摘要
本文对高脂血症治疗药物及其应用现状作了综述。高脂血症治疗药物以其结构及作用特点可分为九大类。①胆酸络合剂为阴离子交换树脂类，可降低血总胆固醇及低密度脂蛋白胆固醇，但该类药物不能降低甚至升高血甘油三酯；临床试验研究发现考来烯胺可降低冠心病死亡率及心梗发生率；②他汀类（ｓｔａｔｉｎｓ）如洛伐他汀、新伐他汀、普伐他汀、氟伐他汀等主要降低血总胆固醇及低密度脂蛋白胆固醇，对血甘油三酯亦有中度降低作用，大规模临床研究证实可降低冠心病发生及死亡率；③甾体衍生物谷固醇一般剂量疗效可疑，临床少用；④烟酸疗效肯定，主要降低血甘油三酯，对胆固醇亦有降低作用，但药物不良反应较多，新一代烟酸类制剂阿西莫司药物不良反应减轻；⑤苯氧酸类主要降低血甘油三酯，氯贝丁酯因有报道可增加消化道肿瘤发生率及胆石症发生率，现已少用。后来出现的非诺贝特等对血甘油三酯、血总胆固醇均有降低作用且可升高高密度脂蛋白胆固醇，临床疗效大规模临床研究正在进行；⑥多不饱和脂肪酸（ＰＵＦＡｓ）分ω－６及ω－３型，对ω－３ＰＵＦＡｓ研究较多，主要降低血甘油三酯；⑦粘多糖及多糖类主要降低血甘油三酯，其对冠心病防治作用有待大规模临床研究证实；⑧雌激素替代治疗可用于低密度脂蛋?
The advances of therapeutic drugs and their use in hyperlipidemia were reviewed. Therapeutic drugs for hyperlipidemia(lipid-regulating drugs) can be classified into 9 categories according to their structures and actions. Resins can decrease plasma total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C), but they can not decrease plasma triglyceride (TG) level. Cholestyramine, one of the resins was shown by clinical trials to be able to reduce the death rate and myocardial infarction rate in patients with coronary artery disease (CAD). Statins including lovastatin, simvastatin, pravastatin, and fluvastatin, etc were shown by many large scale clinical trials to be able to reduce the cardiac events and death rate of CAD. Statins mainly decrease TC and LDL-C, and also decrease plasma TG level moderately. Sitosterol when administered in general dose showed uncertain efficacy, and so is used less in clinical settings. Nicotinic acid mainly decreases TG and also decreases TC. It is with confirmed efficacy in the prevention of CAD, but with relatively more untoward reactions. Acipimox, a new drug of nicotinic acid derivatives is with less untoward reactions. Derivatives of fibric acid mainly decrease TG. Clofibrate of this category may increase tumors of the digestive tract and cholelithiasis, and is less advocated in clinical settings. Fenofibrate can decrease TG and TC, and also increase high density lipoprotein cholesterol(HDL-C). Large scale clinical trials are being undertaken to study their clinical efficacy. Polyunsaturated fatty acids (PUFAs) are classified as ω-6 and ω-3 types. ω-3 PUFAs are with better clinical efficacy, but large scale clinical trials are needed. Mucopolysaccharides and polysaccharides have lipid-regulating effects, but the efficacy in the primary and secondary prevention of CAD need to be confirmed. Estrogen and/or progesterone replacement therapy can be used in postmenopausal women with CAD, and secondary prevention efficacy was found. Other lipid-regulating drugs, such as probucol have mild lipid-regulating effects, but may be beneficial to the prevention and treatment of CAD through their antioxidant effects.
出处
《中国临床药理学杂志》
CAS
CSCD
北大核心
1999年第1期58-62,共5页
The Chinese Journal of Clinical Pharmacology
