EHJ:儿童和青少年家族性高胆固醇血症的管理

2015-06-11 小田 译 医学论坛网

家族性高胆固醇血症(FH)是早产儿冠心病(CHD)的常见遗传原因。全球每分钟就有一例FH婴儿出生。如果在儿童早期阶段进行诊断和治疗,FH个体可有正常人的预期寿命。5月25日,《欧洲心脏杂志》(Eur Heart J)刊文阐述了FH的早期检测和管理策略。FH的诊断文章指出,可通过表型标准和/或遗传诊断或基因检测来诊断FH,前者包括低密度脂蛋白胆固醇(L

家族性高胆固醇血症(FH)是早产儿冠心病(CHD)的常见遗传原因。全球每分钟就有一例FH婴儿出生。如果在儿童早期阶段进行诊断和治疗,FH个体可有正常人的预期寿命。5月25日,《欧洲心脏杂志》(Eur Heart J)刊文阐述了FH的早期检测和管理策略。

FH的诊断

文章指出,可通过表型标准和/或遗传诊断或基因检测来诊断FH,前者包括低密度脂蛋白胆固醇(LDL-C)水平联合LDL-C升高的家族史以及早产儿存在冠心病来综合判断。儿童期是利用LDL-C筛查手段识别FH和非FH的最佳时期。LDL-C ≥5 mmol/L (190 mg/dL),或LDL-C ≥4 mmol/L (160 mg/dL)合并早产儿CHD和/或父母亲一方存在高基线胆固醇水平的家族史,即可做出FH的表型诊断。如果父母一方有遗传缺陷,则儿童LDL-C的临界值为≥3.5 mmol/L (130 mg/dL)。研究者们建议,用表型联合基因诊断方法进行家庭级联筛查;儿童从5岁时进行相关检测,如果疑为纯合子FH则应更早检测。

FH的治疗

杂合子FH的管理以健康生活方式和他汀类药物治疗(从8至10岁)为基础。10岁以上儿童的LDL-C目标值为<3.5 mmol/L (130 mg/dL);对于8至10岁的儿童,理想状态为基线LDL-C水平降低50%;特别是对那些LDL-C水平极高,脂蛋白(a)升高,有早产儿CHD家族史或存在其他心血管危险因素的患者,需权衡治疗副作用的长期风险。

预后

早期识别和进行降LDL-C的最佳治疗可减少累积LDL-C负担,并给患者带来健康和社会经济学的益处。增加对FH的认识和早期诊断以及从儿童期即进行最佳的治疗,这些对增加FH儿童和成人患者的健康寿命至关重要。研究者最后呼吁,在年轻人进行进一步的研究,以便及时检测和管理FH。

原始出处:

Albert Wiegman , Samuel S. Gidding , Gerald F. Watts et al.Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment.EHJ, May 25, 2015.

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    2015-06-26 huaxipanxing

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    2015-06-21 caierhong

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    2015-06-21 caierhong

    全面管理

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1937431, encodeId=43b7193e4319b, content=<a href='/topic/show?id=b3252822854' target=_blank style='color:#2F92EE;'>#儿童和青少年#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28228, encryptionId=b3252822854, topicName=儿童和青少年)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jul 09 19:02:00 CST 2015, time=2015-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29542, encodeId=411f2954262, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Fri Jun 26 12:39:00 CST 2015, time=2015-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28628, encodeId=11d928628e2, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28629, encodeId=22ea286292f, content=全面管理, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28630, encodeId=ac5828630f9, content=利好消息, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380016, encodeId=b25613800166e, content=<a href='/topic/show?id=bef6102602a9' target=_blank style='color:#2F92EE;'>#高胆固醇血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102602, encryptionId=bef6102602a9, topicName=高胆固醇血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1d1470, createdName=刘阔, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629470, encodeId=65d516294e0c5, content=<a href='/topic/show?id=c61d4641821' target=_blank style='color:#2F92EE;'>#家族性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46418, encryptionId=c61d4641821, topicName=家族性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26fc21339997, createdName=wetgdt, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27196, encodeId=93e92e1962c, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:17:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27195, encodeId=57542e19557, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:16:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27026, encodeId=17fd2e0261f, content=值得重视, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5c31627260, createdName=Darcy2500, createdTime=Thu Jun 11 15:42:00 CST 2015, time=2015-06-11, status=1, ipAttribution=)]
    2015-06-21 caierhong

