNIACIN**InhibitsuptakeofapoA-IbutnotCEExtend
3、ed-ReleaseNiacinfor TreatmentofDyslipidemia*Significantdifference(P<0.001)betweendosagegroups.1.MorganJMetal.AmJCardiol1998;82(12A):29U–34U2.CapuzziDMetal.AmJCardiol1998;82(12A):74U–81U?Copyright1998,withpermissionfromExcerptaMedicaInc.%changefrombaselineBaseline(mg/dL):-617-1523-28-
4、2028-40-30-20-10010203040TG(156)LDL-C(197)HDL-C(44)TG(137)LDL-C(206)HDL-C(42)TG(174)LDL-C(195)HDL-C(45)1,000mg/d*(1)(12wk;n=35)2,000mg/d*(1)(12wk;n=31)?3,000mg/d(2)(96wk;n=225)-21-28FibrateChemicalStructuresClCOOCH3CH3CCOOCHCH3CH3ClFenofibrateClofibrateOCCOOC2H5CH3CH3CCOOHCH3CH3CH2OC
5、H2CH2CH2CH3CH3GemfibrozilDrugEffectsonHDL:FibratesLiverBBTGCMR/IDLC-IICM/VLDLLPLA-ICECEFCFCLCATA-IABC1MacrophageMatureHDLNascent HDLLDLRHLFIBRATES++FIBRATESIntestineFenofibrateforTreatmentofTypesIV andVHyperlipoproteinemia*Meanpercentagechanges,notpercentagechangesinmeans.GoldbergACe
6、tal.ClinTher1989;11:69–83.14.519.6-46.245.022.9-54.5-60-50-40-30-20-1001020304050GroupA(TG=350–499mg/dL)GroupB(TG=500–1,500mg/dL)%changefrombaseline*LDL-C(128.4)HDL-C(33.7)LDL-C(103.1)HDL-C(29.6)Meanbaseline(mg/dL):Total-TG(432.0)Total-TG(725.6)TrialsofAgentsThatIncreaseHDL-CinPatien
7、tsWithIsolatedLowHDL-CRandomized,Placebo-ControlledStudies1.VegaGL,GrundySM.JAMA1989;262:3148–31532.MillerMetal.AmJMed1993;94:7–123.LavieCJetal.AmJCardiol1992;69:1083–10854.KingJMetal.AmJMed1994;97:323–3315.MillerMetal.ArteriosclerThrombVascBiol1995;15:2151–21569927311205101520253035
8、Vega(1)(n=22
