20575 30 7ClinicalFocusJuly5205Vol30No.7 725 (204 ) : 2 ( ) 3 4 5 6 [ (ACEI) Ⅱ (ARB) β ] 72 2 20/0mmHg 8 40/90mmHg 9 : ( ) 0 : 3 2~4 瑏瑡 瑏瑢 : :R544. doi:0.3969/j.issn.004-583x.205.07.002 :A :004-583X(205)07-0725-20 4 5 6 3 2~4 8 2009 2009 9 ( ) 2030 : 2 ( ) 3 ( ) : Email:wangwen5588@26.com 7 : ( )
726 20575 30 7ClinicalFocusJuly5205Vol30No.7 [] ( [2]. 2.. 2. 3 40 mmhg() 90mmHg 40/90..2 : [4] mmhg 2.2 ( ) 2.2. 8 ( ) 2 : 20 ( ).2.2. () 2 (2) 40 () 90 ( ) 40~59 () 90~99 2 ( ) 60~79 () 00~09 2 3 ( ) 80 () 0 3 40 <90 : 2 3 4 35 2.2.2.2.2 () : [ 30~39 mmhg() 85~89 mmhg]2 [ (BMI) [3].2.3 [ 40 2 mmhg() 90 mmhg] 2.3.2 [ 80 mmhg () 0 mmhg] [ 3 3~4 40 mmhg<80 mmhg() 90 mmhg<0 mmhg] 2 ) 4 :2 ~2 3 :3 2 3 ( ) (3~6 ) ( (mmhg) / (mmhg) <20 <80 20~39 () 80~89 35/85 mmhg 35/85 mmhg24 24~27.9kg/m 2 )(BMI 28kg/m 2 )] 30/80mmHg [5] : 90cm(2.7) 85cm(2.5 2.3 )3 ( )4 2.3. 5 [ 00 ml(2 )] : 6 55 (2) (3) (4) 2 : 2
20575 30 7ClinicalFocusJuly5205Vol30No.7 727 ) ( ) 2.4.2 ( ) <302 ( 3)3 4 2 5 6 ( ) 2 3 :BMI 28kg/m 2 : 90cm 85cm : >55 >65 ( 55 65 ) ( ) ( : ) ( ) 7.0mmol/L : (TC) 5.7 mmol/l (LDL-C) 3.3 mmol/l (HDL-C)<.0 mmol/l (TG).7mmol/L : 5μmol/L(.3mg/dl) 07μmol/L(.2mg/dl) 300mg/24h 30~300 mg/24h / 22 mg/g (2.5mg/mmol) 3mg/g(3.5mg/mmol) X : (PWV) 2m/s 3 (mmhg) :40~59/ 90~99 2 :60~79/ 00~09 3: 80/0 4 (mmhg) 2 3 40~59/90~99 60~79/00~09 80/0 ~2 3 : 200 2.5.4 2.4 5%~0% : 2 2.4. : 3 : 4 : 7 8 20mmHg 9 2.5 2.5. : ( ) 2 : ( ) ( ) 3 : 4 : 5 : 2.5.2 2 : 3 4 : 2.5.3 () : ( )2 ( )3 : (TCLDL-C HDL-CTG) 4 (2) : 24 / PWV
728 20575 30 7ClinicalFocusJuly5205Vol30No.7 3 3. 3.. 2~4 ~2 3..4 4~2 3..2 40/ 90mmHg [6-7] ( 65 ) 3.2 50/90mmHg 40/90mmHg 3 3..3 40() 90 mmhg :* 5mmHg( 35/85mmHg 40/90mmHg) 3.3 0kg 5~20mmHg [8-9] ( ( ) <6g/d) 2~8mmHg [0] 3.3. 3.3.2 5 3
20575 30 7ClinicalFocusJuly5205Vol30No.7 729 5 6g 2 6g 3 4 <30% <0% <25g 50~00g 250g 2 3~4 3 3 400~500g 00g 4 : : 5~7 30 2 : 30 303 = 70-4 5 6 30 BMI(kg/m 2 )<24 : <90cm <85cm [] 2 3 4 5 6 2 3 4 5 6 7 : <50 ml/d (/d) <00 ml/d(2 /d) 2 <250ml/d(5/d) 3 4 5 [4] 3.4 3.4. : [2] α 2 2 : 24 4 24 2~3 5 3 : 3.4.3 2 2 4 : () : 3.4.2 [3-5] 5 : ACEI ARB β 5
