2016 中国成人血脂异常防治指南(2016年修订版)

2016-10-23 中国成人血脂异常防治指南修订联合委员会 中国循环杂志.2016,31(10):937-953.

2013 年11 月,在国家卫生和计划生育委员会疾病预防控制局的支持下,由国家心血管病中心、中华医学会心血管病学分会、中华医学会糖尿病学分会、中华医学会内分泌学分会以及中华医学会检验医学分会组成血脂指南修订联合委员会,在委员会成员中广泛征集新指南拟回答的核心问题,经讨论后最终确定了4 个方面(指南修订的总体原则、心血管总体风险评估、调脂治疗的目标和特殊人群调脂治疗)共17 个核心问题;指南工作组针

中文标题:

2016 中国成人血脂异常防治指南(2016年修订版)

发布日期:

2016-10-23

简要介绍:

本指南对推荐类别定义借鉴了欧美血脂相关指南的定义,具体表述如下:Ⅰ类:指已证实和(或)一致公认有益、有用和有效的操作或治疗,推荐使用。Ⅱ类:指有用和(或)有效的证据尚有矛盾或存在不同观点的操作或治疗。Ⅱa类:有关证据/观点倾向于有用和(或)有效,应用这些操作或治疗是合理的。Ⅱb类:有关证据/观点尚不能被充分证明有用和(或)有效,可考虑应用。Ⅲ类:指已证实和(或)一致公认无用和(或)无效,并对一些病例可能有害的操作或治疗,不推荐使用。 

本指南对证据级别水平定义表述如下:证据水平A:证据基于多项随机临床试验或荟萃分析。证据水平B:证据基于单项随机临床试验或多项非随机对照研究。证据水平C:仅为专家共识意见和(或)基于小规模研究、回顾性研究和注册研究结果。 

血脂异常病因分类 

1继发性高脂血症 

继发性高脂血症是指由于其他疾病所引起的血脂异常。可引起血脂异常的疾病主要有:肥胖、糖尿病、肾病综合征、甲状腺功能减退症、肾功能衰竭、肝脏疾病、系统性红斑狼疮、糖原累积症、骨髓瘤、脂肪萎缩症、急性卟啉病、多囊卵巢综合征等。此外,某些药物如利尿剂、非心脏选择性β-受体阻滞剂、糖皮质激素等也可能引起继发性血脂异常。 

2原发性高脂血症 

除了不良生活方式(如高能量、高脂和高糖饮食、过度饮酒等)与血脂异常有关,大部分原发性高脂血症是由于单一基因或多个基因突变所致。由于基因突变所致的高脂血症多具有家族聚集性,有明显的遗传倾向,特别是单一基因突变者,故临床上通常称为家族性高脂血症。 

例如编码LDL受体基因的功能缺失型突变,或编码与LDL受体结合的ApoB基因突变,或分解LDL受体的前蛋白转化酶枯草溶菌素9(proprotein convertases subtilisin/kexintype9,PCSK9)基因的功能获得型突变,或调整LDL受体到细胞膜血浆表面的LDL受体调整蛋白基因突变可引起家族性高胆固醇血症(familial hypercholesterolemia,FH)。80%以上FH患者是单一基因突变所致,但高胆固醇血症具有多个基因突变的特性。LDL受体基因的功能缺失型突变是FH的主要病因。纯合子型家族性高胆固醇血症(homozygous familialhyper cholesterolemia,HoFH)发病率约1/30万~1/16万,杂合子型家族性高胆固醇血症(heterozygous familial hypercholesterolemia,HeFH)发病率约1/500~1/200。家族性高TG血症是单一基因突变所致,通常是参与TG代谢的脂蛋白脂解酶、或ApoC2、或ApoA5基因突变导致,表现为重度高TG血症(TG>10mmol/L),其发病率为1/100万。轻中度高TG血症通常具有多个基因突变特性。

