Department of Cardiology, Gold Coast Hospital, Griffith University School of Medicine, and Griffith Health Institute, Heart Foundation Research Centre, Southport, Queensland, Australia.
Int J Evid Based Healthc. 2012 Sep;10(3):181-90. doi: 10.1111/j.1744-1609.2012.00275.x.
Fibrates have been prescribed for decades as 'broad-spectrum' lipid modifying agents that can improve plasma levels of triglycerides, high-density lipoprotein cholesterol, and triglyceride-rich lipoproteins, including very low- and intermediate-density lipoproteins. Fibrates are variably effective in lowering low-density cholesterol levels. Available fibrates include gemfibrozil, fenofibrate, bezafibrate, etiofibrate and ciprofobrate; only fenofibrate and gemfibrozil are available in Australia.
Members of the Queensland Lipid Group provided consensus grades of recommendations for the clinical use of fibrates based on PubMed searches, product information, and personal clinical experience.
Fibrates are well tolerated, and the combination of fenofibrate with statins appears to be safer than gemfibrozil, particularly with regard to adverse effects on muscle. Evidence has been provided recently for the efficacy of fenofibrate in reducing microvascular complications in diabetic patients, including progression of retinopathy, progression of microalbuminuria and nephropathy, development of sensory neuropathy, and leg amputation. Macrovascular benefits appear to be confined to those with reduced high-density lipoprotein cholesterol and/or increased triglyceride levels, and the relationship of microvascular benefits of fenofibrate to baseline lipid levels is variable and requires further assessment.
Indications for fibrate therapy may be extended in the future to include protection from both macro- and micro-vascular disease, particularly in diabetic patients and patients with residual dyslipidaemia in spite of statin therapy. We provide recommendations on the use of fibrates in clinical practice to highlight these potential indications.
数十年来，贝特类药物一直被用作“广谱”调脂药物，可改善甘油三酯、高密度脂蛋白胆固醇和富含甘油三酯的脂蛋白（包括极低密度脂蛋白和中间密度脂蛋白）的血浆水平。贝特类药物在降低低密度胆固醇水平方面的效果不一。现有的贝特类药物包括吉非贝齐、非诺贝特、苯扎贝特、益多酯和氯贝丁酯；只有非诺贝特和吉非贝齐在澳大利亚有售。
昆士兰血脂专家组的成员根据 PubMed 搜索、产品信息和个人临床经验，对贝特类药物的临床应用提供了共识推荐等级。
贝特类药物耐受性良好，且与他汀类药物联合使用似乎比吉非贝齐更安全，特别是在肌肉不良反应方面。最近有证据表明，非诺贝特可降低糖尿病患者的微血管并发症，包括视网膜病变进展、微量白蛋白尿和肾病进展、感觉性神经病发展以及腿部截肢。大血管获益似乎仅限于高密度脂蛋白胆固醇降低和/或甘油三酯水平升高的患者，且非诺贝特对微血管获益与基线血脂水平的关系是可变的，需要进一步评估。
贝特类药物的治疗适应证未来可能会扩大，包括预防大血管和微血管疾病，特别是在糖尿病患者和他汀类药物治疗后仍存在血脂异常的患者中。我们提供了贝特类药物在临床实践中的应用建议，以突出这些潜在适应证。