730 20575 30 7ClinicalFocusJuly5205Vol30No.7 6 4 ( ) (2)ACEI: ( ~2 / (3)ARB: ARB ~2 ACEI ( ) (4) : ~2 [6] β Ⅱ~Ⅲ ACEIARB 3.4.4 () : [7-9] 6 : (5) β : ACEI2 ARB3ACEI 4ARB 5 ( 80 /min 6 )~2 β β (α2 Ⅱ~Ⅲ : ) β 3~4 3 : ACEI(ARB) ACEIARB (6) : ⑵ : 6 2 Ⅱ~Ⅲ ) ACEI ( ) / / ACEI ( )
20575 30 7ClinicalFocusJuly5205Vol30No.7 73 (3) 2 : 7 7 2 C+D A+C C+A A+D D+A C+B + + + + + + + + + + + + + + + + + + + + + + + + + + + + + :A(ACEIARB)B( β ) C[ ( )]D( ) ⑷ : mmhg 2 2 2 2 <60/00 mmhg 2 2 60/00 mmhg 20/0 :A(ACEIARB)B( β ) C[ ( )]D( )α(α )F( ) 2 2 ⑸ : 0. mg 2.5 mg 2.5 mg 2.5 mg ( ) 0.03mg 5mg ( 3.4.5 ) ( 0 ) 0.032 mg 3. mg 2.mg 4.2 mg 3.4.6 (
732 20575 30 7ClinicalFocusJuly5205Vol30No.7 3.4.7 ) ⑴ 2~3 ⑵ [20] ⑴ : ⑶ 2 TC (TC 6.2 mmol/l) TC<5.2 mmol/l 2 TC 5.2 mmol/l(ldl-c 3.4 ⑷ mmol/l) TC< 4.mmol/L(LDL-C<2.6 mmol/l) 3 <50/min β TC 4. mmol/l (LDL-C 2.6 mmol/l) TC< ACEIARB 3.mmol/L(LDL-C<2.mmol/L) ⑸ [ (ALT) (AST) (CK)] ⑹~2 [2] ⑵ : ( ) (75~00 mg/d) [0 : >0%(50 )] ( < 60/00mmHg) 6 [22] ⑶ : 2 : <50mmHg : 4.4~7.0 mmol/l <40mmHg80 <0.0 mmol/l (HbA c)< <50/90mmHg 7.0% 203 2 ACEI [4] 3.4.8 ⑴ (65 ) 60mmHg 50mmHg
20575 30 7ClinicalFocusJuly5205Vol30No.7 733 60mmHg 50mmHg ()α ( ACEIARB) ⑺ β ⑵ ACEIARB ( β ACEI ARB ) β 60 mmhg ⑶ ACEIARB β ⑻ ⑼ 20 (4) ACEIARB ⑸ ACEIARB 3.4.9 ⑹ 8 ARBACEI β 8 : 0mg 2~3 2 0mg 3 0~20mg 2 ~3 4 ~2 2~3 5 2.5~25mg 2~3 6 0 7 2.5mg 8.25~2.5mg 9 2.5~25mg ~2 0 ~2 2 瑏瑡 ~2 2~3 2 : 0~20mg 2 2 20mg 2 3 30~60mg 4 5mg 5 2.5~5mg 6 0~2 7 20mg ~2 8 20mg 2 9 80mg 0 60mg 瑏瑡 00mg 瑏瑢 4~8mg 瑏瑣 5~0mg 瑏瑤 5~0mg 瑏瑥 20mg 瑏瑦 0~20mg ( ) 30mg 2 2.5~5mg 3 5mg 4 4mg 5 0mg ~2 6 50~00mg 7 80~60mg 8 40~80mg 9 2.5~5mg 0 2.5mg 瑏瑡 0~20mg ~2 瑏瑢 0mg 瑏瑣 5~0mg 2.5~5mg+ 40mg 2 30mg+ 8mg 3 5mg + 2.5mg 4 0mg+ 2.5mg 5 4mg+ 2.5~25mg 6 2.5~5mg+ 7 20mg + 25mg ~2 8 30mg+ 2.5mg 9 50mg+ 2.5mg 0 80mg+ 2.5mg 瑏瑡 50mg+ 2.5mg 瑏瑢 5mg+ 25mg 瑏瑣 2.5mg+ 5mg 瑏瑤 4mg+.25mg 瑏瑥 80mg+ 5mg 瑏瑦 5mg+ 0mg 瑏瑧 0mg+ 2.5mg 3 : 5mg + 80mg 5~0mg+ 2.5mg 2 0mg+ 5mg 2 60mg+ 5mg 3 5~0mg+ 2.5mg 3 30~60mg+ 8mg 4 30~60mg+ 2.5mg 4 5mg + 4mg 5 5mg+ 5 5mg+ 5mg 6 0mg+ 2.5mg 6 5mg+ 2.5mg 7 4mg+ 20mg 7 00mg+ 5mg 8 20mg+ 5mg : 3.4.0 20 80 (Syst-China) [3] (STONE) [4]
