三种指南对颈动脉斑块患者血脂管理的对比分析

A Comparative Analysis of Three Guidelines for the Management of Dyslipidemia

目的分析三种血脂异常管理指南(2001NCEP ATPIII指南及其2004年修订版、2007年中国成人血脂异常防治指南、2011ESC/EAS血脂指南)对颈动脉斑块患者血脂管理的异同。了解血脂异常评估与干预治疗的新观念,为临床决策提供参考。方法分析43例彩色多普勒确诊的颈动脉斑块患者的血脂水平及其在三种血脂管理指南中的危险分层和LDL-C目标值。结果 2001NCEPATPIII指南及2007年中国成人血脂异常防治指南对颈动脉斑块患者危险分层结果相同,极高危占37.21%,高危占62.79%,LDL-C达标值:极高危NCEPATPIII标值<1.8mmol/L,达标率0%,我国标值<2.07mmol/L,达标率18.75%,高危标值<2.59mmol/L,达标率22.22%。2011ESC/EAS血脂指南对43例颈动脉斑块患者危险分层,100%极高危,LDL-C达标值<1.8mmol/L,达标率0%。结论与另两种指南相比,2011ESC/EAS血脂指南将43例颈动脉斑块患者明确为极高危人群,强调其风险更高,调脂治疗更加积极,目标值更低,达标率低。

Objective To analyze the sameness and difference of the management of lipidemia for patients with carotid atherosclerotic plaque among three guidelines for the management of dyslipidemia（NCEP ATPIII Guidelines in 2001 and revision in 2004,Guidelines for preventive cure of dyslipidemia for Chinese adults in 2007,ESC/EAS guidelines in 2011）.To know new concepts of evaluation and intervenient cure for dyslipidemia,and to provide reference for making clinic decision.Methods A total of 43 patients with carotid atherosclerotic plaque diagnosed by color-Doppler were studied to compare the level of lipidemia,as well as risk stratification and the target value of LDL-C（Low-density lipoprotein cholesterol） among three guidelines for the management of dyslipidemia.Results There is the same result of risk stratification for patients with carotid atherosclerotic plaque by both NCEP ATPIII Guidelines in 2001 and Guidelines for preventive cure of dyslipidemia for Chinese adults in 2007.37.21% is for very high-risk,62.79% for high-risk.The target value of LDL-C： NCEP ATPIII target value for very high risk1.8mmol/L,ratio of target value achieved is 0%.Target valve in China2.07 mmol/L,ratio of target value achieved is 18.75%,target value for high-risk 2.59mmol/L,ratio of target value achieved is 22.22%.It is concluded after risk stratification for patients with carotid atherosclerotic plaque by ESC/EAS guidelines in 2011 that 100% is for very high-risk,the target value achieved of LDL-C 1.8mmol/L,ratio of target value achieved is 0%.Conclusions Compared with 2 other guidelines,it is diagnosed by ESC/EAS guidelines in 2011 that 43 patients with carotid atherosclerotic plaque are of very high-risk group,have higher risk,more active cure for lipidemia,lower target value,and low ratio of target value achieved.