Rodenburg Jessica, Vissers Maud N, Daniels Stephen R, Wiegman Albert, Kastelein John J P
Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, the Netherlands, and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, USA.
Pediatr Endocrinol Rev. 2004 Nov;2 Suppl 1:171-80.
In the last decades, there has been an important progression in the development and assessment of various cholesterol-lowering agents. Until recently, in children under age 10, the focus of treatment has been on dietary and lifestyle adjustments. For children older than 10 years, bile acid-binding resins were also recommended if LDL-C levels remained high after dietary adjustment. However, the lipid-lowering effect of bile acid-binding resins is modest at best and long-term compliance is often poor. In contrast, HMG-CoA reductase inhibitors (statins) are currently widely used in adults and are considered the first choice in the treatment of hypercholesterolemia. In the last few years, several randomized trials have shown that statins are also effective in reducing LDL cholesterol levels in children and seem safe at least in the short term. Another novel development is the cholesterol-lowering agent, ezetimibe, which inhibits cholesterol absorption in the intestine. Although efficacy and safety data in children are still lacking, ezetimibe has a good safety profile in adults, either as monotherapy or in combination with a statin. Lastly, two other classes of lipid-lowering drugs include fibrates and nicotinic acid, but most agree that the side effect profile precludes their use in children except in extreme circumstances. Overall, therapeutic options to lower cholesterol levels in children are expanding.
在过去几十年中，各种降胆固醇药物的研发和评估取得了重要进展。直到最近，对于10岁以下儿童，治疗重点一直是饮食和生活方式调整。对于10岁以上儿童，如果饮食调整后低密度脂蛋白胆固醇（LDL-C）水平仍高，也推荐使用胆汁酸结合树脂。然而，胆汁酸结合树脂的降脂效果充其量只是中等，而且长期依从性往往较差。相比之下，HMG-CoA还原酶抑制剂（他汀类药物）目前在成人中广泛使用，被认为是治疗高胆固醇血症的首选药物。在过去几年中，多项随机试验表明，他汀类药物在降低儿童LDL胆固醇水平方面也有效，并且至少在短期内似乎是安全的。另一个新进展是降胆固醇药物依折麦布，它可抑制肠道内胆固醇吸收。尽管儿童的疗效和安全性数据仍然缺乏，但依折麦布在成人中作为单一疗法或与他汀类药物联合使用时具有良好的安全性。最后，另外两类降脂药物包括贝特类药物和烟酸，但大多数人认为，除极端情况外，其副作用限制了它们在儿童中的使用。总体而言，降低儿童胆固醇水平的治疗选择正在扩大。
