儿科 2 型糖尿病患者的血脂异常。
Dyslipidemia in Pediatric Type 2 Diabetes Mellitus.
机构信息
Department of Pediatrics, Division of Endocrinology and Diabetes, University of Alabama at Birmingham, CPPII M30, 1601 4th Ave S, Birmingham, AL, 35233, USA.
出版信息
Curr Diab Rep. 2020 Sep 9;20(10):53. doi: 10.1007/s11892-020-01336-6.
PURPOSE OF REVIEW
Cardiovascular (CV) disease is a major cause of mortality in type 2 diabetes mellitus (T2D). Dyslipidemia is prevalent in children with T2D and is a known risk factor for CVD. In this review, we critically examine the epidemiology, pathophysiology, and recommendations for dyslipidemia management in pediatric T2D.
RECENT FINDINGS
Dyslipidemia is multifactorial and related to poor glycemic control, insulin resistance, inflammation, and genetic susceptibility. Current guidelines recommend lipid screening after achieving glycemic control and annually thereafter. The desired lipid goals are low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) > 35 mg/dL, and triglycerides (TG) < 150 mg/dL. If LDL-C remains > 130 mg/dL after 6 months, statins are recommended with a treatment goal of < 100 mg/dL. If fasting TG are > 400 mg/dL or non-fasting TG are > 1000 mg/dL, fibrates are recommended. Although abnormal levels of atherogenic TG-rich lipoproteins, apolipoprotein B, and non-HDL-C are commonly present in pediatric T2D, their measurement is not currently considered in risk assessment or management.
目的综述
心血管（CV）疾病是 2 型糖尿病（T2D）患者死亡的主要原因。血脂异常在 T2D 患儿中很常见，是 CVD 的已知危险因素。在这篇综述中，我们批判性地检查了儿科 T2D 患者血脂异常的流行病学、病理生理学和管理建议。
最新发现
血脂异常是多因素的，与血糖控制不佳、胰岛素抵抗、炎症和遗传易感性有关。目前的指南建议在血糖控制达标后进行血脂筛查，此后每年进行一次。理想的血脂目标是低密度脂蛋白胆固醇（LDL-C）<100mg/dL，高密度脂蛋白胆固醇（HDL-C）>35mg/dL，甘油三酯（TG）<150mg/dL。如果 6 个月后 LDL-C 仍>130mg/dL，则建议使用他汀类药物，治疗目标为<100mg/dL。如果空腹 TG>400mg/dL 或非空腹 TG>1000mg/dL，则建议使用贝特类药物。尽管儿科 T2D 患者常存在致动脉粥样硬化的富含 TG 的脂蛋白、载脂蛋白 B 和非 HDL-C 水平异常，但目前在风险评估或管理中不考虑其测量值。
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