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[AttachmentFileName(sort=100, fileName=2016 中国成人血脂异常防治指南(2016年修订版))] GetToolGuiderByIdResponse(projectId=1, id=f2b491c0013139fe, title=2016 中国成人血脂异常防治指南(2016年修订版), enTitle=, guiderFrom=中国循环杂志.2016,31(10):937-953., authorId=null, author=, summary=2013 年11 月,在国家卫生和计划生育委员会疾病预防控制局的支持下,由国家心血管病中心、中华医学会心血管病学分会、中华医学会糖尿病学分会、中华医学会内分泌学分会以及中华医学会检验医学分会组成血脂指南修订联合委员会,在委员会成员中广泛征集新指南拟回答的核心问题,经讨论后最终确定了4 个方面(指南修订的总体原则、心血管总体风险评估、调脂治疗的目标和特殊人群调脂治疗)共17 个核心问题;指南工作组针, cover=, journalId=null, articlesId=null, associationId=1318, associationName=中国成人血脂异常防治指南修订联合委员会, associationIntro=, copyright=0, guiderPublishedTime=Sun Oct 23 00:00:00 CST 2016, originalUrl=, linkOutUrl=, content=<p class="MsoNormal">本指南对推荐类别定义借鉴了欧美血脂相关指南的定义,具体表述如下:Ⅰ类:指已证实和(或)一致公认有益、有用和有效的操作或治疗,推荐使用。Ⅱ类:指有用和(或)有效的证据尚有矛盾或存在不同观点的操作或治疗。Ⅱa类:有关证据/观点倾向于有用和(或)有效,应用这些操作或治疗是合理的。Ⅱb类:有关证据/观点尚不能被充分证明有用和(或)有效,可考虑应用。Ⅲ类:指已证实和(或)一致公认无用和(或)无效,并对一些病例可能有害的操作或治疗,不推荐使用。<span style="font-size: 9pt;"> </span></p><p class="MsoNormal">本指南对证据级别水平定义表述如下:证据水平A:证据基于多项随机临床试验或荟萃分析。证据水平B:证据基于单项随机临床试验或多项非随机对照研究。证据水平C:仅为专家共识意见和(或)基于小规模研究、回顾性研究和注册研究结果。<span style="font-size: 9pt;"> </span></p><p class="MsoNormal"><span style="font-weight: bold; color: rgb(51, 102, 255);">血脂异常病因分类<span style="font-size: 9pt;"> </span></span></p><p class="MsoNormal"><span style="font-weight: bold;">1继发性高脂血症<span style="font-size: 9pt;"> </span></span></p><p class="MsoNormal">继发性高脂血症是指由于其他疾病所引起的血脂异常。可引起血脂异常的疾病主要有:肥胖、糖尿病、肾病综合征、甲状腺功能减退症、肾功能衰竭、肝脏疾病、系统性红斑狼疮、糖原累积症、骨髓瘤、脂肪萎缩症、急性卟啉病、多囊卵巢综合征等。此外,某些药物如利尿剂、非心脏选择性β-受体阻滞剂、糖皮质激素等也可能引起继发性血脂异常。<span style="font-size: 9pt;"> </span></p><p class="MsoNormal"><span style="font-weight: bold;">2原发性高脂血症<span style="font-size: 9pt;"> </span></span></p><p class="MsoNormal">除了不良生活方式(如高能量、高脂和高糖饮食、过度饮酒等)与血脂异常有关,大部分原发性高脂血症是由于单一基因或多个基因突变所致。由于基因突变所致的高脂血症多具有家族聚集性,有明显的遗传倾向,特别是单一基因突变者,故临床上通常称为家族性高脂血症。<span style="font-size: 9pt;"> </span></p><p class="MsoNormal">例如编码LDL受体基因的功能缺失型突变,或编码与LDL受体结合的ApoB基因突变,或分解LDL受体的前蛋白转化酶枯草溶菌素9(proprotein convertases subtilisin/kexintype9,PCSK9)基因的功能获得型突变,或调整LDL受体到细胞膜血浆表面的LDL受体调整蛋白基因突变可引起家族性高胆固醇血症(familial hypercholesterolemia,FH)。80%以上FH患者是单一基因突变所致,但高胆固醇血症具有多个基因突变的特性。LDL受体基因的功能缺失型突变是FH的主要病因。纯合子型家族性高胆固醇血症(homozygous familialhyper cholesterolemia,HoFH)发病率约1/30万~1/16万,杂合子型家族性高胆固醇血症(heterozygous familial hypercholesterolemia,HeFH)发病率约1/500~1/200。家族性高TG血症是单一基因突变所致,通常是参与TG代谢的脂蛋白脂解酶、或ApoC2、或ApoA5基因突变导致,表现为重度高TG血症(TG>10mmol/L),其发病率为1/100万。轻中度高TG血症通常具有多个基因突变特性。</p><div> 拓展指南:<strong>与<font color="red">血脂异常</font>相关指南:</strong><br><ul><li><a href="http://www.medsci.cn/guideline/show_article.do?id=f2b491c0013139fe" title="2016 中国成人血脂异常防治指南(2016 年修订版)" target="_blank">2016 中国成人血脂异常防治指南(2016 年修订版)</a></li> <li><a href="http://www.medsci.cn/guideline/show_article.do?id=2a79a1c0012995d8" title="2016 CCS指南:血脂异常管理预防成人心血管病" target="_blank">2016 CCS指南:血脂异常管理预防成人心血管病</a></li> <li><a href="http://www.medsci.cn/guideline/show_article.do?id=0aac41c001265289" title="2016 ESC:欧洲血脂异常管理指南" target="_blank">2016 ESC:欧洲血脂异常管理指南</a></li> <li><a href="http://www.medsci.cn/guideline/show_article.do?id=620d41c001261992" title="2016 ESC/EAS指南:血脂异常的管理" target="_blank">2016 ESC/EAS指南:血脂异常的管理</a></li> <li><a href="http://www.medsci.cn/guideline/show_article.do?id=b7b721c00125e9dd" title="2016 USPSTF建议声明:儿童和青少年血脂异常的筛查" target="_blank">2016 USPSTF建议声明:儿童和青少年血脂异常的筛查</a></li> 更多信息请点击:<a href="http://www.medsci.cn/guideline/list.do?q=%E8%A1%80%E8%84%82%E5%BC%82%E5%B8%B8" target="_blank">有关血脂异常更多指南</a></ul></div>, tagList=[TagDto(tagId=3785, tagName=血脂异常)], categoryList=[CategoryDto(categoryId=2, categoryName=心血管, tenant=100), CategoryDto(categoryId=21100, categoryName=达仁堂循证e学界, tenant=100)], articleKeywordId=null, articleKeyword=null, articleKeywordNum=null, guiderKeywordId=null, guiderKeyword=null, guiderKeywordNum=null, haveAttachments=1, attachmentList=null, guiderType=0, guiderArea=指南, guiderLanguage=1, guiderRegion=3, opened=0, paymentType=null, paymentAmount=10, recommend=0, recommendEndTime=null, sticky=0, stickyEndTime=null, allHits=26689, appHits=1527, showAppHits=6, pcHits=22421, showPcHits=4404, likes=190, shares=119, comments=14, approvalStatus=1, publishedTime=Mon Oct 24 10:32:07 CST 2016, publishedTimeString=2016-10-23, pcVisible=1, appVisible=1, editorId=5295957, editor=lili, waterMark=0, formatted=0, memberCards=[], isPrivilege=0, deleted=0, version=1, createdBy=null, createdName=lili, createdTime=Mon Oct 24 10:32:07 CST 2016, updatedBy=null, updatedName=null, updatedTime=Sat Jan 06 11:17:15 CST 2024, courseDetails=[], otherVersionGuiders=[], isGuiderMember=false, ipAttribution=, attachmentFileNameList=[AttachmentFileName(sort=100, fileName=2016 中国成人血脂异常防治指南(2016年修订版))])
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    2022-04-06 蓝莓兔子

