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1、糖尿病脂代謝紊亂及其與冠心病的關(guān)系內(nèi)分泌科糖尿病中心中山醫(yī)科大學(xué)附屬第一醫(yī)院廖志紅黃知敏糖尿病脂代謝紊亂及其與冠心病的關(guān)系WHYWHO-----GOALSWHENHOW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）和類脂（磷脂、糖脂、固醇、類固醇）的總稱脂蛋白是由蛋白質(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)FredericksonClassificationofDyslipidemiasTypicalLipidRange,mg/dLPhenotype
2、LipoproteininExcessCholesterolTriglycerideICM300to5005,000to6,000IIALDL250to800<250IIBLDL,VLDL240to350250to500IIIb-VLDL,IDL300to450300to1,000IVVLDL200to240300to700VCM,VLDL200to1,000500to6,000表型分類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CausesofSecondaryDys
3、lipidemiasHypercholesterolemiaHypertriglyceridemiaCombinedHyperlipidemiaCommondisordersHypothyroidismDiabetesHypothyroidismNephroticsyndromeObesityNephroticsyndromeObstructiveliverdiseaseAlcoholChronicrenalfailureChronicrenalfailureUncommondisordersPregnancyMyocardialin
4、farctionAcromegalyAnorexianervosaAcuteinfectionLiverdiseaseConnectivetissuediseasesNephroticsyndromePregnancyBulimiaMedicationsThiazidediureticsb-blockersThiazidediureticsRetinoidsRetinoidsGlucocorticoidsGlucocorticoidsOralestrogensRetinoidsCyclosporineProgestinsAndroge
5、nsWHY?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MortalityinpeoplewithdiabetesCausesofdeathGeissLS,etal.In:DiabetesinAmerica.2nded.1995;chap11.0%ofdeathsIschemicOtherStrictlyCancerStrokeInfectionOtherheartheartdiabetes-diseasediseaserelated50403020
6、10Type2diabetesandCHD:7-yearincidenceoffatal/nonfatalMI(EastWestStudy)MI=myocardialinfarction.*ThesepatientshadnopriorMIatbaseline.HaffnerSM,etal.NEnglJMed.1998;339:229–234.051015202530354045507-yearincidence rateofMINopriorMI*MINopriorMI*MINondiabeticDiabeticn=1373n=10
7、59P<0.001P<0.0014%19%20%45%Type2diabetesandCHD:7-yearincidenceoffatal/nonfatalMI(EastWestStudy)糖尿病合并冠心病的臨床特點(diǎn)較高的合并動(dòng)脈粥樣硬化的比例；發(fā)病率高且發(fā)病年齡提前，女性的保護(hù)作用消失；無痛性心梗發(fā)生率高；心梗并發(fā)癥（心衰、心律失常、心源性休克等）發(fā)生率高；更容易合并感染；住院時(shí)間長，住院病死率高。Across-sectionalaxialimagefroma56-year-olddiabeticpatientwithextensi
8、vecalcificationoftheleftanteriordescendingartery(LAD)anddiagonalbranch.AmHeartJ141(4):637-644,2001WHY?糖尿病冠心病的危