734 20575 30 7ClinicalFocusJuly5205Vol30No.7 (PATS) [6] 2 ( ) (FEVER) [658] 3 ( 7) 4 (CHIEF) [9] 85% 4.2.3 2 3 6 4 ( 4 4. 4.2.4 4.. 2 3 4 4..2 5 6 30~39/85~89 mmhg / 203 ( ) 4..3 ( [24] ) 5 5. )5 4.2 3 4.2. 2~4 2 2009 ( 3 2 3 ) [23] 4.2.2 ( ) 9
20575 30 7ClinicalFocusJuly5205Vol30No.7 735 9 (<40/90mmHg) ( 40/90mmHg) [25] 3 2~4 2 3 2 : : 3 5.2 3 5.3 5.3. 5.4 5~0 5.3.2 [26] 2~3 7 6 5.5 ( )
736 20575 30 7ClinicalFocusJuly5205Vol30No.7 : = / 00% ( : ) ( ) ( ( ) ) (2): ( ) : = / 00% 6 (3) : 6. : = / 00% 6.2 <40 mmhg 6.2. <90mmHg 2 2 : 33 4 : 40/ 5 6 90mmHg 2 : ( ) 70% 6.2.2 40/90mmHg 2~3 2 7.2.2 3 () : 4 5 : 6 = / 00% 6.2.3 (2) : 2 2 3 : 7 =2 / 7. 00% 2 (3) : 3 : / / ( )/ : ( )/ = / 00% 7.2 3 : ( )2000 000 500 2 7.2. () : 40/90mmHg 400
20575 30 7ClinicalFocusJuly5205Vol30No.7 737 50%(000/2000) 25%(500/2000) 20%(400/2000) 600 5 400 300(4) (<40/90mmHg) 30%(600/2000) 67%(400/600) 50%(300/600) (5) 2.5cm ~2 (6) 8 Ⅰ ( ) Ⅴ ( ) Ⅰ Ⅴ 2 Ⅳ ( ) (7) (0 2 4 6 8) 02468 [ (20± 0)% ] 0 (8) 3 2 2 5 mmhg 3 3 24 (2) 80% (3) ( ) 2 () :35/85 mmhg 40/90 [ (ESH) mmhg <35/85mmHg (BHS) (AAMI)] 30
738 20575 30 7ClinicalFocusJuly5205Vol30No.7 7 6~9 :24 <30/ 6~9 2~3 80mmHg <35/85 mmhg 6 <20/70 mmhg 6 0%~5% 5 2030 3060 80% 3 24 24 2 (~3) >55 TC 5.7mmol/L(220mg/dl) LDL-C 3.3mmol/L(30mg/dl) HDL-C<.0mmol/L(40mg/dl) : <55 <65 BMI 28kg/m 2 WC 90cm 85cm : (LVMI) (IMT) (WC) 3 :LVMI X IMT 0.9mm 5~33μmol/L(.3~.5mg/dl) 07~24μmol/L(.2~.4mg/dl) ( ) 30~300mg/24h >33μmol/L(.5mg/dl) / : >24μmol/L(.4mg/dl) 22mg/g(2.5mg/mmol) (>300mg/24h) 3mg/g(3.5mg/mmol) : : : 7.0mmol/L(26mg/dl).mmol/L(200mg/dl) 2 : 3 6g/d
20575 30 7ClinicalFocusJuly5205Vol30No.7 739 4 3 5 2 6 2 4 5 6 7 7 : 2 : 6~0 : 2 3 3 00 ml( 2 ) 80/0mmHg 250ml( ) 50 ml( ) 4 5 3 ( : ( () 4 : 2 3 20 4 (/ min)=70-5 0 : (2) : 2 3 5~7 : 30 30 2 : 4 5 2 6 (4000/h) 7 2 30 (kcal) 30~40 : ( ) 40~70 (600m/h) ( ) (8.5km/h) 00 ( ) (20m/min) (0km/h) 20 000~2000m/0min 75 ) ( ) 50 ( ) (5km/h) 80 (5% ) ( ) 200 ) (9~22km/h) 200~250 (50m/min) (22~26km/h) (60m/min) 300
740 20575 30 7ClinicalFocusJuly5205Vol30No.7 5 4 5 : 6 ( 2 ) 3 4 3 (mg/d) (/d) 0~40 2 2.5~0 20~60 2~3 30~60 (Ⅲ) 30~60 (ⅠⅡ) 0~40 2 4~8 2.5~0 2.5~5 90~360 ~2 80~240 2~3 ACEI 25~50 2~3 5~40 ~2 5~80 ~2.25~0 4~8 0~40 5~40 ARB 25~00 80~60 20~80 50~300 8~32 6.25~25.25~2.5 20~80 ~2 50~00 ~2 5~0 ~2 20~40 ~2 β 2.5~50 ~2 25~00 ~2 2.5~0 5~20 2 30~90 2 α 2~20 2~3 2~4 ~2 ~20 ~2 β 2.5~50 2 200~400 2 α2 0.~0.8 2 ( ) 0.25 / 25~00 2 : 25~00mg2~3 ( 25~00mg 2~3)
