摘要
血脂异常作为心血管代谢性疾病的核心病理因素,与高血压、2型糖尿病、冠心病等多系统疾病存在复杂的交互关联。文章系统探讨了血脂紊乱在心血管代谢性疾病中的潜在机制(如内皮功能障碍和炎症激活),并通过孟德尔随机化研究证实了血脂水平与心血管事件的因果关联。在2型糖尿病中,血脂异常与胰岛素抵抗形成双向恶性循环,尤其在合并高血压患者中,脂蛋白颗粒变化显著增加心血管残余风险。尽管当前降脂策略(如他汀类药物)已显著降低心血管负担,但指南优化治疗下仍存在残余风险,这促使研究者探索新型靶点:前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂、脂蛋白(a)调控剂及促消退脂质介质等新兴药物显示出转化潜力。此外,血脂波动性被证实独立于平均水平影响心血管预后,强化了长期稳定管理的重要性。针对代谢综合征和糖尿病患者的联合降脂策略(如贝特类与他汀联用)及个体化目标值设定[包括低密度脂蛋白胆固醇(LDL-C)、甘油三酯和高密度脂蛋白胆固醇(HDL-C)的综合调控]成为优化治疗的关键方向。未来研究需整合脂质组学技术,通过识别敏感分子标志物,开发精准干预手段,同时解决特殊人群(如他汀不耐受患者)的治疗难题,以进一步降低全球心血管代谢性疾病的负担。
Dyslipidemia,as a central pathological factor in cardiometabolic diseases,is intricately associated with multiple disorders including hypertension,type 2 diabetes mellitus(T2DM),and coronary heart disease.This article systematically reviews the potential mechanisms by which lipid abnormalities contribute to cardiometabolic diseases,such as endothelial dysfunction and inflammatory activation,and highlights evidence from Mendelian randomization studies confirming causal relationships between lipid levels and cardiovascular events.In T2DM,dyslipidemia and insulin resistance form a bidirectional vicious cycle,with altered lipoprotein particle profiles substantially increasing residual cardiovascular risk.particularly in patients with concomitant hypertension.Although current lipid-lowering therapies,such as statins,have markedly reduced cardiovascular burden,significant residual risk persists under guideline-directed management.This has prompted the exploration of novel therapeutic targets:proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors,lipoprotein(a)regulators,and pro-resolving lipid mediators,all of which hold translational potential.Furthermore,lipid variability has been identified as an independent determinant of cardiovascular outcomes beyond average lipid levels,underscoring the importance of long-term stability in lipid management.Combined lipid-lowering strategies-—such as statins plus fibrates-and individualized treatment goals,including the comprehensive regulation of low-density lipoprotein cholesterol(LDL-C),triglycerides,and high-density lipoprotein cholesterol(HDL-C),represent key directions for therapeutic optimization in patients with metabolic syndrome and diabetes.Future studies should integrate lipidomic technologies to identify sensitive molecular biomarkers for precision interventions and address the treatment problems in specific populations,such as statin-intolerant patients,in order to further alleviate the global burden of cardiometabolic diseases.
作者
马润泽
全南虎
MA Run-ze;QUAN Nan-hu(Department of Cardiovascular Center,the First Hospital of Jilin University,Changchun 130021,China)
出处
《中国实用内科杂志》
北大核心
2025年第11期921-926,共6页
Chinese Journal of Practical Internal Medicine
基金
国家自然科学基金面上项目(82270387)。
关键词
血脂异常
心血管代谢性疾病
降脂治疗
dyslipidemia
cardiometabolic diseases
lipid-lowering therapy
