脂肪代谢异常已经成为流行性疾病，将对许多人的生活质量甚至寿命都产生特别重要的影响，因此我们不得不关注象高脂血症这类“疾病”。最近来自美国加洲大学的一个关于这一问题的综述提出了一些新的观点。一是关于生活习惯改变的建议，二是关于营养补充的建议，最后是关于药物使用的建议。这不仅对临床实践有帮助，更多普通大众的健康的生活习惯具有重要指导意义。现在介绍如下。

高脂血症和心血管疾病和胰腺炎的关系非常密切，根据最新的内分泌学会临床指南，成年人每5年应该进行一次血液甘油三脂含量的检查。一旦发现高甘油三脂血症，患者需要进一步进行其他心血管危险因子评估，例如肥胖、高血压、糖代谢异常和肝脏功能异常等。

更新的建议来自美国加洲大学Lars Berglund领导的的课题组，他们在《临床内分泌和代谢杂志》上发表了一篇综述。文章提出，尽管大量证据支持低密度脂蛋白水平和心血管疾病关系密切，但高甘油三脂和心血管疾病关系密切并不十分明确。他们仍建议筛选高甘油三脂采用空腹甘油三脂水平检查

此外，他们提出如下建议：

诊断高脂血症应该用空腹甘油三脂水平为指标。

空腹高甘油三脂个体应对高脂血症原发因素进行评估，这些因素不包括内分泌异常、药物以及针对原发因素的治疗手段。

原发高脂血症患者应进行其他心血管危险因素进行全面检查。

原发高脂血症患者应调查患者血脂代谢异常和心血管疾病家族史，以评估将来发生心血管疾病危险度。

中重度高甘油三脂血症同时有肥胖或超重患者应进行生活方式治疗，包括饮食指导和减肥运动。

严重或极端严重高甘油三脂血症患者不仅需要控制饮食中脂肪和简单碳水化合物比例，还必须结合药物治疗才能降低胰腺炎的风风险。

中度高甘油三脂血症合的治疗目标应达到NCEP ATP III指南所规定的高密度脂蛋白胆固醇水平。

食物纤维素应作为降低高甘油三脂血症的胰腺炎风险的第一线药物。

中重度高甘油三脂血症可单独用纤维素烟酸、（又叫维生素B3或维生素PP）和欧米伽（DHA或脑黄金），或联合用他汀类药物治疗。

尽管他汀类药物有利于降低重或严重高甘油三脂血症患者的心血管疾病的风险，但是这类患者不应单独使用他汀类药物。

根据这些作者的看法，严重或特别严重的高甘油三脂血症的胰腺炎风险大增，即使轻和中度高甘油三脂血症仍属于心血管疾病的危险因素。因此作者建议成年人每5年应进行一次空腹甘油三脂水平检查。

New Clinical Guidelines for Treating, Screening Hypertriglyceridemia

Michael O’Riordan

Authors and Disclosures

September 10, 2012 (Chevy Chase, Maryland) — Adults should be screened for high triglyceride levels once every five years because of the potential risk of cardiovascular disease and pancreatitis associated with hypertriglyceridemia, according to new clinical-practice guidelines from the Endocrine Society [1]. Individuals with high triglyceride levels should undergo further assessment of other cardiovascular risk factors, such as obesity, hypertension, abnormal glucose metabolism, and liver dysfunction.

The new recommendations, led by task-force chair Dr Lars Berglund (University of California, Davis), are published in the September 2012 issue of the Journal of Clinical Endocrinology and Metabolism. In the review, the expert panel notes that while there is robust evidence supporting the association between LDL-cholesterol levels and cardiovascular disease, the association between triglyceride levels and cardiovascular disease is more uncertain. However, they recommend screening adults for high triglycerides as part of a fasting lipid panel.

In addition to these recommendations, Berglund and colleagues recommend that:

• The diagnosis of hypertriglyceridemia be made on fasting triglyceride levels and not nonfasting levels.
• Individuals with high fasting triglyceride levels be evaluated for secondary causes of hyperlipidemia, including endocrine conditions and medications, and that treatment be focused on secondary causes.
• Patients with primary hypertriglyceridemia be screened for other cardiovascular risk factors.
• Patients with primary hypertriglyceridemia be evaluated for a family history of dyslipidemia and cardiovascular disease in order to assess future cardiovascular risk.
• Obese and overweight patients with mild to moderate hypertriglyceridemia be treated with lifestyle therapy, including dietary counseling, and physical-activity programs to achieve weight reduction.
• Dietary fat and simple-carbohydrate consumption be reduced in combination with drug therapy to lower the risk of pancreatitis for patients with severe and very severe hypertriglyceridemia.
• The treatment goal for patients with mild hypertriglyceridemia be a non–HDL-cholesterol level in agreement with the National Cholesterol Education Panel Adult Treatment Panel (NCEP ATP III) guidelines.
• Fibrates be used as a first-line drug to reduce triglycerides in patients at risk of triglyceride-induced pancreatitis.
• Fibrates, niacin, or omega-3 fatty acids be used alone or in combination with statins in patients with moderate to severe hypertriglyceridemia.
• And finally, statins not be used as monotherapy in patients with severe or very severe hypertriglyceridemia, although statins can be used to modify the risk of cardiovascular disease.

"Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, while mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease," according to the authors of the clinical-practice guidelines. "Therefore, similar to the NCEP ATP III guidelines committee's recommendations, we recommend screening adults for hypertriglyceridemia as part of a fasting lipid panel at least every five years."

References