ACS降脂治疗ppt课件

急性冠脉综合症的降脂治疗急性冠脉综合症的降脂治疗Lipid-lowering treatment of acute coronary syndrome1Contents概述1ACS与血脂关系2降脂治疗对 ACS临床益处3Changping Chinese traditional medical hospitalACS病理基础Changping Chinese traditional medical hospitalACS病理基础Changping Chinese traditional medical hospitalACS斑块特征 大脂池（脂质核心占 40%） 大量炎性细胞浸润 易损性（ vulnerability） 血中血脂异常增高 内皮细胞功能损伤 局部炎症 血液动力学异常李娇娇 .心血管病防治知识 (下半月 ),2013,12:150-153Changping Chinese traditional medical hospital ACS 血脂 关系ACS与血脂状态有报道 ACS患者应激状态下，血脂浓度有较大波动。AMI发生 24h后， TC、 LDL-C、 HDL-C、 apoA1和 apoB均有明显下降， TG却增加。 4 5d后变化最为明显，2 3个月后可回到基线状态。此时 LDL和 HDL颗粒性质发生了变化。作者认为，对于 ACS患者，无论基线血脂浓度如何，都需要积极地应用他汀类药物进行强化降脂治疗。xx Changping Chinese traditional medical hospitalACS血脂状态有人对 59例 ACS患者急性期 24h内的血脂 6项指标（ TC、 TG、 HDL-C、 LDL-C和 ApoB、 apoA1）与 47例健康人的水平进行了比较Changping Chinese traditional medical hospital结果结论： TC、 TG、 LDL-C、 ApoB水平升高和 HDL-C、ApoA1水平降低可能是 ACS发病的危险因素，血脂 6项指标联合检测有助于预测 ACS的发生并监控病情的变化。丁玲新等 . 海南医学院学报 ,2011,11:1476-1478Changping Chinese traditional medical hospitalACS与血脂状态另一篇报道：经冠脉造影诊断为 CHD的 367例患者，其中男性 261例，女性 106例，年龄29 89(59.511.0) 岁。 268例 ACS患者， 99例非 ACS患者作为对照，对两组患者的 Lp(a)、HDL-C、 ApoAl、 TC、 TG、 LDL-C以及 ApoB水平进行观察。Changping Chinese traditional medical hospital结果Changping Chinese traditional medical hospital结论Lp(a)、 HDL-C和 ApoAl的水平在 ACS患者和对照组患者中差异有统计学意义，提示我们在重视降低患者的 TC,TG和 LDL-C水平的同时，也应该关注 HDL-C, ApoA1和 Lp(a)水平的影响曲环 .中国心血管病研究 ,2008,6(6):410-412Changping Chinese traditional medical hospitalACS与血脂状态另一项研究纳入 333例 ACS患者，男性 232例（ 69.7%），女性 101例（ 30.3%），年龄6210.63 岁。其中 UA257例（ 77.2%），NSTEMI50例， STEMI26例（ 7.8%），在发病期对患者血浆血脂浓度进行检测。Changping Chinese traditional medical hospital结果Changping Chinese traditional medical hospital结论1.在 ACS患者中，血脂异常较为常见2.大于 50%是 HDL-C 1.0mmol/LxxChangping Chinese traditional medical hospitalACS发病与血浆血脂浓度相关小结ACS患者血脂浓度高低可能与病情严重程度相关？ACS发病时血浆血脂浓度高低不同，多数表现 TC、 TG、 LDL-C、apoB升高和 HDL-C、 apoA降低Changping Chinese traditional medical hospitalACS降脂治疗临床益处Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. A randomized, double-blind trial 1997.5 to 1999.9 follow-up 16 weeks 122 clinical centers in Europe, NorthAmerica, South Africa, and Australasia.Changping Chinese traditional medical hospital A total of 3086 adults aged 18 years or older with unstable angina or non-Q-wave acute myocardial infarction. To determine whether treatment with atorvastatin 80 mg/d atorvastatin, initiated 24 to 96 hours after an acute coronary syndromeChangping Chinese traditional medical hospital Primary end point :death, nonfatal acute myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence and requiring emergency rehospitalization.Changping Chinese traditional medical hospitalRulstChangping Chinese traditional medical hospitalChangping Chinese traditional medical hospitalConclusionFor patients with acute coronary syndrome, lipid-lowering therapy with atorvastatin, 80 mg/d, reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalization.Schwartz GG， et al. JAMA. 2001 Apr 4;285(13):1711-8.Changping Chinese traditional medical hospitalEarly Intensive vs a Delayed Conservative Simvastatin Strategy in Patients With Acute Coronary Syndromes Phase Z of the A to Z TrialJAMA. 2004;292(11):1307-1316. doi:10.1001/jama.292.11.1307.Changping Chinese traditional medical hospitalA to Z(the Aggrastat to Zocor）vTime: December 29, 1999, and January 6, 2003vDesign: patients(n = 2265) with ACS receiving 40 mg/d of simvastatin for 1 month followed by 80 mg/d patients(n = 2232) with ACS patients receiving placebo for 4 months followed by 20 mg/d of simvastatinChangping Chinese traditional medical hospitalvFollow-up : 6 24months.vThe primary end point: Cardiovascular deathNonfatal myocardial infarction Readmission for ACSStrokeChangping Chinese traditional medical hospitalChangping Chinese traditional medical hospitalsimvastatinChangping Chinese traditional medical hospitalAmong patients with ACS, the early initiation of an aggressive simvastatin regimen resulted in a favorable trend toward reduction of major cardiovascular events.Concl