    学习了

    0

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    2021-09-03 微探

    这个应该是最新最权威的吧

    0

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    2021-05-17 ms1000002096361084

    学习,积分不够了哎

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1208956, encodeId=ee851208956c2, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54ff5497451, createdName=蓝莓兔子, createdTime=Wed Apr 06 11:46:33 CST 2022, time=2022-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014170, encodeId=9f0b10141e008, content=这个应该是最新最权威的吧, beContent=null, objectType=guider, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=555f5538552, createdName=微探, createdTime=Fri Sep 03 06:44:23 CST 2021, time=2021-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966202, encodeId=6f8c96620205, content=学习,积分不够了哎 , beContent=null, objectType=guider, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b085453434, createdName=ms1000002096361084, createdTime=Mon May 17 10:12:56 CST 2021, time=2021-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=951261, encodeId=4bbb951261dd, content=分享给同事了 大家都学到了了很多,也用到了临床实践中, beContent=null, objectType=guider, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bc565473135, createdName=ms3000000712548994, createdTime=Thu Mar 25 19:41:27 CST 2021, time=2021-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=949359, encodeId=330494935986, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=648d5444192, createdName=ms7000000737941079, createdTime=Thu Mar 18 22:00:51 CST 2021, time=2021-03-18, status=1, ipAttribution=)]
    2021-03-25 ms3000000712548994

    分享给同事了 大家都学到了了很多,也用到了临床实践中

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1208956, encodeId=ee851208956c2, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54ff5497451, createdName=蓝莓兔子, createdTime=Wed Apr 06 11:46:33 CST 2022, time=2022-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014170, encodeId=9f0b10141e008, content=这个应该是最新最权威的吧, beContent=null, objectType=guider, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=555f5538552, createdName=微探, createdTime=Fri Sep 03 06:44:23 CST 2021, time=2021-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966202, encodeId=6f8c96620205, content=学习,积分不够了哎 , beContent=null, objectType=guider, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b085453434, createdName=ms1000002096361084, createdTime=Mon May 17 10:12:56 CST 2021, time=2021-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=951261, encodeId=4bbb951261dd, content=分享给同事了 大家都学到了了很多,也用到了临床实践中, beContent=null, objectType=guider, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bc565473135, createdName=ms3000000712548994, createdTime=Thu Mar 25 19:41:27 CST 2021, time=2021-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=949359, encodeId=330494935986, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=648d5444192, createdName=ms7000000737941079, createdTime=Thu Mar 18 22:00:51 CST 2021, time=2021-03-18, status=1, ipAttribution=)]
    2021-03-18 ms7000000737941079

    学习了

    0