Betteridge D J
Royal Free and University College of Medical School, University College London, UK.
Diabetes Obes Metab. 2000 Mar;2 Suppl 1:S31-6. doi: 10.1046/j.1463-1326.2000.00021.x.
Dyslipidaemia is an important component of the metabolic syndrome observed in patients with type 2 diabetes, and is characterized by moderate hypertriglyceridaemia and low levels of high-density lipoprotein (HDL) cholesterol concentrations. Dyslipidaemia contributes to increased vascular risk and is therefore a good target for therapeutic intervention in the form of glycaemic control, lifestyle measures and hypolipidaemic drugs. It is proposed that lipid abnormalities in type 2 diabetes are secondary consequences of insulin resistance. Any approach that lowers insulin resistance would be anticipated to have a beneficial effect on dyslipidaemia, but in many cases patients with type 2 diabetes fail to achieve normal lipidaemia through diet, exercise and glycaemic control. Subgroup analyses of major clinical trials suggests that lipid-lowering therapy reduces CHD risk in patients with diabetes, but trials performed specifically in populations of patients with diabetes are ongoing. Until then, patients with type 2 diabetes who have established CHD or high individual risk already warrant aggressive lipid-lowering pharmacotherapy. In the author's view, when ongoing studies are complete it is likely that most patients with type 2 diabetes will be prescribed lipid-lowering drugs.
血脂异常是2型糖尿病患者中观察到的代谢综合征的一个重要组成部分，其特征为中度高甘油三酯血症和高密度脂蛋白（HDL）胆固醇浓度水平较低。血脂异常会增加血管风险，因此是以血糖控制、生活方式干预和降血脂药物等形式进行治疗干预的一个良好靶点。有人提出，2型糖尿病中的脂质异常是胰岛素抵抗的继发性后果。任何降低胰岛素抵抗的方法预计都会对血脂异常产生有益影响，但在很多情况下，2型糖尿病患者无法通过饮食、运动和血糖控制实现血脂正常。主要临床试验的亚组分析表明，降脂治疗可降低糖尿病患者的冠心病风险，但专门针对糖尿病患者群体开展的试验仍在进行中。在此之前，已确诊患有冠心病或个体风险较高的2型糖尿病患者已经需要积极的降脂药物治疗。在作者看来，当正在进行的研究完成时，很可能大多数2型糖尿病患者都将被开降脂药物。