    利好消息

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1937431, encodeId=43b7193e4319b, content=<a href='/topic/show?id=b3252822854' target=_blank style='color:#2F92EE;'>#儿童和青少年#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28228, encryptionId=b3252822854, topicName=儿童和青少年)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jul 09 19:02:00 CST 2015, time=2015-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29542, encodeId=411f2954262, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Fri Jun 26 12:39:00 CST 2015, time=2015-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28628, encodeId=11d928628e2, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28629, encodeId=22ea286292f, content=全面管理, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28630, encodeId=ac5828630f9, content=利好消息, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380016, encodeId=b25613800166e, content=<a href='/topic/show?id=bef6102602a9' target=_blank style='color:#2F92EE;'>#高胆固醇血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102602, encryptionId=bef6102602a9, topicName=高胆固醇血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1d1470, createdName=刘阔, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629470, encodeId=65d516294e0c5, content=<a href='/topic/show?id=c61d4641821' target=_blank style='color:#2F92EE;'>#家族性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46418, encryptionId=c61d4641821, topicName=家族性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26fc21339997, createdName=wetgdt, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27196, encodeId=93e92e1962c, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:17:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27195, encodeId=57542e19557, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:16:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27026, encodeId=17fd2e0261f, content=值得重视, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5c31627260, createdName=Darcy2500, createdTime=Thu Jun 11 15:42:00 CST 2015, time=2015-06-11, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1937431, encodeId=43b7193e4319b, content=<a href='/topic/show?id=b3252822854' target=_blank style='color:#2F92EE;'>#儿童和青少年#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28228, encryptionId=b3252822854, topicName=儿童和青少年)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jul 09 19:02:00 CST 2015, time=2015-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29542, encodeId=411f2954262, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Fri Jun 26 12:39:00 CST 2015, time=2015-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28628, encodeId=11d928628e2, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28629, encodeId=22ea286292f, content=全面管理, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28630, encodeId=ac5828630f9, content=利好消息, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380016, encodeId=b25613800166e, content=<a href='/topic/show?id=bef6102602a9' target=_blank style='color:#2F92EE;'>#高胆固醇血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102602, encryptionId=bef6102602a9, topicName=高胆固醇血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1d1470, createdName=刘阔, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629470, encodeId=65d516294e0c5, content=<a href='/topic/show?id=c61d4641821' target=_blank style='color:#2F92EE;'>#家族性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46418, encryptionId=c61d4641821, topicName=家族性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26fc21339997, createdName=wetgdt, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27196, encodeId=93e92e1962c, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:17:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27195, encodeId=57542e19557, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:16:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27026, encodeId=17fd2e0261f, content=值得重视, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5c31627260, createdName=Darcy2500, createdTime=Thu Jun 11 15:42:00 CST 2015, time=2015-06-11, status=1, ipAttribution=)]
    2015-06-13 wetgdt
  8. [GetPortalCommentsPageByObjectIdResponse(id=1937431, encodeId=43b7193e4319b, content=<a href='/topic/show?id=b3252822854' target=_blank style='color:#2F92EE;'>#儿童和青少年#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28228, encryptionId=b3252822854, topicName=儿童和青少年)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jul 09 19:02:00 CST 2015, time=2015-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29542, encodeId=411f2954262, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Fri Jun 26 12:39:00 CST 2015, time=2015-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28628, encodeId=11d928628e2, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28629, encodeId=22ea286292f, content=全面管理, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28630, encodeId=ac5828630f9, content=利好消息, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66c61628089, createdName=caierhong, createdTime=Sun Jun 21 21:34:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380016, encodeId=b25613800166e, content=<a href='/topic/show?id=bef6102602a9' target=_blank style='color:#2F92EE;'>#高胆固醇血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102602, encryptionId=bef6102602a9, topicName=高胆固醇血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1d1470, createdName=刘阔, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629470, encodeId=65d516294e0c5, content=<a href='/topic/show?id=c61d4641821' target=_blank style='color:#2F92EE;'>#家族性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46418, encryptionId=c61d4641821, topicName=家族性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26fc21339997, createdName=wetgdt, createdTime=Sat Jun 13 00:02:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27196, encodeId=93e92e1962c, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:17:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27195, encodeId=57542e19557, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Thu Jun 11 21:16:00 CST 2015, time=2015-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27026, encodeId=17fd2e0261f, content=值得重视, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5c31627260, createdName=Darcy2500, createdTime=Thu Jun 11 15:42:00 CST 2015, time=2015-06-11, status=1, ipAttribution=)]
    2015-06-11 18619c0a62m

    很有用

    0

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    2015-06-11 18619c0a62m

    值得关注

    0

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    2015-06-11 Darcy2500

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