高甘油三酯血症临床管理多学科专家共识

Multidisciplinary Expert Consensus on the Clinical Management of Hypertriglyceridemia

高甘油三酯血症(HTG)是国人常见的血脂异常类型。流行病学研究表明,HTG是动脉粥样硬化性心血管疾病(ASCVD)及急性胰腺炎的危险因素之一,且与超重/肥胖、胰岛素抵抗/2型糖尿病、非酒精性脂肪性肝病、慢性肾脏病有明确关联。近十年来,HTG与临床疾病关联的基础与药物(贝特类药物、烟酸类药物、处方级ω-3脂肪酸等)干预研究取得了一些进展,但临床处理尚存不同意见。本共识由多学科专家组成工作组,在系统回顾和总结国内外文献的基础上,分析了国人HTG高发的原因,阐述了HTG与ASCVD、肥胖、2型糖尿病、非酒精性脂肪性肝病、慢性肾脏病之间的关系;强调HTG早期发现、加强生活方式改变和终生管理的临床意义,有效、长期的HTG管理可降低ASCVD风险,并且有助于预防急性胰腺炎、肥胖、2型糖尿病、非酒精性脂肪性肝病等多种代谢性疾病,有一箭多雕的作用。本共识建议,心血管医师及相关学科医师和基层医师尤其应重视HTG,在临床实践中应对HTG患者定期评估,指导其避免不健康饮食、大量饮酒等,改善血糖管理,提倡规律适量运动、保持良好睡眠。对于HTG患者,应在严格改变生活方式的基础上,启动贝特类药物或处方级ω-3脂肪酸治疗;对于混合型高脂血症患者,他汀类药物也能降低甘油三酯,并显著降低ASCVD风险。

Hypertriglyceridemia(HTG)is a common type of dyslipidemia in Chinese population.Epidemiological studies have shown that HTG is one of the risk factors for atherosclerotic cardiovascular disease(ASCVD)and acute pancreatitis.The clear associations of HTG with overweight/obesity,insulin resistance/type 2 diabetes,nonalcoholic fatty liver disease and chronic kidney disease have been illustrated.In the past ten years,progress has been made in the basic research and drug intervention trials(fibrates,niacin,prescriptionω-3 fatty acids,etc)on the relationship between HTG and clinical diseases,but there are still different opinions on clinical management of HTG.This consensus consists of a working group composed of multidisciplinary experts.On the basis of systematically reviewing and summarizing relevant literature at home and abroad,we analyzed the reasons for the high incidence of HTG in Chinese population,and briefly explained the relationship between HTG and ASCVD,obesity,type 2 diabetes,nonalcoholic fatty liver disease,and chronic kidney disease.This consensus emphasized the clinical importance of early detection of HTG,enhanced lifestyle modifications and life-long management of HTG.Effective and longterm HTG management can reduce the risk of ASCVD and help prevent/attenuate the occurrence of acute pancreatitis,obesity,diabetes and nonalcoholic fatty liver disease,reach the goal of killing multiple birds with one stone.This consensus recommended that HTG should not only attract the attention of cardiologists,but also doctors from other related disciplines and medical professionals working in the primary hospitals.In clinical practice,patients with HTG should be regularly evaluated and guided to avoid unhealthy diet and heavy drinking,improve blood glucose management,and advocate regular exercise and healthy sleep.For patients with HTG,treatment with fibrates orω-3 fatty acids should be initiated on the basis of strict lifestyle changes.For patients with mixed hyperlipidemia,statins can also lower triglyceride level and significantly reduce the risk of ASCVD.