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2型糖尿病合并血脂代谢异常血脂谱的特点是血清三酰甘油(TG)及小而密低密度脂蛋白-胆固醇(sLDL-C)升高,高密度脂蛋白-胆固醇(HDL-C)降低。治疗措施包括生活方式干预、控制高血糖和调脂药物应用3个方面。治疗的首要目标是降低低密度脂蛋白-胆固醇(LDL-C),调脂药物首选他汀类,其他尚有依折麦布、血脂康、多廿烷醇、胆酸螯合剂及普罗布考等。单纯TG升高或TG明显升高(>4.52 mmol.L-1)患者,选择以降低TG为主的贝特类、烟酸类及其衍生物和Omega-3(ω-3)脂肪酸等药物。HDL-C低下患者除了生活方式干预外,可选择以烟酸类为主的调脂药物治疗。糖尿病合并混合型血脂异常患者的处理是在严格掌握适应症的情况下,选择以他汀类为主与其他调脂药物联合应用方案;非诺贝特对治疗该类血脂异常患者具有一定的优势。
Type 2 diabetes mellitus with dyslipidemia is characterized by an increase in serum triglyceride (TG) and small, dense low-density lipoprotein-cholesterol (sLDL-C), and a decrease in high-density lipoprotein-cholesterol (HDL-C). Treatment measures include lifestyle interventions, control of hyperglycemia and lipid-lowering drug applications in three areas. The primary goal of treatment is to lower LDL-C, lipid-lowering drugs are the first choice of statins, others are ezetimibe, Xuezhikang, policosanol, bile acid sequestrants and probucol . In patients with elevated TG or elevated TG (> 4.52 mmol.L-1), drugs such as fibrates, niacin and its derivatives, and Omega-3 (omega-3) fatty acids . In addition to lifestyle intervention, HDL-C patients with low HDL-C may choose niacin-based lipid-lowering drugs. Patients with diabetes mellitus and mixed dyslipidemia are treated with statins and other lipid-lowering drugs under strict control of indications. Fenofibrate has certain advantages in the treatment of patients with such dyslipidemia.