20575 30 7ClinicalFocusJuly5205Vol30No.7 74 5 4 (/d) ( ) 30~60mg 0~20mg 2.5~0mg 4~8mg 2.5~0mg 0~20mg 0~20mg 2.5~5mg 2 2~3 ~2 : ACEI 0~20mg 2.5~50mg 0~40mg 0~40mg 5~40mg ~2 2~3 ~2 : ARB 25~00mg 80~60mg 50~300mg 20~80mg ACEI ACEI ( ) 6.25~25mg.25~2.5mg : : β 2.5~25mg 25~50mg 2.5~0mg ~2 2 ~2 ~3 2~3 ~2 /~2 / ~2 / /~2 / / / ~2 ~2 / ~2 ~2 2~3 ~2 : Ⅱ~Ⅲ : ~2 Ⅱ~Ⅲ ACEI 6 ( 60 mmhg ) ACEIARB <50 mmhg (>65 ) <60 mmhg < 50mmHg 50 mmhg ACEI 60 mmhg ACEIARB 2 80 β
742 20575 30 7ClinicalFocusJuly5205Vol30No.7 ACEI (2) : β ACEI β 8 3 ACEI β 3 ACEI(ARB) β ( ) β (2) : 4 ( <265μmol/L) ACEI ARB 20/0mmHg ( ) ( ACEIARB ) ( β ) ( HbA c< 7% ) ( 5 ACEIARB (3) β 9 >32μmol/L () : ACEI/ARB <30% >30% ( 80/20 mmhg) >220 mmhg() > >32.6μmol/L(.5 mg/dl) 30mmHg ( >3mg/dl) : ACEIARB 6 220/20 mmhg 20 ( ) ACEI ARB 7 () : 20 ( 40/90 mmhg) 20%~25% 60/00mmHg 30/5 mmhg 6 : () : () : : ( ) 2 : ) 3 (2) :
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744 20575 30 7ClinicalFocusJuly5205Vol30No.7 [20]. [24]. [J]. [J]. 200735(5):390-49. [2]. [25].2 : (2005)[J]. [J]. 209 200634(3):28-284. (4):336-34. [22]. 2 (203 )[J]. 2046(7):447-498. [23]. (2009 ) [J]. 2008():-30. 2032(2):23-49. [26]. [J]. 206(6):435-439. :205-04-28 : ( 050000) : :R563.3 :B :004-583X(205)07-0744-0 doi:0.3969/j.issn.004-583x.205.07.003 ( 0.93/0 /.4/0 / (ILD) 2.9/0 / 0.8/0 /) () 6.8~8.8/0 / (IPF)ILD 5.08~7.57/0 / ( 0.68~ 50.2/0 /) (.2/0 /.84/0 /.23/0 /) (UIP) ( 0.26/0 /) 5.08~6.49/0 / IPF IPF 20 80 IPF (IP) IPF 2000~2008 7.44/0 / Hutchinson 99~2003 IPF 4.6/0 / ( [] IPF )IPF 979~2000 0.68/0 / IPF 996~200.2/0 / IPF IPF IPF IPF meta IPF 0.22~93.7/0 ILD Medline (946 )Embase (974 ) (2000 ) 2046 IPF 2.8~9.3/0 / Google : [] HutchinsonJFogarty AHubbard Retal.Global 34 2968~ incidence and mortality of idiopathic pulmonary 202 25 5 fibrosis:asystematicreview[j].eurrespirj205 22 May4.[Epubaheadofprint] : Email:46973257@qq.com 28 8 IPF (7.44~8.65/0 /) ( 7.27/0 / 4.3/0 /) :205-06-23 :