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1 2020 / IAS IAS IAS 1

2 / NCEP III ATPIII,NCEP

3 3 NCEP ATPIII - Meta,, N-9 N-6

4 N-3 N-9 N-9 N-9 N-3 / BMI kg/m 2 BMI BMI kg/m 2 BMI kg/m / 4

5 102cm 40in 90cm 85cm 88cm 35in 80cm 90cm 5

6 1/3 6 LDL LDL LDL LDL HDL LDL LDL 6

7 LDL LDL HDL HDL HDL HDL HDL-C HDL HDL HDL HDL HDL HDL HDL HDL HDL LDL HDL-C HDL-C HDL-C 126mg/dl 7.0mmol/l

8 ATP CHD CVD CHD 1 CHD 2 2 ATP CVD CVD CVD CHD CVD CVD 1 2 CVD CHD 8

9 LDL-C 2-12 (a) PROCAM

10 LDL HDL (a) B C AI Meta LDL HDL (a) (a) LDL Lp(a) LDL Lp(a) B(apoB) LDL TGRLP apob LDL-C apob HDL-C TC HDL-C LDL HDL-C ATPIII HDL-C LDL-C CIII (apociii) HDL-C AI(apo AI) 10

11 -1(PAI-1) D- PAI-1 D- V (tpa) vw V Leiden C III PAI-1 Antithrombotic Trialists Collaboration Meta 1/4 1/3 1/4 1/6 C- (hs-crp) -6 1(sICAM-1) E- P- hs-crp hs-crp 11

12 12 hs-crp HMG-CoA (statin) PPAR PPAR TZDS /, mg/dl 2 / ( ) 2 PROCAM MONICA ARIC /

13 TC HDL-C TC/HDL-C TC/HDL-C TC/HDL-C 5 TC/HDL-C TC HDL-C X ATPIII - - LDL - HDL ATP ATPIII * 150mg/dl 1.69mmol/l HDL-C - <40mg/dl 1.0mmol/l - <50mg/dl 1.3mmol/l - 130mmHg 13

14 85mmHg 110mg/dl 6.0mol/l * 102cm 40in 90cm 85cm 88cm 35in 80cm 90cm WHO ATPIII ATP CVD ATPIII CHD 14

15 CHD CHD CHD 20% CHD CHD ABI<0.9 TIAs CHD a. b Framingham PROCAM 15

16 ATPIII CHD CHD 1997 CHD CHD 30 CHD, HDL C ATP CHD PROCAM Westphalia PROCAM PROCAM LDL C HDL C CHD PROCAM CHD ( com) PROCAM PROCAM CHD CVD 16

17 2 2 ATP CHD ATP CHD CHD CVD PROCAM CHD CVD CHD PROCAM CHD CHD 2 CHD CHD CVD CHD CHD CHD CHD CHD CHD CVD CVD 17

18 ATP CHD ATPIII IAS ATPIII CHD 20 /10, /10 LDL C 130mg/dl( 2.6mmol/l) CHD QALY OALY LDL C 130mg/dl 18

19 ATP CHD CHD LDL C LDL C 160mg/dl 2 CHD CHD ATP CVD CHD PROCAM CVD 10 19

20 CVD CHD 1 CVD CVD 10 LDL C 190mg/dl 4.9mmol/l 1 30kg m 2 IAS CHO 10 20% 20

21 LDL- ATP NCEP % 200mg/ LDL-C ATP / 2g/ 10g/ LDL 21

22 mg N-3 1% -- N-3 1g/ 20-30g 10-20g 100mmol mmol / / 10% 10% 10% kcal 22

23 / / U.S. Surgeon General's 23

24 a / b c a SR b c d e a b / / 130/85mmHg 24

25 / /85-89mmHg LDL-C LDL HMG A LDL-C 30% 1/3 LDL-C NCEP LDL-C 100mg/dL 2.6mmol/L LDL-C 3.0mmol/L 115mg/dL LDL-C LDL-C LDL LDL-C 100mg/dL 2.6mmol/L 100mg/dL LDL-C ATP LDL LDL-C LDL LDL-C 30% LDL-C 100 mg/dl ( 2.6 mmol/l) LDL-C< 100 mg/dl(< 2.6 mmol/l) LDL 25

26 LDL-C LDL LDL-C HDL-C HDL LDL LDL-C HDL HDL HDL HDL ATP HDL-C HDL mg 75mg/ % LDL JNC <130/85mmHg <130/80mmHg ATP LDL-C<100mg/dl(< 2.6mmol/L) CHD10 >20% PROCAM <20% ATP 26

27 CHD ATP % % 10 >20% PROCAM ATP CHD CHD ( %) (Killip II ) - - CHD10 <20% CHD10 <20% 27

28 IAS CHD10 <20% CHD % / / 10% / 28

29 / % %-50% 29

30 JNC CHD10 20% /85-89mmHg /90-99mmHg 2/3 160/ 100mmHg JNC JNC <140/90mmHg 100mmol mmol JNC JNC LDL-C LDL 10 <20% LDL-C 30

31 10 <20% LDL 5 ATP 10 <20% LDL ATP 2 10 >20% 10 LDL-C LDL-C <130mg/dl <3.4mmol/l LDL-C 130mg/dl 3 3 LDL-C 130mg/dl LDL LDL-C<130 mg/dl LDL LDL 130mg/dl LDL-C <130mg/dl LDL-C 130mg/dl LDL-C LDL-C<160mg/dl <4.1mmol/l LDL LDL-C l60mg/dl LDL-C<130mg/dl 0-1 LDL-C <160mg/dl 3 LDL-C<160mg/dl LDL-C mg/dl mmol/l CHD 31

32 HDL-C 10 10% LDL-C 190mg/dl 4.9mmol/l LDL-C<160mg/dl 0-1 LDL-C 160mg/dl LDL LDL-C 190mg/dl 4.9mmol/l LDL-C LDL-C 10 20% CHD HDL-C HDL IAS ATP HDL-C HDL-C LDL-C LDL HDL-C mg/dl mmol/l HDL-C 200mg/dl 2.24mmol/l HDL-C HDL CHD CHD 32

33 Lp(a) 33

34 LDL-C 190mg/dl 4.9mmol/l LDL-C B CHD + LDL Meta CHD 60% 2 A ATP < 150 mg/dl (< 1.69 mmol/l) mg/dl ( mmol/l) mg/dl ( mmol/l) 500 mg/dl ( 5.63 mmol/l) CHD VLDL VLDL-C VLDL-C ATP LDL-C VLDL-C HDL-C TC HDL-C 200mg/dl 2.24mmol/l HDL-C 30mg/dl 0.8mmol/l LDL-C VLDL-C 30mg/dl 0.8mmol/l LDL-C 100mg/dl(< 2.6 mmol/l) HDL-C 130mg/dl(< 3.4 mmol/l) 34

35 LDL-C mg/dl mmol/l ATP mg/dl mmol/l HDL-C LDL-C HDL-C VLDL-C HDL-C HDL-C 500mg/dl 5.63mmol/l 15% 500mg/dl (< 5.63 mmol/l) LDL CHD 2 LDL HDL-C / HDL-C LDL-C ATP CHD LDL-C 100mg/dl(< 2.6 mol.l) ATP LDL-C 130mg/dl 3.4mmol/l LDL-C LDL-C mg/dl mmol/l LDL LDL-C mg/dl LDL CHD 65 35

36 35-65 CHD CHD CHD LDL CHD CHD 65 CHD 65 CHD CHD CHD 10 LDL-C CHD LDL-C CHD 65 LDL-C HDL-C CHD 65 CHD LDL LDL LDL 36

37 CHD CVD CVD CVD CHD CHD CHD LDL-C LDL-C 130mg/dl 3.4mmol/l LDL-C mg/dl mmol/m ATP LDL LDL-C 190mg/dl 5.0mmol/l CVD / 37

38 / CVD / CVD HDL-C CHD IAS CVD / 38

39 CVD CVD CVD IAS CHD JCN IAS <

40 HDL HDL HDL HDL <40 2 < <0 <1% 5 2% 11 8% 0 1% 6 2% 12 10% 1 1% 7 3% 12 12% 2 1% 8 4% 14 16% 3 1% 9 5% 15 20% 4 1% 10 6% 16 25%

41 < HDL HDL HDL HDL <40 2 < <9 <1% 14 2% 20 11% 9 1% 15 3% 21 14% 41

42 10 1% 16 4% 22 17% 11 1% 17 5% 23 22% 12 1% 18 6% 24 27% 13 2% 19 8% 25 30% 42

43 3 10 PROCAM LDL-C mg/dl LDL-C mmol/l HDL-C TG mg/dl mmol/l mg/dl mmol/l ( 60 ) 120mg/dl(6.66mmol/l)

44 PROCAM :

45 4 - a b c - a 2 3 b 2 3 c 45

46 5 CHD10 <20% LDL-C * LDL-C 2 <130mg/dL 10 (<3.4mmol/L) 20% <160mg/dL 0 1 (<4.1mmol/L) 130mg/dL ( 3.4mmol/L) 160mg/dL ( 4.1mmol/L) % 130mg/dL(3.4mmol/L) 10 10% 160mg/dL(4.1mmol/L) 190mg/dL(4.9mmol/L) mg/dL( mmol/l): LDL * (BP 140/90mmHg ) HDL <40mg/dl <55 < CHD10 <10% 10 46

47 6 47

48 48

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多饮多食烦渴多食的女士一进行本案例讨论, 学生应具备的背景知识生物化学与分子生物学组织学免疫学病理生理学诊断学内科学二学习目的 1 糖尿病病因及发病机制 2 糖尿病的代谢紊乱及主要并发症 3 糖尿病的诊断和鉴别诊断 4 糖尿病的